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Objective To analyze risk factors of acute respiratory failure (ARF) in patients with hypertriglyceridemia acute pancreatitis (HTG-AP) and construct a risk prediction model. Methods A total of 222 HTG-AP patients were included in this study and divided into the non-ARF group (176 cases) and the ARF group (46 cases) according to diagnostic guidelines for ARF. Clinical data of the two groups were compared and the predictive factors were screened. These selected factors were then utilized in a multivariate Logistic regression analysis to construct a Logistic regression model. Subsequent evaluation of the model's predictive ability, accuracy and clinical utility was conducted through ROC, curve analysis, calibration plot examination and decision curve analysis (DCA), respectively. Results Compared with the non-ARF group, the levels of high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL)-C and albumin (ALB) were decreased in the ARF group (P＜0.05), while the levels of creatinine (Cr), urea nitrogen (BUN), aspartate aminotransferase (AST) and C-reactive protein (CRP) were increased, and the incidence of pleural fluid and ascites was also increased (P＜0.05). Multivariate Logistic regression analysis showed that higher levels of Cr and AST, lower levels of ALB, HDL-C and ascites were independent risk factors for HTG-AP complicated ARF (P＜0.05). Based on these results, a column-line prediction model for HTG-AP complicated ARF was established. After internal verification, the area under curve (AUC) of receiver operating characteristic (ROC) curve of the nomogram model was 0.952 (95%CI: 0.923-0.981), the Youden index was 0.808 and the sensitivity and specificity were 93.33% and 87.43%, respectively. The calibration curve showed that the probability of HTG-AP concurrent ARF predicted by the model was in good agreement with the actual probability. The DCA curve showed that the model had certain clinical value. Conclusion The nomogram prediction model combined could provide a scheme for the clinical prevention of HTG-AP complicated with ARF. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to determine the correlation between the blood serum mean platelet volume (MPV) and the dynamics of the OF course during the early phase in patients with moderately severe and severe acute pancreatitis (AP). Methods: The predetermined criterion was the presence of the OF according to the revised Atlanta criteria 2012 for moderately severe and severe AP. A prospective sample of patients was stratified by severity, and two groups were defined based on MPV. Demographic indicators, comorbidities and clinical outcomes were compared between these groups. Multifactorial analysis determined whether an elevated MPV is independently associated with early OF and other unfavorable outcomes. Results: Out of 108 patients, 20 had moderately severe AP and 88 had severe AP. The blood serum MPV, measured within 72 h of the onset of AP symptoms was lower 11.8 fL in 32 patients and equal to or greater 11.8 fL in 76 patients. Patients with elevated MPV were older (63 vs. 48 years), had obesity (59.2 % vs. 25 %), diabetes mellitus (DM) (51.3 % vs. 12.5 %), ischemic heart disease (70.8 % vs. 28.1 %) and more frequently experienced persistent OF (93.4 % vs. 53.1 %) compared to those with MPV lower 11.8 fL. The incidence of early OF increased proportionally with the severity of MPV (81.6 % vs. 34.4 % in the group with MPV lower 11.8 fL, Ptrend

Liver failure often has rapid progression, multiple complications, and dangerous conditions. Acute pancreatitis is a common comorbidity during the progression of liver failure, and since acute pancreatitis has extremely similar clinical symptoms and signs to liver failure complicated by spontaneous peritonitis, it is often neglected in clinical practice. This article elaborates on the mechanisms of liver failure complicated by acute pancreatitis from the five aspects of inflammatory response, duodenal papillary dysfunction, gut microbiota dysbiosis, oxidative stress, and microcirculatory disturbance and proposes corresponding preventive measures based on these mechanisms. [ABSTRACT FROM AUTHOR]

Alcoholic foamy degeneration (AFD) is an uncommon presentation of alcoholic liver disease (ALD) with characteristic histologic findings of foamy-looking hepatocytes due to the presence of abundant microvesicles of fat within the cytoplasm predominantly in perivenular and midzonal regions without inflammation and fibrosis. It is underdiagnosed as the patients quickly recover after alcoholic abstinence and are rarely caught on biopsies. AFD has better prognosis than alcoholic hepatitis, and the injury mechanism is different, warranting a different diagnosis. We present an uncommon case of AFD incidentally diagnosed during autopsy in a chronic alcoholic and diabetic man.

