Association of circulating inflammation proteins and gallstone disease

Association between C-reactive protein to lymphocyte ratio and gallstones: a cross-sectional study

BACKGROUND

Inflammation plays a key role in the development of gallstones, and the C-reactive protein to lymphocyte ratio (CLR) has been introduced as a promising biomarker for evaluating inflammatory processes. Nonetheless, its correlation with gallstone prevalence remains ambiguous. This study aims to evaluate the potential link between CLR levels and gallstone prevalence.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey, covering the periods from March 2017 to 2020 and 2021 to 2023. Multivariate logistic regression was employed to examine the association between CLR and gallstone prevalence. Furthermore, smoothed curve fitting, subgroup analysis, and interaction testing were performed to provide a comprehensive evaluation. We also employed receiver operating characteristic (ROC) curves to determine the predictive ability of the index for gallstones.

RESULTS

Among the 13,386 participants included in this study, 1,444 were diagnosed with gallstones. In a fully adjusted model, a small but statistically significant positive association between CLR and the prevalence of gallstones was observed (odds ratio [OR] = 1.07, 95% CI: 1.01-1.12). Compared to individuals in the lowest tertile of CLR (T1), those in the middle tertile (T2) showed a non-significant increase in gallstone prevalence (OR = 1.10, 95% CI: 0.94-1.29), while the highest tertile (T3) exhibited a statistically significant elevation (OR = 1.20, 95% CI: 1.03-1.41). Smoothed curve fitting further confirmed this positive relationship. Bonferroni-corrected subgroup analysis demonstrated a statistically significant association between CLR and gallstones in the "Married/Living with Partner" subgroup (P < 0.0015), while no significant associations were observed in the other subgroups. Additionally, Bonferroni-corrected interaction tests indicated no significant interactions between CLR and gallstones across all subgroups (P for interaction > 0.0038).

CONCLUSION

Higher CLR was associated with higher gallstone prevalence. However, additional large-scale prospective studies are required to further investigate the role of CLR in the prevalence of gallstones.

Association Between Metabolic Dysfunction and Gallstone Disease in U.S. Adults: An Analysis of the National Health and Nutrition Examination Survey

OBJECTIVES

Gallstones affect a significant proportion of U.S. adults and can cause serious complications. We aimed to investigate the association between gallstone disease and common metabolic disorders in a nationally representative sample in the United States.

METHODS

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected from 2017 to 2020. We included 6164 participants meeting the eligibility criteria, which represented 171 407 370 participants. The associations between gallstone disease and six metabolic disorders were analyzed using multivariate logistic regression analyses, accounting for potential confounding factors. Subgroup analyses were conducted by age, gender, and race.

RESULTS

Altogether 10.9% of participants had gallstone disease, with prevalence increasing with age (mean age with vs. without gallstones: 56.435 years vs. 46.896 years, p < 0.001) and a female predominance (75.1% vs. 24.9%, p < 0.001). Non-alcoholic fatty liver disease (NAFLD), obesity, hypertension, and diabetes mellitus were significantly associated with an increased risk of gallstone formation, with adjusted odds ratios (OR) of 1.523 (95% confidence interval [CI] 1.180-1.965, p = 0.002), 1.733 (95% CI 1.265-2.374, p = 0.001), 1.466 (95% CI 1.203-1.785, p = 0.001), and 1.522 (95% CI 1.165-1.989, p = 0.003), respectively. These associations were more pronounced in individuals under 60 years of age and in females. No significant associations were observed with hyperlipidemia or hyperuricemia.

CONCLUSIONS

Gallstone disease is significantly associated with obesity, NAFLD, diabetes mellitus, and hypertension, with stronger associations found in younger individuals and females. Sensitivity analyses confirmed the robustness of these findings.

The association between inflammatory biomarkers and gallstones in Americans under 50 years old

BACKGROUND

This study aimed to assess the link between inflammatory biomarkers (like the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammatory index (SII), and systemic inflammation response index (SIRI)) and gallstones in American individuals aged under 50 years.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) covering 2017 to 2020, centering on individuals under 50 years with comprehensive data on NLR, SII, SIRI, and gallstones. It employed a weighted multiple logistic regression approach to investigate the link between inflammatory biomarkers and gallstones. Furthermore, dose-response relationships and threshold effects were evaluated utilizing restricted cubic spline (RCS) methods and segmented linear regression models. Subgroup examinations and interaction assessments were conducted, too.

RESULTS

The investigation encompassed a total of 3,295 individuals. Upon comprehensive adjustment for variables, multivariate logistic regression revealed a positive relationship between inflammatory biomarkers and gallstones: ln-NLR (OR = 1.68, 95% CI: 1.06-2.66, p = 0.033), ln-SII (OR = 1.79, 95% CI: 1.08-2.98, p = 0.032), and ln-SIRI (OR = 1.46, 95% CI: 1.07-1.99, p = 0.025). A non-linear association, shaped like an inverse "U", was noted between ln-SIRI and gallstones. To the left of the inflection point (ln-SIRI = 0.35, SIRI = 1.42), a positive link existed between ln-SIRI and gallstones (OR = 2.45, 95% CI: 1.20-5.03); whereas, to the right of the inflection point, the association was statistically insignificant (OR = 0.60, 95% CI: 0.21-1.73).

CONCLUSION

ln-NLR and ln-SII exhibited a linear and positive relationship with the likelihood of developing gallstones. ln-SIRI demonstrated a nonlinear dose-response relationship with gallstone risk, characterized by an inverted "U" shape.

Association between platelet-to-high-density lipoprotein cholesterol ratio and gallstone prevalence in the American adult population: a cross-sectional study analysis

OBJECTIVE

The platelet-to-high-density lipoprotein cholesterol ratio(PHR), a novel marker of inflammatory response and metabolic dysregulation, has been linked to various chronic conditions.This study aimed to evaluate the association between PHR and the prevalence of gallstones.

METHODS

This cross-sectional study analyzed data collected from the United States National Health and Nutrition Examination Survey(NHANES)between 2017 and 2023. Multivariate logistic regression, generalized additive models, and subgroup analyses were employed to assess the relationship between PHR and gallstone prevalence.

RESULTS

A total of 13,163 participants were included, of whom 1,441(10.95%) self-reported a history of gallstones. After adjusting for potential confounders, a positive association was observed between the natural log-transformed PHR(LN[PHR])and gallstone prevalence(OR = 1.27, 95%CI: 1.09-1.49). This positive correlation became more pronounced with increasing PHR levels(P-trend = 0.01). Smooth curve fitting analysis indicated a linear relationship between PHR and gallstone prevalence. Subgroup analyses revealed that the association was strongest in participants aged 20-39 years, women, and individuals of other racial/ethnic groups.

CONCLUSION

Elevated PHR levels are significantly associated with a higher risk of gallstones. While our observational data suggest plausibility for PHR-gallstone, these findings should be interpreted as hypothesis-generating rather than definitive clinical evidence. Future mechanistic studies should elucidate whether this association reflects causal pathways or epiphenomenal relationships.

MAFLD mediates the association between CHR and gallstones in the U.S. adults: evidence from NHANES 2021-2023

BACKGROUND

Gallstones, a global hepatobiliary disorder, are linked to systemic inflammation, lipid disturbances, and metabolic-associated fatty liver disease (MAFLD). This population-based study aims to investigate the association of the novel inflammation-lipid composite biomarker high-sensitivity C-reactive protein-to-HDL cholesterol ratio (CHR) with gallstones and evaluate whether MAFLD mediates this relationship.

METHODS

This cross-sectional analysis utilized data from the National Health and Nutrition Examination Survey (NHANES, 2021-2023) to assess the correlation between the CHR and gallstone prevalence through weighted logistic regression. To evaluate potential nonlinear relationships and assess heterogeneity across key demographics, restricted cubic splines (RCS) were employed to model the association, complemented by subgroup analyses stratified by age, sex, and other covariates. A mediation analysis was used for elucidating the mediating effects of MAFLD.

RESULTS

Among 4,078 participants, 432 (10.60%) had gallstones. After adjusting for confounders, each unit increase in CHR was associated with a 165% increased risk of gallstones (OR: 2.65, 95% CI: 1.43-4.93, P = 0.006). The RCS curve demonstrated a nonlinear association between the CHR and gallstones (Poverall < 0.001, Pnonlinear < 0.001). Mediation analysis indicated that MAFLD explained 27.1% of this association.

CONCLUSIONS

CHR is positively associated with gallstones, with MAFLD partially mediating this relationship. Managing CHR levels and preventing MAFLD may reduce gallstone incidence.

