Metabolic inflammation as an instigator of fibrosis during nonalcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD)is characterized by excessive storage of fatty acids in the form of triglycerides in hepatocytes.It is most prevalent in western countries and includes a wide range of clinical and histopathological findings,namely from simple steatosis to steatohepatitis and fibrosis,which may lead to cirrhosis and hepatocellular cancer.The key event for the transition from steatosis to fibrosis is the activation of quiescent hepatic stellate cells(qHSC)and their differentiation to myofibroblasts.Pattern recognition receptors(PRRs),expressed by a plethora of immune cells,serve as essential components of the innate immune system whose function is to stimulate phagocytosis and mediate inflammation upon binding to them of various molecules released from damaged,apoptotic and necrotic cells.The activation of PRRs on hepatocytes,Kupffer cells,the resident macrophages of the liver,and other immune cells results in the production of proinflammatory cytokines and chemokines,as well as profibrotic factors in the liver microenvironment leading to qHSC activation and subsequent fibrogenesis.Thus,elucidation of the inflammatory pathways associated with the pathogenesis and progression of NAFLD may lead to a better understanding of its pathophysiology and new therapeutic approaches.

Depression in military medicine cadets: a cross-sectional study

Background: Military medicine cadets undergo strenuous military training alongside demanding medical studies. This stressful and complex educational environment can lead to the emergence of depressive symptoms. We investigated the prevalence of depressive symptoms in a cohort of military medicine cadets.Methods: We conducted a descriptive questionnaire-based cross-sectional study among Greek military medicine cadets in the undergraduate program of the Hellenic Military School of Combat Support Officers. The Greek translation of the Zung self-rating depression scale questionnaire was used to screen for the presence of depressive symptoms. In addition, demographic, academic and dietary information was collected. The Shapiro-Wilk test of normality, Pearson correlation test, Chi-square test, t-test and Mann Whitney U test were employed for statistical analysis.Results: We enrolled 55 female and 91 male military medicine cadets with a mean age of 19.84 years(SD=0.99). The mean Zung crude score was 43.32(SD=4.55): 42.8(SD=4.43) for female cadets and 43.64(SD=4.6) for male cadets. Cadets were further subdivided into low and high risk groups for the presence of depressive symptoms. We identified 57(39%) cadets with a total Zung crude score of 45 or above: 21 females and 36 males. Statistical analysis did not reveal any significant differences between the two groups based on gender, year of training, academic performance, alcohol consumption, smoking status, vitamin supplementation, dietary habits or BMI.Conclusion: We report a high prevalence of depressive symptoms in a cohort of military medicine cadets that underscores the need for effective screening and appropriate and timely interventions. We did not identify any related risk factors. Military medicine cadets are exposed to a challenging military and medical training environment, and thus represent a group at risk for development of depression.