title: Spectral and morphological classification of different chronic and acute Taiwanese gallstones via FTIR, SEM and ESEM-EDX microanalyses.
abstract: BACKGROUND
  Gallstone disease is one of the leading upper gastrointestinal surgical problems in different countries.
  
  
  OBJECTIVE
  To analyze the chronic gallstones and acute gallbladder sludge retrieved from 36 Taiwanese patients.
  
  
  METHODS
  FTIR microspectroscopy was used to classify the types of gallstones, and an ESEM-EDX microanalysis was first applied to determine the microstructural features and elemental compositions of the various gallstones. Bacteria presented on the surface of gallstones were also detected by SEM.
  
  
  RESULTS
  Four types of gallstones were obtained from these 36 Taiwanese patients: calcium bilirubinate (CaBR) stones (30.6%), cholesterol stones (19.4%), mixed stones including 6 subtypes (47.2%), and acute gallbladder sludge (2.8%) made of CaBR and protein/insoluble biomaterials. Bacteria imprints and bacterial discharges or bacterial biofilms were also found on the surface of gallstones and acute sludge under a SEM observation. ESEM-EDX results revealed that calcium was found to be the main constituent of all of the types of stones except cholesterol stones, and aluminum was also presented in most of the stones and sludge samples. Chloride was only detected in the acute gallbladder sludge.
  
  
  CONCLUSIONS
  FTIR spectra, morphological features, and elemental compositions of the acute gallbladder sludge were different from those of the chronic gallstones.
authors.affiliation: Department of Nursing, National Tainan Institute of Nursing, Tainan, Taiwan, ROC.
authors.forename: Ching-Li
authors.initials: CL
authors.lastname: Cheng
authors.affiliation: Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan, ROC. Electronic address: shchang@vghtpe.gov.tw.
authors.forename: Hsiao-Huang
authors.initials: HH
authors.lastname: Chang
authors.affiliation: Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Tien-Hua
authors.initials: TH
authors.lastname: Chen
authors.affiliation: Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Pei-Jiun
authors.initials: PJ
authors.lastname: Tsai
authors.affiliation: Department of Biotechnology and Pharmaceutical Technology, Yuanpei University of Medical Technology, Hsin Chu, Taiwan, ROC.
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Huang
authors.affiliation: Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Pei-Jung
authors.initials: PJ
authors.lastname: Huang
authors.affiliation: Department of Biotechnology and Pharmaceutical Technology, Yuanpei University of Medical Technology, Hsin Chu, Taiwan, ROC. Electronic address: sylin@mail.ypu.edu.tw.
authors.forename: Shan-Yang
authors.initials: SY
authors.lastname: Lin
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000535:Aluminum / Q000032:analysis; D001646:Bile / Q000737:chemistry* / Q000382:microbiology; D001663:Bilirubin / Q000032:analysis*; D002118:Calcium / Q000032:analysis; D002712:Chlorides / Q000032:analysis; D002784:Cholesterol / Q000032:analysis*; D002908:Chronic Disease; D017886:Durapatite / Q000032:analysis; D004577:Electron Probe Microanalysis; D005260:Female; D042882:Gallstones / Q000737:chemistry* / Q000145:classification* / Q000382:microbiology; D006801:Humans; D008297:Male; D008855:Microscopy, Electron, Scanning / Q000379:methods; D008875:Middle Aged; D017550:Spectroscopy, Fourier Transform Infrared; D013229:Stearic Acids / Q000032:analysis; D013624:Taiwan
chemical_list: D002712:Chlorides; D013229:Stearic Acids; C031183:stearic acid; D017886:Durapatite; D002784:Cholesterol; D000535:Aluminum; D001663:Bilirubin; D002118:Calcium
keywords: Acute gallbladder sludge; Chronic gallstone; EDX; ESEM; FTIR; SEM