The only curative treatment available is liver transplantation and should be considered at a MELD score of 15. © Georg Thieme Verlag KG Stuttgart · New York.Gallstones develop in the gallbladder or the bile ducts. According to their chemical composition, gallstones can be divided into cholesterol stones, which are common, and the rare bile pigment stones. Altogether, up to 20 % of all adults develop gallstones and more than 20 % of them symptoms or complications. Female sex, age, pregnancy, physical inactivity, obesity, overnutrition and genetic factors such as ABCB4 deficiency of the hepatic lecithin transporter are kown risk factors for gallstone formation. In about one half of all patients biliary symptoms precede the three common and potentially life-threatening complications (acute cholecystitis, acute cholangitis and biliary pancreatitis). Although our knowledge about the genetics and pathophysiology of gallstones has improved, current treatment algorithms are predominantly invasive (ERC and surgery). Thus, better strategies are needed to prevent the formation of gallstones in general. © Georg Thieme Verlag KG Stuttgart · New York.Fibromyalgia is characterized by chronic, widespread musculoskeletal pain and associated fatigue, sleep disturbances, and other cognitive and somatic symptoms. For many patients, these symptoms persist for years and lead to frequent health care use; for some, fibromyalgia and its symptoms can be debilitating. Although many treatments are available, management remains challenging. This article highlights the clinical features of fibromyalgia, discusses diagnostic criteria and their evolution, and reviews treatment options.Background Cannabis use disorder (CUD) is a growing concern, and evidence-based data are needed to inform treatment options.  https://www.selleckchem.com/ATM.html  Purpose To review the benefits and risks of pharmacotherapies for the treatment of CUD. Data Sources MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, and clinical trial registries from inception through September 2019. Study Selection Pharmacotherapy trials of adults or adolescents with CUD that targeted cannabis abstinence or reduction, treatment retention, withdrawal symptoms, and other outcomes. Data Extraction Data were abstracted by 1 investigator and confirmed by a second. Study quality was dually assessed, and strength of evidence (SOE) was determined by consensus according to standard criteria. Data Synthesis Across 26 trials, the evidence was largely insufficient. Low-strength evidence was found that selective serotonin reuptake inhibitors (SSRIs) do not reduce cannabis use or improve treatment retention. Low- to moderate-strength evidence was found that buspirone does not improve outcomes and that cannabinoids do not increase abstinence rates (moderate SOE), reduce cannabis use (low SOE), or increase treatment retention (low SOE). Across all drug studies, no consistent evidence of increased harm was found. Limitations Few methodologically rigorous trials have been done. Existing trials are hampered by small sample sizes, high attrition rates, and heterogeneity of concurrent interventions and outcomes assessment. Conclusion Although data on pharmacologic interventions for CUD are scarce, evidence exists that several drug classes, including cannabinoids and SSRIs, are ineffective. Because of increasing access to and use of cannabis in the general population, along with a high prevalence of CUD among current cannabis users, an urgent need exists for more research to identify effective pharmacologic treatments. Primary Funding Source U.S. Department of Veterans Affairs. (PROSPERO CRD42018108064).Background Observational studies using traditional research designs suggest that influenza vaccination reduces hospitalizations and mortality among elderly persons. Accordingly, health authorities in some countries prioritize vaccination of this population. Nevertheless, questions remain about this policy's effectiveness given the potential for bias and confounding in observational data. Objective To determine the effectiveness of the influenza vaccine in reducing hospitalizations and mortality among elderly persons by using an observational research design that reduces the possibility of bias and confounding. Design A regression discontinuity design was applied to the sharp change in vaccination rate at age 65 years that resulted from an age-based vaccination policy in the United Kingdom. In this design, comparisons were limited to individuals who were near the age-65 threshold and were thus plausibly similar along most dimensions except vaccination rate. Setting England and Wales. Participants Adults aged 55 to 75 years residing in the study area during 2000 to 2014. Intervention Seasonal influenza vaccine. Measurements Hospitalization and mortality rates by month of age. Results The data included 170 million episodes of care and 7.6 million deaths. Turning 65 was associated with a statistically and clinically significant increase in rate of seasonal influenza vaccination. However, no evidence indicated that vaccination reduced hospitalizations or mortality among elderly persons. The estimates were precise enough to rule out results from many previous studies. Limitation The study relied on observational data, and its focus was limited to individuals near age 65 years. Conclusion Current vaccination strategies prioritizing elderly persons may be less effective than believed at reducing serious morbidity and mortality in this population, which suggests that supplementary strategies may be necessary. Primary Funding Source National Institute on Aging.The effects of providing rest on physiological and behavioural indicators of welfare of cattle being transported by road has not been well studied in North America. New revisions to Canada's Health of Animals Regulations Part XII Transportation of Animals indicate un-weaned and weaned calves can be transported a maximum of 12 and 36 h, respectively, before an 8 h rest is required. Therefore, the aim of this study was to assess the effects of rest duration, after 12 and 36 h of transport, on physiological and behavioural indicators of welfare in 7-8 mo-old beef calves. Three hundred and twenty conditioned calves (258 ± 23.9 kg BW) were randomly assigned to a 2 × 4 factorial design where the main factors included transport duration 12 h (12; n = 160) and 36 h (36; n = 160) and rest stop duration 0 h (R0; n = 80), 4 h (R4; n = 80), 8 h (R8; n = 80) and 12 h (R12; n = 80). After the resting period, animals were transported for an additional 4 h. Blood and hair samples were taken from 12 animals per treatment prior to and after the first and the 4 h transport; and then 7 h, 2 d and 28 d after the 4 h transport.