Gallstone and gallbladder disease: biliary tract and cholangiopathies

: Cholestatic liver diseases are named primarily due to the blockage of bile flow and buildup of bile acids in the liver. Cholestasis can occur in cholangiopathies, fatty liver diseases, and during COVID-19 infection. Most literature evaluates damage occurring to the intrahepatic biliary tree during cholestasis; however, there may be associations between liver damage and gallbladder damage. Gallbladder damage can manifest as acute or chronic inflammation, perforation, polyps, cancer, and most commonly gallstones. Considering the gallbladder is an extension of the intrahepatic biliary network, and both tissues are lined by biliary epithelial cells that share common mechanisms and properties, it is worth further evaluation to understand the association between bile duct and gallbladder damage. In this comprehensive article, we discuss background information of the biliary tree and gallbladder, from function, damage, and therapeutic approaches. We then discuss published findings that identify gallbladder disorders in various liver diseases. Lastly, we provide the clinical aspect of gallbladder disorders in liver diseases and ways to enhance diagnostic and therapeutic approaches for congruent diagnosis. © 2023 American Physiological Society. Compr Physiol 13:4909-4943, 2023

Functional role of the secretin/secretin receptor signaling during cholestatic liver injury

Liver diseases are a major health concern and affect a large proportion of people worldwide. There are over 100 types of liver disorders, including cirrhosis, cholangiocarcinoma (CCA), hepatocellular carcinoma, and hepatitis. Despite the relevant number of people who are affected by liver diseases, and the increased awareness with regard to these disorders, the number of deaths corresponding to liver injury is expected to increase in the foreseeable future. One of the possible reasons for this is that a complete comprehension of the mechanisms of hepatic damage involving specific liver anatomical districts is lacking, and, as a consequence, current treatments available are suboptimal

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

Experimental Investigation on Time Reversal Precoding for Space-Time Focusing in Wireless Communications

This work presents the results of indoor wideband measurements investigating the spacetime properties of wireless signal transmission with online time reversal precoding. The measurements were conducted using a new time-reversal wideband MIMO channel sounder operating at 2.45 GHz with a bandwidth of 240 MHz. Both line of sight and non line of sight propagation conditions were investigated. Spatial focusing and temporal compression can be seen clearly with time reversal precoding, which may be useful for future wireless systems applications. Channel hardening due to time reversal is also observed under both line and non line of sight conditions

Evaluation of depression in patients with heart failure

Background: Despite advances in medical therapy heart failure consists a prevalent debilitating disease of poor prognosis, strongly associated with high mortality and morbidity rates. On the same time, depression rates are higher in patients with heart failure than in the general population. Depression may be underdiagnosed and consequently undertreated in the patients, as symptoms can often be similar in the two disease states. Purpose: The purpose of the present study was to explore the frequency of occurrence of depression in patients with heart failure and to evaluate possible precipitating factors. Method and material: Study sample consisted of 139 patients with heart failure, who were hospitalized or visited outpatients' clinics in two major hospitals in Athens. Collection of data was performed using the Zung Self-Rating Depression Scale. Statistical analyses (Student's t-test, One-way ANOVA) were conducted using the Statistical Package for Social Sciences 13.0 (SPSS, Chicago, Il, USA). Results: 110 patients (79.1%) were male and only 29 patients were female, over the age of 40. 71.9% were outpatients, 20.2% were hospitalized in the departments of cardiology, while 7.9% were I.C.U. patients. Analysis of data showed that 34.6% of patients scored lower than 40 in Zung Self-Rating Scale, indicating absence of depression, 27.3% scored 40 to 47, indicating mild depression, 20.9% scored 48 to 55, indicating moderate depression, and 17.2% scored over 56, indicating severe depression. More specifically, it was found that, regarding patients' gender and age, women (p=0.001) and patients over the age of 60 (p=0.001) experienced higher levels of depression, while regarding educational background patients who received only basic education may have been more prone to depression (p=0.05, non-significant). In addition, higher levels of depression were observed for those retired (p=0.028), those living in metropolitan areas (p=0.021), patients at 2 or 3 stage of heart failure (p<0.001), patients who had been diagnosed for over 1 year (p=0.032), as well as those who reported that were less informed about the extent of their condition (p=0.001). Conclusions: The majority of patients with heart failure experience various levels of depression. The main precipitating factors are age, gender, educational and economic status, place of residence, amount of receiving information as well as the stage and the onset of the disease. Nurses and physicians must act towards identification, assessment and management of depression in this clinical population

What Greek mothers know about evaluation and treatment of fever in children: An interview study

Background: Fever is one of the most common symptoms in childhood. Mothers&apos; insufficient knowledge about its evaluation and treatment frequently leads to excessive fear and anxiety. Objectives: To explore mothers&apos; knowledge concerning management of fever in their children, at home. Design: Descriptive, correlational. Settings: An emergency department of a pediatric hospital. Participants: A total of 327 mothers with febrile children randomly selected in the waiting room. Methods: Data collection was based on interviews by using a questionnaire which was specifically developed for this study. Results: Almost one out of three mothers (32.4%) evaluated fever as a temperature between 37-38 °C and the 38.1% of them considered that side effects could be a result of these temperatures. The majority of the mothers (73.7%) administered antipyretics at body temperatures of 37-38.5 °C, usually without a medical instruction (49.2%). Younger mothers with lower education levels and those who admitted to hospital for the first time with children less than 12 months of age showed the poorest level of Knowledge about fever evaluation and treatment. Conclusions: Educational interventions by health care professionals aiming at educating young mothers with a low educational level and those with a child younger than 12 months old who seek medical attention at hospital, for the first time, are needed to dispel misconceptions about fever and to promote the appropriate management of the febrile child. © 2007 Elsevier Ltd. All rights reserved