Association between advanced lung cancer inflammation index and gallstone prevalence among U.S. adults: A population-based study

INTRODUCTION

Gallstones are a common digestive disorder, with a global prevalence of 10%-15%, posing a significant economic burden on public health. The formation of gallstones is closely associated with inflammation and nutritional status. The Advanced Lung Cancer Inflammation Index (ALI) is a composite measure for assessing inflammation and nutritional status; however, its relationship with gallstone risk remains unclear. This study aims to investigate the association between ALI and gallstone prevalence among U.S. adults.

METHODS

This study is based on data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) and includes 5,826 adults aged 20 years and older. The Advanced Lung Cancer Inflammation Index (ALI) was calculated using body mass index (BMI), serum albumin levels, and the neutrophil-to-lymphocyte ratio (NLR). The prevalence of gallstones was determined through questionnaire surveys. Multivariable logistic regression models were employed to analyze the relationship between ALI and the risk of gallstones. Additionally, trend analysis, smooth curve fitting, and subgroup analyses were conducted.

RESULTS

The study results showed a significant positive correlation between ALI levels and the risk of gallstone disease. After fully adjusting for covariates, each unit increase in lnALI was associated with a 42% increase in the risk of gallstone disease (OR =  1.42, 95% CI: 1.12-1.80). Trend analysis indicated a significant dose-response relationship between ALI and gallstone risk (P for trend <  0.01). Subgroup analysis further revealed that the correlation between ALI and gallstone risk was more pronounced in females, non-diabetic patients, individuals with higher education levels, those with insufficient physical activity, and non-drinkers, with gender showing a significant interaction effect (interaction P <  0.05). Smooth curve fitting further validated the linear relationship between ALI and gallstone risk, and this association was particularly prominent in the female population.

CONCLUSIONS

This study demonstrates that ALI is significantly associated with the risk of gallstones, particularly among women. As a simple and readily accessible indicator, ALI may help identify high-risk populations and provide a new clinical tool for the prevention and management of gallstones. Future longitudinal studies should further validate these findings and evaluate the predictive value of ALI across different populations.

Cardiometabolic index as a predictor of gallstone risk: evidence from NHANES 2017-2020

BACKGROUND

The Cardiometabolic Index (CMI), a composite marker integrating lipid profiles (triglycerides-to-HDL-C ratio) and abdominal obesity (waist-to-height ratio), we aimed to assess its association with gallstone prevalence.

METHODS

We analyzed data from 2,692 participants in the NHANES 2017-2020 dataset. Gallstones were identified through self-reported data, which may introduce bias in the diagnosis. This limitation should be considered when interpreting the results. Logistic regression modelling, smoothed curve fitting and threshold effect analysis assessed the association between CMI and gallstones.

RESULT

Higher CMI was significantly associated with an increased risk of gallstones (OR = 1.90, 95% CI: 1.37-2.62, P < 0.0001). A threshold effect was observed at CMI = 0.85, below which risk increased significantly (OR = 2.62, 95% CI:1.34-5.12, P = 0.0049), but became non-significant above this value. The association was stronger in women.

CONCLUSION

Our findings support the use of CMI as a potential predictive marker for gallstone risk, suggesting its integration into clinical assessments for early detection and prevention.

Non-steroidal anti-inflammatory drug use and inflammatory markers associated with gallbladder dysplasia: A case-control analysis within a series of patients undergoing cholecystectomy

Inflammation has been associated with the development of gallbladder cancer (GBC). However, little is known about the associations of both, inflammation and the use of non-steroidal anti-inflammatory drugs (NSAIDs), with preneoplastic lesions. We analyzed the association of NSAIDs and gallbladder dysplasia in 82 patients with dysplasia and 1843 patients with gallstones among symptomatic patients from a high-risk population. We also analyzed associations for 33 circulating immune-related proteins in a subsample of all 68 dysplasia cases diagnosed at the time of sample selection and 136 gallstone controls. We calculated age- and sex-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). Biliary colic was reported among most cases (97.6%) and controls (83.9%). NSAID use was inversely associated with gallbladder dysplasia (OR: 0.48, 95%CI: 0.26-0.83). Comparing the highest versus lowest category of each immune-related protein, eight proteins were inversely associated with dysplasia with sex- and age-adjusted ORs ranging from 0.30 (95%CI: 0.12-0.77) for IL-33 to 0.76 (95%CI: 0.59-0.99) for MIP-1B. Of those, GRO remained associated with dysplasia (OR: 0.64, 95%CI: 0.45-0.91) and BCA-1 was borderline associated (OR: 0.74, 95%CI: 0.54-1.01) after adjusting the logistic regression model for sex, age, and NSAIDs. In conclusion, NSAID users were less likely to have gallbladder dysplasia, suggesting that NSAIDs might be beneficial for symptomatic gallstones patients. The inverse association between immune-related markers and dysplasia requires additional research, ideally in prospective studies with asymptomatic participants, to understand the role of the inflammatory response in the natural history of GBC and to address the biological effect of NSAIDs.

Global variations in gallbladder cancer incidence: What do recorded data and national estimates tell us?

On a global scale, gallbladder cancer is a relatively rare cancer with a striking variability in incidence across countries and world regions. We examined recent geographic variations worldwide based on national gallbladder cancer incidence estimates for the year 2022 from the GLOBOCAN database for 185 countries alongside recorded incidence data from the most recent volume of Cancer Incidence in Five Continents. In 2022, 122,491 new gallbladder cancer cases and 89,055 deaths were estimated to occur worldwide, of which 64.5% and 64.7% respectively were among females. The highest reported rates (ASR per 100,000) were in subpopulations of Northeastern regions of India and Southern Chile in both males (ASR of 6.1 and 5.3, respectively) and in females, though rates were two times higher than males (ASR of 14.9 and 15.4). The lowest incidence rates were reported in subpopulations of Uganda for males and South Africa for females (0.21 and 0.14, respectively). Recorded gallbladder cancer incidence rates among subnational populations within countries differed considerably from their respective national estimates and revealed a 100-fold variation in gallbladder cancer, highlighting the importance of subnational population-based cancer registry data in pinpointing areas of high risk, driving research and prioritizing tailored public health actions.

Association of dietary quality indicators with gallstones in the US: NHANES 2017-2020

BACKGROUND

While dietary factors are known to influence gallstone development, the specific relationships between comprehensive dietary quality indicators and gallstone risk remain poorly understood. This study aimed to explore the association between dietary quality indicators and gallstones using data from the 2017 to 2020 US National Health and Nutrition Examination Survey (NHANES).

METHODS

A total of 6,623 US adults were extracted from the 2017-2020 NHANES, of which 734 participants self-reported having gallstones. Dietary quality indicators were assessed using 24-hour dietary recall data. We used multivariate logistic regression analysis to evaluate the association between dietary quality indicators and the likelihood of gallstones. To delineate the non-linear relationships and threshold effects, we utilized a restricted cubic spline (RCS) regression model. Subgroup analyses were also performed.

RESULTS

After adjusting for sex, age, race, education, poverty-to-income ratio, body mass index, large weight loss, alcohol use, smoking, physical activity, diabetes, hypertension, heart failure, coronary heart disease, angina pectoris, heart attack, total calories, total cholesterol, estrogen use, antihyperglycemic drug use, statin use, and glucocorticosteroid use (Model 4), a higher Dietary Inflammatory Index (DII) and lower Alternative Healthy Eating Index (AHEI), Healthy Eating Index (HEI-2020), Dietary Approaches to Stop Hypertension (DASH), and Mediterranean Diet (MED) were all significantly associated with gallstones. Further RCS analysis revealed a nonlinear relationship between the DII and gallstones, with a threshold value of 1.842. Above this threshold, for each unit increase in the DII score, the odds of developing gallstones increased by 27.5%. Subgroup analysis demonstrated that this association was consistent across all subgroups.

CONCLUSION

Participants with gallstones exhibited poor dietary habits. Adopting a diet that reduces inflammation and supports overall health may help lower the risk of gallstone development, with potential implications for dietary recommendations in clinical practice.

Preoperative SII Can Predict Postoperative Recurrence and Serious Complications in Patients with Hepatolithiasis

Purpose

The occurrence and progression of hepatolithiasis are related to inflammatory reactions and immune proteins. This study aims to evaluate the relationship between systemic immune index (SII) in recurrence-free survival (RFS), as well as the incidence of severe postoperative complications in hepatolithiasis patients.

Patients and Methods

We retrospectively analyzed 177 patients with hepatolithiasis. The optimal cut-off values of SII, systemic inflammatory response index (SIRI), neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR) and prognostic nutritional index (PNI) were evaluated by the analysis of the receiver operating characteristic (ROC) curve. The relationship between SII, SIRI, NLR and clinical results was tested with χ²-test. Logical regression analysis is used to evaluate the risk factors of postoperative serious complications. The Kaplan-Meier survival curve and Cox regression analyses are used to evaluate the impact of SII, SIRI, NLR on RFS.