Objective To investigate the differences in the influencing factors for acute necrotizing pancreatitis (ANP) and infectious pancreatic necrosis (IPN) between Eastern and Western countries, and to provide a theoretical basis for the prediction and prevention of ANP. Methods Databases including PubMed, Embase, the Cochrane Library, and Web of Science were searched for articles on the influencing factors for ANP and IPN published up to January 21, 2021, and a Meta-analysis was performed. Results A total of 59 studies were included, with 22 studies from Eastern countries and 37 studies from Western countries.The Meta-analysis showed that in Eastern countries, male sex (odds ratio[OR]=1.51, 95% confidence interval[CI]: 1.18-1.91, P < 0.01), C-reactive protein (CRP)(standardized mean difference[SMD]=1.39, 95%CI: 1.06-1.71, P < 0.01), D-dimer (SMD=0.44, 95%CI: 0.07-0.81, P=0.02), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE-Ⅱ) score (mean difference[MD]=3.51, 95%CI: 1.38-5.64, P < 0.01), alcoholic etiology (OR=3.57, 95%CI: 2.68-4.75, P < 0.01), and biliary etiology (OR=0.60, 95%CI: 0.46-0.77, P < 0.01) were the influencing factors for ANP, and in Western countries, male sex (OR=1.63, 95%CI: 1.30-2.05, P < 0.01), CRP (SMD=2.09, 95%CI: 1.12-3.05, P < 0.01), APACHE-Ⅱ score (MD=4.28, 95%CI: 2.73-5.83, P < 0.01), Ranson score (MD=2.99, 95%CI: 2.50-3.47, P < 0.01), and organ failure (OR=10.87, 95%CI: 2.62-45.04, P < 0.01) were the influencing factors for ANP.In Eastern countries, age (MD=2.16, 95%CI: 0.43-3.89, P=0.01), body mass index (BMI)(MD=1.74, 95%CI: 1.23-2.25, P < 0.01), albumin level (SMD=-0.43, 95%CI: -0.75 to-0.12, P < 0.01), CRP (SMD=0.58, 95%CI: 0.04-1.11, P=0.03), procalcitonin (SMD=0.80, 95%CI: 0.56-1.04, P < 0.01), D-dimer (MD=0.23, 95%CI: 0.15-0.31, P < 0.01), APACHE-Ⅱ score (MD=2.47, 95%CI: 0.73-4.22, P < 0.01), Ranson score (MD=1.60, 95%CI: 1.46-1.73, P < 0.01), and extent of necrosis ≥30%(OR=2.52, 95%CI: 1.26-5.06, P < 0.01) were the influencing factors for IPN, while in Western countries, age (MD=4.07, 95%CI: 1.82-6.31, P < 0.01), APACHE-Ⅱ score (MD=3.28, 95%CI: 1.39-5.17, P < 0.01), Ranson score (MD=2.18, 95%CI: 1.75-2.62, P < 0.01), SIRS score (OR=3.88, 95%CI: 1.58-9.51, P < 0.01), alcoholic etiology (OR=0.61, 95%CI: 0.42-0.87, P < 0.01), and organ failure (OR=3.63, 95%CI: 1.11-11.92, P=0.03) were the influencing factors for IPN. Conclusion Current evidence shows that biliary etiology and alcoholic etiology are unique influencing factors for ANP in the Eastern population, while Ranson score is a unique influencing factor in the Western population.BMI and extent of necrosis ≥30% are unique influencing factors for IPN in the Eastern population, while alcoholic etiology is a unique influencing factor in the Western population. [ABSTRACT FROM AUTHOR]

Objective To explore the predictive value of serum soluble leukocyte differentiation antigen subtype 14 (sCD14 st) and pentamerin-3 (PTX-3) in severe acute pancreatitis (SAP) complicated with peripancreatic necrosis infection. Methods A total of 112 SAP patients were selected and divided into the infection group (54 cases) and the non-infection group. Cultures of pathogenic bacteria were performed in patients of the infection group. Enzyme-linked immunosorbent assay was used to detect serum levels of sCD14 st, PTX-3, procalcitonin (PCT) and C-reactive protein (CRP). Results A total of 61 strains of pathogenic bacteria were detected in the infection group, including 45 strains of Gram-negative bacteria (73.77%), 14 strains of Gram-positive bacteria (22.95%) and 2 strains of fungi (3.28%). The serum levels of sCD14-ST, PTX-3, PCT and CRP were significantly higher in the infected group than those in the non-infected group (P＜0.05). Serum sCD14-ST was positively correlated with PTX-3, PCT and CRP in SAP patients (P＜0.05). Serum PTX-3 was positively correlated with sCD14-ST, PCT and CRP (P＜0.05). The high levels of sCD14-ST, PTX-3, PCT and CRP were the risk factors of peripancreatic necrosis infection in SAP patients (P＜0.05). The areas under the curve of sCD14-ST, PTX-3, PCT and CRP predicting peripancreatic necrosis infection in SAP patients were 0.854 (95%CI: 0.784-0.925), 0.851 (95%CI: 0.780-0.923), 0.837 (95%CI: 0.756-0.919) and 0.749 (95%CI: 0.654-0.844) respectively. Conclusion The serum levels of sCD14-ST and PTX-3 are abnormally elevated in SAP patients with peripancreatic necrosis infection, and their expression levels are closely related to the risk of infection. Both of them have high predictive value for SAP patients with peripancreatic necrosis infection. [ABSTRACT FROM AUTHOR]