Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines

This article discusses the definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis. Acute cholangitis and cholecystitis mostly originate from stones in the bile ducts and gallbladder. Acute cholecystitis also has other causes, such as ischemia; chemicals that enter biliary secretions; motility disorders associated with drugs; infections with microorganisms, protozoa, and parasites; collagen disease; and allergic reactions. Acute acalculous cholecystitis is associated with a recent operation, trauma, burns, multisystem organ failure, and parenteral nutrition. Factors associated with the onset of cholelithiasis include obesity, age, and drugs such as oral contraceptives. The reported mortality of less than 10% for acute cholecystitis gives an impression that it is not a fatal disease, except for the elderly and/or patients with acalculous disease. However, there are reports of high mortality for cholangitis, although the mortality differs greatly depending on the year of the report and the severity of the disease. Even reports published in and after the 1980s indicate high mortality, ranging from 10% to 30% in the patients, with multiorgan failure as a major cause of death. Because many of the reports on acute cholecystitis and cholangitis use different standards, comparisons are difficult. Variations in treatment and risk factors influencing the mortality rates indicate the necessity for standardized diagnostic, treatment, and severity assessment criteria

Responsible Product Design to Mitigate Excessive Gambling: A Scoping Review

Researchers and gambling operators have developed game-based responsible gambling tools and interventions that are intended to mitigate risks for gambling-related harm. We conducted a scoping review of this literature, with a focus on replicability and transparency. We charted 86 studies on characteristics such as study design and sample size. No tools or interventions had unambiguous evidence of efficacy, but some show promise. Pre-registration of research hypotheses, methods, and analytic plans was absent until 2019, reflecting a more recent awareness of open science practices. Published studies also inconsistently reported effect sizes and power analyses. Finally, we observed that the replicability of the responsible product design literature is uncertain but could be low. Specifically, entering each study’s primary result into a z-curve analysis—a tool for quantifying the replicability of a body of literature—revealed some evidence of publication bias based on statistical significance. Greater transparency and precision are paramount to improving the evidence base for responsible product design to mitigate gambling-related harm