Results

The analysis of the ROC curve determines the optimal cut-off value and the area under the curve (AUC) of SII, SIRI, NLR, MLR, PLR and PNI, and then grouped. In the multivariate analysis, surgical method (HR=3.331, 95% CI: 1.360-8.158, p=0.008) and SII (HR=2.883, 95% CI: 1.084-7.668, p=0.034) were identified as independent risk factors for serious postoperative complications; the multivariate cox regression analysis demonstrated that a history of gallstones (HR=1.965, 95% CI: 1.206-3.201, p=0.007), SII (HR=2.818, 95% CI: 1.340-5.926, p=0.006), and MLR (HR=3.240, 95% CI: 1.158-9.067, p=0.025) were independent risk factors for RFS; survival analysis results show that patients with low levels of SII (p<0.001), SIRI (p=0.005), and NLR (p<0.001) had significantly higher RFS compared to those in the high-level group.

Conclusion

Preoperative high levels of SII, SIRI, and NLR are associated with postoperative recurrence in patients with hepatolithiasis, with SII identified as an independent risk factor for both postoperative RFS and serious complications.

Inflammatory burden index (IBI) and body roundness index (BRI) in gallstone risk prediction: insights from NHANES 2017-2020

BACKGROUND

The Inflammatory Load Index (IBI) and Body Roundness Index (BRI) were employed to evaluate the systemic inflammatory status and body fat. This study aims to elucidate the association between IBI and the prevalence of gallstones, as well as to analyze the mediating role of BRI in this association.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) (2017-2020) were utilized in our cross-sectional study. A total of 2598 participants aged ≥ 20 years were enrolled. The Boruta algorithm, a supervised classification feature selection method, is leveraged to identify the confounding variables most strongly associated with the prevalence of gallstones. Weighted multivariate logistic regression, restricted cubic splines (RCS), and subgroup analyses were employed to investigate the association between IBI and gallstones, assess the presence of a linear association, and evaluate the effect of IBI on gallstone risk across different populations. Finally, the mediating effect of BRI was examined.

RESULTS

In the fully adjusted model, when IBI was in the highest tertile, each unit increase in IBI (corresponding to an increase of 1 in the natural logarithm of IBI) was linked to a 110.8% higher prevalence of gallstones (OR = 2.108, 95% CI: 1.109-4.005; P = 0.028). The odds ratio for gallstones increased with higher IBI levels across unadjusted, partially adjusted, and fully adjusted models (P for trend < 0.05). This positive association was confirmed to be linear by the RCS curve (P for nonlinear = 0.887). Subgroup analysis indicated that the risk of gallstones was significantly elevated in individuals aged ≥ 60, females, and those with a Poverty-to-Income Ratio (PIR) ≥ 2 (P < 0.05). Mediation analysis revealed that IBI had a significant indirect effect on gallstone prevalence through BRI, with an effect size of 0.0129 (95% CI: 0.0121-0.0136; P < 0.001), and the mediation contributed to 33.24% of the total effect.

CONCLUSIONS

This study demonstrates a significant linear positive relation of IBI to gallstone prevalence. Furthermore, BRI mediates the effect of IBI on gallstone risk. These findings provide a more precise inflammatory marker for gallstone prevention and treatment.

TRIAL REGISTRATION

Not applicable.

Moderate and severe depression increase the incidence of cholelithiasis: Results from Mendelian randomization study and the NHANES 2017-March 2020

BACKGROUND

Depression may be a contributing factor to cholelithiasis. However, the exact correlation between cholelithiasis and depression severity remains unclear.

METHODS

First, a two-sample Mendelian randomization (MR) analysis was performed to validate previous research findings, utilizing separate datasets for major depressive disorder (MDD) and cholelithiasis. The MDD dataset (135,458 cases, 344,901 controls) came from a published GWAS, and cholelithiasis data (19,023 cases, 195,144 controls) were sourced from FinnGen. The primary analytical approach for the MR study was the inverse variance weighting (IVW) method. Second, an observational study based on the National Health and Nutrition Examination Survey (NHANES) was conducted to explore the relationship between the severity of depression and cholelithiasis. 7071 participants were included in the observational study in total. Depression severity (no, mild, moderate, severe) was measured by Patient Health Questionnaire-9 (PHQ-9). Weighted multivariable-adjusted logistic regression was employed to assess the association between depression severity and cholelithiasis.

RESULTS

In the MR study, the IVW analysis revealed that MDD may increase the risk of cholelithiasis (OR 1.25, 95% CI 1.07-1.45, P = 0.004). The observational study showed that moderate (OR 1.06, 95% CI 1.00-1.11, p = 0.037) and severe (OR 1.07, 95% CI 1.00-1.15, p = 0.044) depression rises the incidence of cholelithiasis. However, no significant association was found between mild depression and cholelithiasis (p = 0.275).

CONCLUSIONS

Moderate and severe depression might rise the incidence of cholelithiasis, while mild depression may not. Further validation through prospective studies is necessary.

Serum alpha-1 acid glycoprotein and gallstone risk in US adult women: a cross-sectional analysis of the NHANES

Background

Gallstone disease, a common biliary disorder, is linked to inflammation and immune responses. However, the association between serum alpha-1 acid glycoprotein (AGP), a key inflammatory marker, and gallstone risk remains underexplored.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 and 2021-2023 cycles were analyzed. Gallstone disease was determined by self-reported physician diagnosis. Serum AGP levels were measured using a high-sensitivity turbidimetric immunoassay. Weighted logistic regression, subgroup analyses, smoothed curve analysis, and multiple imputation were used to examine the relationship between AGP and gallstone risk.

Results

This cross-sectional analysis included 1,903 adult women in the U.S. aged 20-49. After adjusting for all covariates, serum AGP levels were positively associated with gallstone risk (OR: 3.07; 95% CI: 1.16, 8.11; p = 0.036). Compared to the first tertile (T1), the third AGP tertile (T3) had an OR of 1.87 (95% CI: 1.11, 3.14; p = 0.030). Smoothed curve analysis indicated a positive relationship between AGP and gallstone risk. Subgroup analyses consistently demonstrated this positive association across various demographic and clinical categories, with significant interactions observed for the ratio of family income to poverty. Sensitivity analyses using multiple imputation further supported the conclusion that AGP was associated with increased gallstone risk.

Conclusion

AGP is significantly associated with an increased risk of gallstones in U.S. adult women, suggesting its potential as a biomarker for risk stratification. Further research is needed to elucidate the underlying mechanisms and potential causal relationships.

Immunomodulatory Tissue Factors in the Gallbladder Walls of Pediatric Patients with Chronic Calculous Cholecystitis

BACKGROUND

The rising rates of gallstones and cholecystectomy in pediatric populations underscore the increasing concern regarding chronic cholecystitis. However, the morphopathogenesis of pediatric calculous cholecystitis is still not well understood. This study aimed to determine the expression and distribution of immunomodulatory factors interleukin-12 (IL-12), interleukin-13 (IL-13), interleukin-1β (IL-1β), sonic hedgehog protein (SHH), nuclear factor NF-kappa-B p65 subunit (NFkBp65), and heat shock protein 60 (HSP60) in the gallbladder walls of pediatric patients with chronic calculous cholecystitis.

METHODS

In total, 11 gallbladder samples were collected from pediatric patients with calculous cholecystitis during cholecystectomy, while 5 healthy gallbladder samples served as controls. IL-12, IL-13, IL-1β, SHH, NFkBp65, and HSP60 were detected by immunohistochemistry. The number of positive structures in gallbladder wall epithelium, vasculature, and inflammatory infiltrate was assessed semi-quantitatively by microscopy. A Mann-Whitney U test and Spearman's rank-order correlation coefficient were calculated.

RESULTS

Statistically significant differences were observed between patient and control samples in the expression of IL-1β, SHH, and NFkBp65 in the epithelium, as well as in the expression of IL-12, SHH, and HSP60 in the blood vessels. The expression of IL-1β was stronger in the epithelium of controls, while other markers were more prominent in patient samples.

CONCLUSIONS

An increased number of NFkBp65, IL-12, and HSP60 positive cells in patient gallbladder tissue suggests a significant role of these tissue factors in driving immune modulation and sustaining the inflammation in pediatric chronic calculous cholecystitis. The noticeable expression of SHH in patient gallbladder tissue indicates its part in tissue regeneration and repair processes, as well as in modulating inflammation and vascular responses in calculous cholecystitis. The significant positive correlations between the factors studied highlight the importance of their coordinated interaction and intricate crosstalk in the morphopathogenesis of calculous cholecystitis.

