Gallstones are the primary benign disease diagnosed and treated in biliary surgery.With the development of medical technology and the increasing awareness of health among the population,the detection rate of gallstones has been increasing annually,with the majority being asymptomatic or mild cases.Currently,the clinical treatment of gallstones mainly includes observation,conservative,or surgical treatment(laparoscopic cholecystectomy).However,there remains some controversy regarding the clinical management of these patients.For asymptomatic or mild gallstones,the main point of contention in both academic and clinical settings is how to determine the indications for cholecystectomy.This article reviews relevant literature from both domestic and international sources,addressing the controversies surrounding the clinical management of gallstones and the determination of indications for cholecystectomy,and elaborates on these issues from multiple perspectives.

Gallstones are the primary benign disease diagnosed and treated in biliary surgery.With the development of medical technology and the increasing awareness of health among the population,the detection rate of gallstones has been increasing annually,with the majority being asymptomatic or mild cases.Currently,the clinical treatment of gallstones mainly includes observation,conservative,or surgical treatment(laparoscopic cholecystectomy).However,there remains some controversy regarding the clinical management of these patients.For asymptomatic or mild gallstones,the main point of contention in both academic and clinical settings is how to determine the indications for cholecystectomy.This article reviews relevant literature from both domestic and international sources,addressing the controversies surrounding the clinical management of gallstones and the determination of indications for cholecystectomy,and elaborates on these issues from multiple perspectives.

Objective To establish and validate a ferroptosis model in human aortic vascular smooth muscle cells(HAVSMCs).Methods HAVSMCs were obtained from aortic arch tissues of donors who underwent heart transplantation at the Cardiothoracic and Vascular Surgery Department,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology.Ferroptosis was induced through imidazole ketone erastin(IKE)and cystine-deficient medium(CD)in HAVSMCs.Cell counting kit-8(CCK-8),human lactate dehydrogenase(LDH)assay kit,flow cytometry and cell immunofluores-cence staining were used to evaluate whether ferroptosis was successfully induced in HAVSMCs.Results After the induction of ferroptosis in HAVSMCs for a certain period of time,obvious morphological changes of HAVSMCs were observed under the optical microscope,and the flow cytometry analysis showed that the proportion of propidium iodide(PI)positive stained cells was significantly increased under the induction of IKE/CD.The results of CCK-8 and LDH assays showed that the cell viability of HAVSMCs was significantly reduced,and the level of cell damage was markedly increased under IKE/CD induction.Ferrostatin-1,an inhibitor of ferroptosis,was able to reverse the toxic effects of ferroptosis induction on the cells.The flow cytometry analysis of BODIPY-C11 and immunofluorescence staining of 4-hydroxynonenal(4-HNE)showed a notable increase in lipid peroxidation levels in IKE/CD-induced HAVSMCs.Conclusion In this study,a ferroptosis model was successfully established in human aor-tic vascular smooth muscle cells with IKE and cystine-deficient medium,which provided an experimental basis for subsequent researches.

Objective:To evaluate the relationship between red blood cell distribution width (RDW) and metabolic syndrome (MS) in patients with impaired glucose tolerance (IGT).Methods:A total of 415 patients with abnormal glucose tolerance were screened by oral glucose tolerance test in Changsha Traditional Chinese Medicine Hospital (Changsha Eighth Hospital) from October 2015 to September 2019. General data were collected and blood routine and biochemical indexes were detected. There were 193 cases in the observation group and 222 cases in the control group. The RDW and other clinical indicators were compared between the two groups, the correlation between RDW and other indicators was analyzed, and the risk factors of metabolic syndrome were analyzed.Results:⑴ The RDW, systolic blood pressure (SBP), diastolic blood pressure (DBP), height (Ht), weight (Wt), waist circumferenc (Wc), triglyceride (TG), cholesterol (CHOL), low density lipoprotein (LDL), creatinine (Cr), uric acid (UA), alanine aminotransferase (ALT), high sensitive C-reactive protein (hs-CRP), body mass index (BMI) of the observation group were significantly higher than those of the control group, while the high density lipoprotein (HDL) was significantly lower than that of the control group, with statistically significant difference ( P<0.05); ⑵ correlation analysis showed that RDW was positively correlated with SBP, DBP, Ht, Wt, Wc, TG, CHOL, Cr, UA, ALT, hs-CRP, BMI, and negatively correlated with HDL ( P<0.05); ⑶ binary logistic regression analysis showed that RDW, Wt, Wc, CHOL, HDL, LDL and hs-CRP were independent risk factors for MS in patients with impaired glucose tolerance. Conclusions:The increase of RDW is a predictor of metabolic syndrome in people with abnormal glucose tolerance, which may provide some reference value for the prevention and treatment of metabolic syndrome.