Morusin Reverses Epithelial-Mesenchymal Transition in Gallbladder Cancer Cells by Regulating STAT3/HIF-1α Signaling

Gallbladder cancer is the most prevalent malignancy of the biliary tract and has a dismal overall survival even in the present day. The development of new drugs holds promise for improving the prognosis of this lethal disease. The possible anti-neoplastic role of morusin was investigated both in vitro and in vivo. Through cell viability and colony formation assays, we observed that morusin inhibited the proliferation of gallbladder cancer cells in vitro. Wound healing and transwell assays revealed that morusin impeded the migration and invasion of gallbladder cancer cells. Given the observed morphological changes, we examined epithelial-mesenchymal transition (EMT) markers. Subsequent investigations demonstrated that morusin treatment, both in vitro and in vivo, downregulated the expression of phospho-STAT3 (Signal transducer and activator of transcription 3) and HIF-1α (Hypoxia-inducible factor 1α) in gallbladder cancer cells. Furthermore, morusin effectively reversed EMT induced by phospho-STAT3 or HIF-1α. Morusin has a reversing effect on the EMT of gallbladder cancer cells by modulating STAT3/HIF-1α signaling.

Interaction between alimentary surgery and risk of dementia: a nationwide population-based case-control study

BACKGROUND

Based on current research, it is known that the gastrointestinal tract microbiota and its genome play a crucial role in mental illnesses. Studies indicate a direct correlation between gastrointestinal tract microbiota and the onset of dementia, mediated by metabolic diseases and low-grade inflammation. The association between various gastrointestinal symptoms and neurodegenerative diseases has been recently discussed. However, there is a lack of research regarding the comparative effects of different surgical procedures on neurodegenerative diseases. Therefore, this study primarily focuses on comparing the association between various gastrointestinal surgeries and dementia, aiming to provide guidance for future clinical practice.

METHOD

A nationwide study using the Taiwanese National Health Insurance Research Database included 26 059 patients diagnosed with dementia or Alzheimer's disease and 104 236 controls without diseases. Primary exposures were defined as alimentary surgeries, encompassing cholecystectomy, gastrectomy, bowel resection, and appendectomy. Conditional logistic regression was used to examine the odds ratio and 95% confidence interval for prior alimentary surgery between cases and controls.

RESULTS

The results showed that individuals with dementia had a higher rate of gastrectomy. Additionally, individuals with dementia seemed to exhibit a reduced rate of cholecystectomy and appendectomy. Regarding Alzheimer's disease, all four alimentary surgeries showed comparable trends to those observed with dementia. No significant interaction was observed between alimentary surgery and dementia among the four types of surgery evaluated.

CONCLUSION

Our study demonstrates that gastrectomy is associated with an elevated risk of dementia. We aim to uncover more direct evidence in future experiments.

Positive association between advanced lung cancer inflammation index and gallstones, with greater impact on women: a cross-sectional study of the NHANES database

Background

Previous studies have shown that inflammation is crucial in gallstone formation. The Advanced Lung Cancer Inflammation Index (ALI) is a comprehensive measure that reflects inflammation and nutritional condition. However, there are no studies examining the relationship between ALI and gallstones. This study aimed to analyze this association in US adults.

Methods

This study used a cross-sectional research design with in-depth analyses using data from the National Health and Nutrition Examination Survey (NHANES). The association between gallstones and ALI was systematically assessed by logistic regression analysis, subgroup analysis, basic participant characteristics, and smooth curve fits.

Results

5,646 people participated in the study. ALI was converted into Quartile 1 (-1.47-1.00), Quartile 2 (1.00-1.34), Quartile 3 (1.34-1.69), and Quartile 4 (1.69-4.38). In the fully adjusted model, gallstone prevalence increased by 45% in participants in the highest quartile compared to those in the lowest quartile (OR = 1.45; 95% CI: 1.12-1.87; p = 0.005), and ALI was positively correlated with gallstones (OR = 1.22; 95% CI: 1.03-1.45; p = 0.0232). Smooth curve fits provided evidence in favor of this finding. Significant gender differences were found in the relationship between gallstones and ALI by subgroup analysis (OR = 1.43; 95% CI: 1.16-1.76; p for interaction = 0.0204).

Conclusion

The study concluded that ALI and gallstones had a positive correlation, with ALI having a higher effect on women's gallstone prevalence.

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.

The relationship between high-sensitivity C-reactive protein and gallstones: a cross-sectional analysis

Background and objective

High-sensitivity C-reactive protein (hs-CRP), a classical indicator of inflammation, holds significant clinical value in various diseases. The relationship between hs-CRP and gallstones, however, remains poorly studied at present. The relationship between hs-CRP and gallstones will be investigated in this study.

Methods

Data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) were analyzed, focusing on participants aged 20 years and older who provided complete hs-CRP and gallstone information. Due to the skewed distribution of hs-CRP, the data were log-transformed [Log (hs-CRP)] to achieve normalization. Logistic regression analysis, subgroup analysis, and smoothed fitted curves were applied to determine the relationship between Log (hs-CRP) and the presence of gallstones.

Results

The study included 4,484 participants with an average Log (hs-CRP) of 1.18 ± 0.74. The prevalence of gallstones was 11.15%, increasing with higher Log (hs-CRP) levels (quartile 1: 8.31%; quartile 2: 8.76%; quartile 3: 11.98%; quartile 4: 16.36%; p < 0.0001). Adjusting for all covariates in Model 3, each 10-fold increase in hs-CRP [corresponding to a one-unit increase in log10 (hs-CRP)] corresponded to a 29% increased odds of gallstones prevalence [1.29 (1.12-1.49)]. The smoothed fitted curve showed a positive linear relationship between Log (hs-CRP) and gallstones prevalence. The results of subgroup analyses exhibited a more pronounced positive correlation in the 20-40 age group [1.70 (1.33, 2.16)], compared to those aged 40-60 years [1.22 (1.01, 1.48)], and 60-80 years [1.14 (0.98, 1.34)].

Conclusion

Higher Log (hs-CRP) levels are linked to a greater prevalence of gallstones. We still need to carry out further large prospective research to explore the causal relationship of this association.

Hypoglycemic drugs, circulating inflammatory proteins, and gallbladder diseases: A mediation mendelian randomization study

BACKGROUND

The relationship of hypoglycemic drugs, inflammatory proteins and gallbladder diseases remain unknown.

METHODS

Four hypoglycemic drugs were selected as exposure: glucagon-like peptide-1 receptor agonists (GLP-1RA), dipeptidyl peptidase-4 inhibitors (DPP-4i), sodium-glucose cotransporter 2 inhibitors (SGLT-2i), and metformin. The outcome were two gallbladder diseases: cholecystitis and cholelithiasis. Mendelian Randomization (MR) was employed to determine the association between hypoglycemic drugs and gallbladder diseases.

RESULTS

DPP-4i and SGLT-2i had no effect on cholecystitis and cholelithiasis. However, a causal relationship was found between inhibition of ETFDH gene, a target of metformin expressed in cultured fibroblasts, and cholelithiasis (OR: 0.84, 95 %CI: (0.72,0.97), p = 0.021), as well as between GLP1R expression in the brain caudate basal ganglia and cholecystitis (OR: 1.29, 95 %CI: (1.11,1.49), p = 0.001). The effect of ETFDH inhibition on cholelithiasis through Interleukin-10 receptor subunit beta (IL-10RB) levels and Neurotrophin-3 (NT-3) levels, with a mediated proportion of 8 % and 8 %, respectively.

CONCLUSION

Metformin plays a protective role in cholelithiasis, while GLP-1RA have a harmful effect on the risk of cholecystitis. Metformin may reduce the risk of cholelithiasis by modulating the levels of Neurotrophin-3 (NT-3) and Interleukin-10 receptor subunit beta (IL-10RB). Further clinical and mechanistic studies are required to confirm these findings.

Association between Neutrophil-to-high-density lipoprotein-cholesterol ratio and gallstones: insights from the national health and nutrition examination survey (2017-2020)

BACKGROUND

Inflammatory responses and lipid metabolism make vital impacts on the development of gallstones. This study investigated the relationship between gallstone disease (GSD) and the neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) in American patients with gallstones.

METHODS

The data analyzed were sourced from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) and comprised of participants with complete data on GSD and NHR. The relationship between NHR and GSD was evaluated with weighted multivariable logistic regression analysis. Additionally, subset analyses, interaction tests, smoothed curve fitting, and threshold effect analyses were conducted.

RESULTS

Among the 7894 participants analyzed in this study, the prevalence of GSD was 10.98%, and the average NHR value was 3.41 ± 0.06. The fully adjusted multivariable logistic regression results demonstrated an obvious positive association between NHR and the likelihood of GSD (OR = 1.09, 95% CI: 1.01, 1.16; P = 0.0197). Consistency of this association was confirmed through subset analyses and interaction tests across various subgroups, including those categorized by smoking status and asthma. Furthermore, smoothed curve fitting and threshold effect analyses revealed a nonlinear relationship with a threshold of 2.86.

CONCLUSIONS

NHR shows a positive relationship to an increased likelihood of GSD among Americans. It can act as an easy and cost-effective tool for the early detection and management of individuals at risk for GSD.

Association between lipid accumulation products and gallstones: an analysis of the National Health and Nutrition Examination Survey 2017-2020

AIMS

The aim of the research was to look into the connection between the occurrence of gallstones in adult US citizens and lipid accumulation products (LAP).

METHODS

We conducted a cross-sectional study of 3,582 U.S. adults with relevant indicators collected from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) database. Multifactorial logistic regression was used to investigate the linear relationship between LAP and gallstone incidence, while smoothed curve fitting was used to describe the nonlinear relationship, and subgroup and interaction analyses were used to evaluate the potential differences between groups.

RESULTS

Among the 3582 participants aged ≥ 20 years included, there was a positive association between LAP and gallstones. Following adjustments for all covariates, the likelihood of getting gallstones rose by 29% for each unit rise in log2-LAP (OR = 1.29, 95% CI: 1.13‒1.49). Compared to those in the lowest tertile, those in the highest LAP tertile had a significantly higher risk of developing gallstones (OR = 1.97, 95% CI: 1.31‒2.95). Subgroup analyses indicated that the association between LAP and gallstones was not affected by the stratification of the variables examined.

CONCLUSION

Gallstones and LAP exhibited a positive association in our investigation, indicating that LAP may be utilized as a clinical indicator to determine the occurrence of gallstones.

Association of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and gallstones among US adults aged ≤ 50 years: a cross-sectional study from NHANES 2017-2020

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.

CONCLUSION

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.

Dietary fatty acids and gallstone risk: insights from NHANES and Mendelian randomization analysis

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

The influence of dietary fatty acid composition on gallstone development differs by gender, providing insights into dietary prevention and treatment of gallstones.

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.

Clinical efficacy of laparoscopic cholecystectomy combined with endoscopic papillary balloon dilation in treatment of gallbladder stones with common bile duct stones: A retrospective study

BACKGROUND

The incidence of cholelithiasis has been on the rise in recent years, but the choice of procedure is controversial.

AIM

To investigate the efficacy of laparoscopic cholecystectomy (LC) combined with endoscopic papillary balloon dilation (EPBD) in patients with gallbladder stones (GS) with common bile duct stones (CBDS).

METHODS

The clinical data of 102 patients with GS combined with CBDS were selected for retrospective analysis and divided into either an LC + EPBD group (n = 50) or an LC + endoscopic sphincterotomy (EST) group (n = 52) according to surgical methods. Surgery-related indexes, postoperative recovery, postoperative complications, and expression levels of inflammatory response indexes were compared between the two groups.

RESULTS

Total surgical time, stone free rate, rate of conversion to laparotomy, and successful stone extraction rate did not differ significantly between the LC + EPBD group and LC + EST group. Intraoperative hemorrhage, time to ambulation, and length of hospitalization in the LC + EPBD group were lower than those of the LC + EST group (P < 0.05). The rate of total complications of the two groups was 9.80% and 17.65%, respectively, and the difference was not statistically significant. No serious complications occurred in either group. At 48 h postoperatively, the expression levels of interleukin-6, tumor necrosis factor-α, high-sensitivity C-reactive protein, and procalcitonin were lower in the LC + EPBD group than in the LC + EST group (P < 0.05). At 3 d postoperatively, the expression levels of aspartate transaminase, alanine transaminase, and total bilirubin were lower in the LC + EPBD group than in the LC + EST group (P < 0.05).

CONCLUSION

LC combined with EPBD and LC combined with EST are both effective procedures for the treatment of GS with CBDS, in which LC combined with EPBD is beneficial to shorten the patient's hospitalization time, reduce the magnitude of elevated inflammatory response indexes, and promote postoperative recovery.

Association between plant-based dietary index and gallstone disease: A cross sectional study from NHANES

BACKGROUND

The relationship between plant-based diets and gallstone disease has been debated. This study aimed to shed light on the association between plant-based dietary index and the risk of developing gallstone disease.

METHODS

Eligible participants were selected from National Health and Nutrition Examination Survey (NHANES) 2017-2020. Three plant-based diet indexes (PDI, healthy PDI, unhealthy PDI) were calculated using data from two NHANES 24-h dietary recall interviews. Restricted Cubic Spline and multivariate logistic regression were used to analyze the associations. Subgroup analysis was adopted to make the results more robust.

RESULTS

A total of 5673 eligible participants were analyzed. After adjusting for various confounding variables, uPDI was positively associated with gallstone disease (OR = 1.53, 95%CI: 1.02-2.29). No association was found between PDI/hPDI and gallstone disease (p > 0.05). The results of subgroup analysis did not show any positive association between uPDI and gallstones in specific groups.

CONCLUSION

Our study shows that the elevated uPDI are linked to a higher risk of gallstone disease.

Association between monocyte-to-high-density lipoprotein-cholesterol ratio and gallstones in U.S. adults: findings from the National Health and Nutrition Examination Survey 2017-2020

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.

Characterizing the relationships between dietary indices, gallstone prevalence and the need for gallbladder surgery in the general US population

Background

The dietary inflammatory index (DII) and composite dietary antioxidant index (CDAI) were developed as tools for use when seeking to assess the potential inflammatory and antioxidant activity of a given diet, respectively. The associations between these indices and gallstone incidence remain largely unexplored.

Objective

The present study sought to clarify how both the DII and the CDAI are related to gallstone incidence and age at first gallbladder surgery among adults in the USA.

Methods

Cross-sectional data from the 2017-2020 cycles of the National Health and Nutrition Examination Survey (NHANES) pertaining to 12,426 individuals were used to conduct the present study. Data from 2 days with 24-h dietary recall were employed when calculating DII and CDAI scores. Relationships between dietary indices and the incidence of gallstones were assessed through logistic regression analyses, while linear regression analyses were employed to characterize how these indices are associated with the age at first gallbladder surgery.

Results

Higher DII scores and lower CDAI scores, which, respectively, denote diets with greater inflammatory potential and reduced antioxidant potential, were found to be associated with higher gallstone incidence even following adjustment for potential confounding factors. Smooth curve fitting suggested that the association between DII and gallstones was nearly linear, whereas that between CDAI and gallstone incidence was nonlinear. Higher DII values were also related to first gallbladder surgery at an earlier age (β = -0.64, 95% CI: -1.26, -0.02).

Conclusion

These results emphasize the benefits of anti-inflammatory diets rich in antioxidants, which may help reduce gallstone incidence among adults in the USA. Higher DII scores may also predict the need for gallbladder surgery at a younger age.

Association between dietary inflammatory index and gallstones in US adults

Introduction

Previous studies have found that diet's inflammatory potential is related to various diseases. However, little is known about its relationship with gallstones. The present study aims to investigate the relationship between dietary inflammatory index (DII) and gallstones.

Methods

Data were obtained from the 2003-2020 National Health and Nutrition Examination Survey (NHANES). We used the nearest neighbor propensity score matching (PSM) with a ratio of 1:1 to reduce selection bias. Logistic regression models estimated the association between DII and gallstones. The non-linear relationship was explored with restricted cubic splines (RCS). BMI subgroup stratification was performed to explore further the connection between DII and gallstones in different populations.

Results

10,779 participants were included. Before and after PSM, gallstone group individuals had higher DII scores than non-gallstone group individuals (p < 0.05). Matched logistic regression analysis showed that DII scores were positively correlated with gallstone risk (adjusted OR = 1.14, 95% CI 1.01, 1.29). The stratified analysis showed that this association was stronger in overweight or obese people (adjusted OR = 1.18, 95% CI 1.03, 1.34). RCS analysis suggested that DII and gallstones showed a "J"-shaped non-linear dose-response relationship (p non-linear <0.001).

Conclusion

Higher DII score is positively associated with the risk of gallstones, particularly in overweight or obese population, and this relationship is a "J"-shaped non-linear relationship. These results further support that avoiding or reducing a pro-inflammatory diet can be an intervention strategy for gallstone management, particularly in the overweight or obese population.

The dysregulation of biliary tract microflora is closely related to primary choledocholithiasis: a multicenter study

Bile microecology changes play an important role in the occurrence and development of choledocholithiasis. At present, there is no clear report on the difference of bile microecology between asymptomatic patients with gallbladder polyps and choledocholithiasis. This study compared bile microecology between gallbladder polyp patients and patients with choledocholithiasis to identify risk factors for primary choledocholithiasis. This study was conducted in 3 hospitals in different regions of China. Bile samples from 26 patients with gallbladder polyps and 31 patients with choledocholithiasis were collected by laparoscopic cholecystectomy and endoscopic retrograde choledocholithiasis cholangiography (ERCP), respectively. The collected samples were used for 16S ribosomal RNA sequencing and liquid chromatography mass spectrometry analysis. The α-diversity of bile microecological colonies was similar between gallbladder polyp and choledocholithiasis, but the β-diversity was different. Firmicutes, Proteobacteri, Bacteroidota and Actinobacteriota are the most common phyla in the gallbladder polyp group and choledocholithiasis group. However, compared with the gallbladder polyp patients, the abundance of Actinobacteriota has significantly lower in the choledocholithiasis group. At the genera level, the abundance of a variety of bacteria varies between the two groups, and Enterococcus was significantly elevated in choledocholithiasis group. In addition, bile biofilm formation-Pseudomonas aeruginosa was more metabolically active in the choledocholithiasis group, which was closely related to stone formation. The analysis of metabolites showed that a variety of metabolites decreased in the choledocholithiasis group, and the concentration of beta-muricholic acid decreased most significantly. For the first time, our study compared the bile of gallbladder polyp patients with patients with choledocholithiasis, and suggested that the change in the abundance of Actinobacteriota and Enterococcus were closely related to choledocholithiasis. The role of Pseudomonas aeruginosa biofilm in the formation of choledocholithiasis was discovered for the first time, and some prevention schemes for choledocholithiasis were discussed, which has important biological and medical significance.

The management of a duodenal fistula involving the right hepatic duct: a rare case report

The formation of an internal fistula between the biliary system and the gastrointestinal tract is a rare condition with various etiologies, predominantly associated with recurrent chronic inflammation of the biliary system and tumors. Patients with this condition may lack specific clinical manifestations, presenting with symptoms such as abdominal pain, fever, jaundice, or may show no clinical signs at all. Common types of internal fistulas include cholecystoduodenal fistula, cholecystocolonic fistula, and choledochoduodenal fistula. Among these, the right hepaticoduodenal fistula is extremely rare and seldom reported in clinical literature. We herein report a case of right hepaticoduodenal fistula and analyze its mechanism, treatment principles, and preventive measures through a literature review.

Causal associations of cytokines and growth factors with cholelithiasis: a bidirectional Mendelian randomization study

BACKGROUND

It has been reported that patients with cholelithiasis may have changes in levels of cytokines and growth factors, while their causal relationships were still unclear.

METHODS

This study was a bidirectional Mendelian randomization (MR) study. Datasets of 41 circulation cytokines and growth factors and the data on cholelithiasis were obtained. Six steps of strict instrumental variable filtration were set, and inverse-variance weighted analysis, MR-Egger regression, and weighted median test were used to identify the causal relationships. Benjamini-Hochberg method was used to adjust the P-values.

RESULTS

After adjustments of P-values, four cytokines and growth factors were still causally associated with cholelithiasis significantly: interleukin 2 receptor alpha (adjusted P: 4.59E-02), interleukin 8 (adjusted P: 1.09E-02), monocyte-specific chemokine 3 (adjusted P: 2.73E-04), and stem cell factor (adjusted P: 2.73E-04). In the reverse MR analysis, no significant causal relationship was detected after adjustment.

CONCLUSIONS

Four cytokines and growth factors, including interleukin 2 receptor alpha, interleukin 8, monocyte-specific chemokine 3, and stem cell factor, were proven to relate to cholelithiasis causally and unidirectionally.

Higher levels of systemic immune-inflammatory index are associated with the prevalence of gallstones in people under 50 years of age in the United States: a cross-sectional analysis based on NHANES

Introduction

Inflammation plays a significant role in gallstones formation. The prognosis of various illnesses was initially predicted using the systemic immune-inflammatory index (SII). We performed an updated analysis on the impact of SII and gallstones.

Methods

To investigate the connection between the SII and gallstones occurrence in a sample of individuals from the National Health and Nutrition Examination Survey (NHANES) database from 2017 to 2020, we employed logistic regression analysis, subgroup analysis, and smoothing curve fitting.

Results

In our study, an aggregate of 4,950 individuals over the age of 20 were enrolled, and 429 of them claimed to have gallstones. A fully adjusted model showed that the third and fourth quartiles of SII was parallel associated with gallstones in adults (OR = 2.43, 95% CI = 1.39-4.26; OR = 2.97, 95% CI = 1.72-5.16) under 50 years. Subgroup analysis and smoothed curve fitting provided evidence in favor of this finding.

Conclusion

According to our research, gallstones are more likely to occur in US adults younger than 50 years.

Inflammation-associated ectopic mineralization

Ectopic mineralization refers to the deposition of mineralized complexes in the extracellular matrix of soft tissues. Calcific aortic valve disease, vascular calcification, gallstones, kidney stones, and abnormal mineralization in arthritis are common examples of ectopic mineralization. They are debilitating diseases and exhibit excess mortality, disability, and morbidity, which impose on patients with limited social or financial resources. Recent recognition that inflammation plays an important role in ectopic mineralization has attracted the attention of scientists from different research fields. In the present review, we summarize the origin of inflammation in ectopic mineralization and different channels whereby inflammation drives the initiation and progression of ectopic mineralization. The current knowledge of inflammatory milieu in pathological mineralization is reviewed, including how immune cells, pro-inflammatory mediators, and osteogenic signaling pathways induce the osteogenic transition of connective tissue cells, providing nucleating sites and assembly of aberrant minerals. Advances in the understanding of the underlying mechanisms involved in inflammatory-mediated ectopic mineralization enable novel strategies to be developed that may lead to the resolution of these enervating conditions.

Dietary inflammatory index and risk of gallstone disease in Iranian women: a case-control study

BACKGROUND

Considering inflammation as a primary occurrence in gallstone formation, this study aimed to determine the relation between serum biomarkers of inflammation and oxidative stress, and dietary Inflammatory Index (DII) score with the risk of gallstone disease (GD) among Iranian women.

MATERIALS AND METHODS

Present BMI-matched case-control study was performed among 75 women with GD and 75 healthy controls. Biochemical parameters were measured by standard laboratory methods. A validated food frequency questionnaire (FFQ) was used to assess the usual intake of participants. DII score was calculated for all participants. The linear and logistic regression were used to examine the association of DII with serum inflammatory biomarkers and the odds ratio of GD, respectively.

RESULTS

The mean serum levels of high-sensitivity C-reactive protein (hs-CRP) and Malondialdehyde (MDA) were significantly (P < 0.001) higher in GD patients compared to control subjects. Women in the highest tertile of DII compared to the lowest tertile had lower intake of macronutrients, minerals, vitamins garlic, onion, pepper and fiber. Moreover, the odd of GD was significantly higher in the third tertile of the DII versus the first tertile after adjustment of potential confounders (OR: 17.47; 95% CI: 4.64-65.72). Also, a positive and significant relationship was found between the serum level of inflammatory biomarkers with the risk of GD and the inflammatory score of the diet (P < 0.001).

CONCLUSION

Our data indicate that higher DII score, and serum inflammatory and oxidative stress biomarkers are related to higher risk of GD in Iranian women.

Huge solitary gallstone complicated with liver cirrhosis in a middle-aged woman: case report

Background

Gallstones are increasingly becoming a common diagnosis in hospitals across the continents, with predominance in women. Patients suspected of a gallstone disease require thorough evaluation including endoscopic ultrasound, magnetic resonance imaging, or magnetic resonance cholangiography. A delayed or missed diagnosis is associated with serious complications and poor prognosis.

Case presentation

A 44-year-old female patient presented with fever, vomiting, hypochondria, and epigastric pain for 10 days. Clinical examination showed jaundice and tenderness at the right hypochondriac region. Blood analysis revealed elevated bilirubin, alkaline phosphatase, and white blood cells. The patient was sent for a computed tomography (CT) scan which showed a grossly enlarged liver about 17.2 cm in length and a hypo-attenuating mass in the gallbladder fossa that enhanced moderately and heterogeneously following intravenous contrast administration. Dilated intrahepatic biliary ducts were also appreciated. Explorative laparotomy was performed and revealed an enlarged, cirrhotic-appearing liver, a thickened gallbladder, and a whitish-yellow gallstone about 3 cm in the largest diameter situated at its neck. No isolated tumour was found.

Clinical discussion

Although gallstone disease is very common, misdiagnosis still occurs especially in low and lower-middle-income countries. Inadequate evaluation and increased utilization of CT in emergency and surgical departments are the contributing factors for a missed diagnosis.

Conclusions

A missed gallstone disease occurs due to various factors including inappropriate standard operating procedures, which set a CT scan as the first imaging test for all internal conditions. This case report presents the appropriate approach to achieving the diagnosis of a gallstone disease before surgical intervention.

Co-Expression of Immunohistochemical Markers MRP2, CXCR4, and PD-L1 in Gallbladder Tumors Is Associated with Prolonged Patient Survival

Gallbladder cancer (GBC) is a rare pathology in Western countries. However, it constitutes a relevant health problem in Asia and Latin America, with a high mortality in middle-aged Chilean women. The limited therapeutic options for GBC require the identification of targetable proteins with prognostic value for improving clinical management support. We evaluated the expression of targetable proteins, including three epithelial tumor markers, four proteins associated with multidrug and apoptosis resistance, and eleven immunological markers in 241 primary gallbladder adenocarcinomas. We investigated correlations between tumor marker expression, the primary tumor staging, and GBC patients' survival using automated immunohistochemistry, a semi-automatic method for image analysis, univariate and multivariate statistical analyses, and machine learning algorithms. Our data show a significant association between the expression of MRP2 (p = 0.0028), CXCR4 (p = 0.0423), and PD-L1 (p = 0.0264), and a better prognosis for patients with late-stage primary tumors. The expression of the MRP2/CXCR4/PD-L1 cluster of markers discriminates among short-, medium-, and long-term patient survival, with an ROC of significant prognostic value (AUC = 0.85, p = 0.0012). Moreover, a high MRP2/CXCR4/PD-L1 co-expression is associated with increased survival time (30 vs. 6 months, p = 0.0025) in GBC patients, regardless of tumor stage. Hence, our results suggest that the MRP2/CXCR4/PD-L1 cluster could potentially be a prognostic marker for GBC.

Alarmins and Related Molecules in Elective Surgery

Surgery is associated with alterations of alarmins' and related molecules' levels. The aim of this study was to investigate which biomarkers are most involved in surgery. The studied group consisted of 58 patients with inguinal or umbilical hernia or cholecystolithiasis and 21 healthy controls for compa-rison. We also added seven acute patients with appendicitis, cholecystitis and incarcerated hernia. Serum concentrations of soluble receptor of advanced glycation end-products (sRAGE), extracellular newly identified receptor for advanced glycation end-products binding protein (EN-RAGE), calprotectin, high mobility group box 1 (HMGB1) and interleukin 6 (IL-6) were analysed by ELISA before and after surgery. Preoperative concentrations of calprotectin were significantly decreased while concentrations of sRAGE were significantly increased in patients compared to controls; the concentrations of EN-RAGE and HMGB1 did not differ significantly. IL-6 levels were undetectable in elective patients preoperatively and in controls. Postoperatively, there was a significant increase of EN-RAGE, calprotectin, HMGB1, and IL-6 and a significant decrease of sRAGE compared to preoperative levels. In acute patients, all tested molecules except for sRAGE were significantly increased preoperatively, and sRAGE was significantly decreased. In contrast, after surgery, we could observe a further increase in IL-6; the other biomarkers did not differ significantly. We can conclude that the concentrations of all tested biomarkers are significantly influenced by elective surgery. The postoperative levels of all tested molecules increase except for sRAGE, whose level is significantly decreased after surgery. In acute states, these molecules are already increased, and the influence of surgery is, apart from IL-6, insignificant.

Gallbladder cancer

Gallbladder cancer (GBC) is the most common cancer of the biliary tract, characterized by a very poor prognosis when diagnosed at advanced stages owing to its aggressive behaviour and limited therapeutic options. Early detection at a curable stage remains challenging because patients rarely exhibit symptoms; indeed, most GBCs are discovered incidentally following cholecystectomy for symptomatic gallbladder stones. Long-standing chronic inflammation is an important driver of GBC, regardless of the lithiasic or non-lithiasic origin. Advances in omics technologies have provided a deeper understanding of GBC pathogenesis, uncovering mechanisms associated with inflammation-driven tumour initiation and progression. Surgical resection is the only treatment with curative intent for GBC but very few cases are suitable for resection and most adjuvant therapy has a very low response rate. Several unmet clinical needs require to be addressed to improve GBC management, including discovery and validation of reliable biomarkers for screening, therapy selection and prognosis. Standardization of preneoplastic and neoplastic lesion nomenclature, as well as surgical specimen processing and sampling, now provides reproducible and comparable research data that provide a basis for identifying and implementing early detection strategies and improving drug discovery. Advances in the understanding of next-generation sequencing, multidisciplinary care for GBC, neoadjuvant and adjuvant strategies, and novel systemic therapies including chemotherapy and immunotherapies are gradually changing the treatment paradigm and prognosis of this recalcitrant cancer.

Association between the Dietary Inflammatory Index with gallstone disease: finding from Dena PERSIAN cohort

OBJECTIVE

The Dietary Inflammatory Index (DII) is a documented nutritional tool for assessing diet-induced inflammation that has been linked to various diseases/outcomes. The association between DII and gallstone disease (GSD) is yet to be explored. The objective of this study was to examine the association between DII and GSD.

DESIGN

This cross-sectional study was conducted using the baseline phase data of the Dena PERSIAN cohort. The analysed data included demographic information, lifestyle variables, body mass index, diabetes and fatty liver history, and laboratory test results. The 113-item Food Frequency Questionnaire was used to estimate the dietary intake of participants and quantify the inflammatory potential of the individual's diet. DII score was analysed as a continuous and quartiles variables. Univariable and multivariate logistic regressions were used to investigate the relationship between GSD and DII scores .

RESULTS

Out of 3626 individuals entering the study, 173 (4.77%) had GSD. The median DII was -0.08 (IQR=0.18). In the unadjusted model, the odds of having GSD were significantly higher in the first and second quartiles of DII (anti-inflammatory diet) than in higher quartiles (proinflammatory diet). In the adjusted model, the odds of having GSD in the third and fourth quartiles of DII scores compared with the first quartile were OR=0.59 (95% CI 0.36 to 0.95) and OR 0.51 (95% CI 0.30 to 0.84), respectively.

CONCLUSION

The results of this study suggest that a proinflammatory diet is associated with a reduced chance of GSD. However, longitudinal studies are needed to examine the causal association.

Cholesterol crystals activate NLRP3 inflammasomes and promote gallstone formation by increasing mucin secretion

Cholesterol crystals participate in cholesterol nucleation; however, the role of cholesterol crystals in gallstone development is unknown. Mucin secretion contributes to increased size of gallstones. Cholesterol crystals activate inflammasomes and participate in many sterile inflammation related human diseases. We investigated the role of cholesterol crystals and mucins in sterile inflammation and gallstone enlargement. We found that expression of mucin 5AC (MUC5AC), NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) and interleukin-1b (IL-1b) was increased significantly in tissues adjacent to gallstones. Experiments in vitro showed that cholesterol crystals promote MUC5AC secretion; they also increase expression of NLRP3, NLR family CARD domain-containing 4 (NLRC4), apoptosis-associated speck-like protein containing caspase recruitment domain (ASC), and cleaved caspase-1 in biliary epithelial cells. Inhibition of Inflammasomes by NLRP3, ASC or caspase-1 small interfering RNAs reduced MUC5AC secretion. Also, the IL-1 receptor antagonist, IL1RA, and caspase-1 inhibitor, Ac-YVAD, both inhibited MUC5AC secretion induced by cholesterol crystals. We found that inflammasome activation participates in cholesterol crystal induced mucin secretion and gallstone development.

Environmental and Lifestyle Risk Factors in the Carcinogenesis of Gallbladder Cancer

Gallbladder cancer (GBC) is an aggressive neoplasm that in an early stage is generally asymptomatic and, in most cases, is diagnosed in advanced stages with a very low life expectancy because there is no curative treatment. Therefore, understanding the early carcinogenic mechanisms of this pathology is crucial to proposing preventive strategies for this cancer. The main risk factor is the presence of gallstones, which are associated with some environmental factors such as a sedentary lifestyle and a high-fat diet. Other risk factors such as autoimmune disorders and bacterial, parasitic and fungal infections have also been described. All these factors can generate a long-term inflammatory state characterized by the persistent activation of the immune system, the frequent release of pro-inflammatory cytokines, and the constant production of reactive oxygen species that result in a chronic damage/repair cycle, subsequently inducing the loss of the normal architecture of the gallbladder mucosa that leads to the development of GBC. This review addresses how the different risk factors could promote a chronic inflammatory state essential to the development of gallbladder carcinogenesis, which will make it possible to define some strategies such as anti-inflammatory drugs or public health proposals in the prevention of GBC.

GDF-15 as a Therapeutic Target of Diabetic Complications Increases the Risk of Gallstone Disease: Mendelian Randomization and Polygenic Risk Score Analysis

Growth differentiation factor 15 (GDF-15) levels have been revealed as a robust biomarker for metformin use. We conducted Mendelian randomization (MR) analysis to explore the association between GDF-15 and gallstone disease to inform potential therapeutic effects targeting GDF-15. Four genetic variants associated with GDF-15 levels at p < 5 × 10^-8 were selected as instrumental variables from a genome-wide association meta-analysis including 21,758 individuals. Two-sample MR analysis was conducted using summary-level data from UK Biobank (10,520 gallstone cases and 350,674 controls) and FinnGen consortium (19,023 gallstone cases and 195,144 controls). Polygenic risk score analysis using individual-level data in UK biobank was performed to complement the MR findings by examining the non-linearity of the association. Diabetic complications were taken as positive controls to validate the therapeutic effect of targeting GDF-15. Linear and nonlinear associations between genetically predicted GDF-15 levels and gallstones were estimated with stratification by the diabetic status. In the two-sample MR analysis, the odds ratio (OR) of gallstones was 1.09 (95% confidence interval (CI), 1.03-1.15; p = 0.001) for one standard deviation increase in genetically predicted GDF-15 levels in the meta-analysis of two datasets. Polygenic risk score analysis found this association to be U-shaped (p = 0.037). The observed association was predominantly seen in nondiabetic population (OR = 1.11, 95% CI: 1.01-1.21; p = 0.003). An inverse association between genetically predicted GDF-15 levels and diabetic complications (OR = 0.77, 95% CI: 0.62-0.96; p = 0.023) was observed, validating the potential therapeutic effects of targeting GDF-15 levels. This MR study indicates that the increased risk of gallstone disease should be taken into account when considering GDF-15 as a therapeutic target for diabetic complications.

The Effect of Minimally Invasive Gastrectomy for Gastric Cancer on Postoperative Gallstone Formation

BACKGROUND

Gallstones are known to occur quite frequently after gastrectomy. Most of the studies about postoperative cholelithiasis have focused on open gastrectomy, whereas laparoscopic gastrectomy has recently gained popularity as a type of minimally invasive surgery (MIS). Hence, the efficacy of MIS in preventing post-gastrectomy gallstone formation remains to be elucidated. This study aimed to evaluate the risk of gallstone formation after MIS for clinical stage I/IIA gastric cancer.

METHODS

A total of 1166 patients undergoing gastrectomy for clinical stage I/IIA gastric cancer between 2009 and 2016 were included in this study. Gallstones were detected on abdominal ultrasound and/or computed tomography. Multivariate logistic regression analysis was used to determine factors associated with postoperative gallstone formation.

RESULTS

Gallstone formation was observed in 174 patients (15%), of whom 22 (2%) experienced symptomatic cholelithiasis. In multivariate analysis, the following were identified as risk factors for post-gastrectomy gallstone formation: open approach with an odds ratio (OR) of 1.670 and a 95% confidence interval (CI) of 1.110-2.510 (P = 0.014), older age (OR 1.880; 95% CI 1.290-2.730; P < 0.001), high body mass index (OR 1.660; 95% CI 1.140-2.420; P = 0.008), Roux-en-Y (RY) reconstruction (OR 1.770; 95% CI 1.230-2.530; P = 0.002), hepatic branch vagotomy (OR 1.600; 95% CI 1.050-2.440; P = 0.029), and intra-abdominal infectious complications (OR 3.040; 95% CI 1.680-5.490; P < 0.001).

CONCLUSION

Our study suggested that MIS along with the preservation of the hepatic vagus nerve and non-RY reconstruction could help prevent post-gastrectomy gallstone development.

Gallbladder Interleukins in Children with Calculous Cholecystitis

Calculous cholecystitis connects to inflammation and various complications. It is a common disease in the paediatric population, yet it is still uncertain how inflammation factors are involved in its morphopathogenesis. Twenty calculous cholecystitis surgery tissue samples were obtained from 20 children. As a control, seven unaffected gallbladders were used. Tissues were immunohistochemically stained for IL-1α, IL-4, IL-6, IL-7, IL-8, IL-10, and IL-17A, and the slides were inspected by light microscopy. To evaluate statistical differences and correlations between interleukins, Mann-Whitney U and Spearman's tests were used. Statistically significant difference between patient and control gallbladder epithelium was for IL-1α and IL-17A, but connective tissue-IL-1α, IL-4, IL-6, IL-7, IL-8, and IL-17A positive structures. A strong positive correlation in patients was detected between epithelial IL-1α and IL-1α in connective tissue, epithelial IL-6 and IL-7, IL-6 and IL-17A, IL-7 and IL-10, IL-7 and IL-17A, as well as between IL-6 and IL-7, IL-7 and IL-10 in connective tissue. The increase of IL-1α, IL-4, IL-6, IL-7, IL-8 and IL-17A positive structures suggests their role in the morphopathogenesis of calculous cholecystitis. The correlations between interleukins in epithelium and in connective tissues prove that the epithelial barrier function and inflammatory response in deeper layers are sustained through intercellular signalling pathways.

Recent advances in understanding and managing cholesterol gallstones

The high prevalence of cholesterol gallstones, the availability of new information about pathogenesis, and the relevant health costs due to the management of cholelithiasis in both children and adults contribute to a growing interest in this disease. From an epidemiologic point of view, the risk of gallstones has been associated with higher risk of incident ischemic heart disease, total mortality, and disease-specific mortality (including cancer) independently from the presence of traditional risk factors such as body weight, lifestyle, diabetes, and dyslipidemia. This evidence points to the existence of complex pathogenic pathways linking the occurrence of gallstones to altered systemic homeostasis involving multiple organs and dynamics. In fact, the formation of gallstones is secondary to local factors strictly dependent on the gallbladder (that is, impaired smooth muscle function, wall inflammation, and intraluminal mucin accumulation) and bile (that is, supersaturation in cholesterol and precipitation of solid crystals) but also to "extra-gallbladder" features such as gene polymorphism, epigenetic factors, expression and activity of nuclear receptors, hormonal factors (in particular, insulin resistance), multi-level alterations in cholesterol metabolism, altered intestinal motility, and variations in gut microbiota. Of note, the majority of these factors are potentially manageable. Thus, cholelithiasis appears as the expression of systemic unbalances that, besides the classic therapeutic approaches to patients with clinical evidence of symptomatic disease or complications (surgery and, in a small subgroup of subjects, oral litholysis with bile acids), could be managed with tools oriented to primary prevention (changes in diet and lifestyle and pharmacologic prevention in subgroups at high risk), and there could be relevant implications in reducing both prevalence and health costs.

Circulating inflammatory proteins and gallbladder cancer: Potential for risk stratification to improve prioritization for cholecystectomy in high-risk regions

BACKGROUND

Inflammatory proteins could help identify individuals most likely to have gallbladder cancer (GBC) among those waiting for cholecystectomy.

METHODS

We analyzed 49 circulating inflammation-related proteins in 144 patients with GBC and 150 patients with gallstones. We calculated age- and sex-adjusted odds ratios (ORs) and 95% CIs for protein quantiles and GBC versus gallstones. Using proteins associated with early GBC (stage 1-2) that were selected in stepwise logistic regression, we created an inflammation score and explored the potential utility for risk stratification.

RESULTS

26 proteins (53%) had P values for the trend across categories ≤0.001, with associations for a one category increase ranging from 1.52 (95% CI: 1.20-1.94) for CC motif ligand 4 to 4.00 (95% CI: 2.76-5.79) for interleukin (IL)-8. Soluble tumor necrosis factor receptor 2 (sTNFR2), IL-6, sTNFR1, CC motif ligand 20 (CCL20), vascular cell adhesion molecule 1, IL-16, and granulocyte colony-stimulating factor had P values ≤0.001 for early GBC. Of those, IL-6, IL-16, CCL20, and STNFR1 were included in the inflammation score. In a high-risk setting with a pre-test disease risk of 10% (e.g., elderly patients) and using an inflammation score cutoff that provides 90% sensitivity, 39% of patients on the waiting list would be predicted to be positive, and 23% of those would be predicted to have GBC.

CONCLUSION

These results highlight the strong associations of inflammatory proteins with GBC risk and their potential clinical utility. Larger studies are needed to identify the most effective combinations of inflammatory proteins for detecting early GBC and precursor lesions.