Novel anthropometric indicators of visceral obesity predict the severity of hyperlipidemic acute pancreatitis.

BACKGROUND: Obesity substantially contributes to the onset of acute pancreatitis (AP) and influences its progression to severe AP. Although body mass index (BMI) is a widely used anthropometric parameter, it fails to delineate the distribution pattern of adipose tissue. To circumvent this shortcoming, the predictive efficacies of novel anthropometric indicators of visceral obesity, such as lipid accumulation products (LAP), cardiometabolic index (CMI), body roundness index (BRI), visceral adiposity index (VAI), A Body Shape Index (ABSI), and Chinese visceral adiposity index (CVAI) were examined to assess the severity of AP. METHOD: The body parameters and laboratory indices of 283 patients with hyperlipidemic acute pancreatitis (HLAP) were retrospectively analysed, and the six novel anthropometric indicators of visceral obesity were calculated. The severity of HLAP was determined using the revised Atlanta classification. The correlation between the six indicators and HLAP severity was evaluated, and the predictive efficacy of the indicators was assessed using area under the curve (AUC). The differences in diagnostic values of the six indicators were also compared using the DeLong test. RESULTS: Patients with moderate to severe AP had higher VAI, CMI, and LAP than patients with mild AP (all P < 0.001). The highest AUC in predicting HLAP severity was observed for VAI, with a value of 0.733 and 95% confidence interval of 0.678-0.784. CONCLUSIONS: This study demonstrated significant correlations between HLAP severity and VAI, CMI, and LAP indicators. These indicators, particularly VAI, which displayed the highest predictive power, were instrumental in forecasting and evaluating the severity of HLAP.

Machine learning improves early prediction of organ failure in hyperlipidemia acute pancreatitis using clinical and abdominal CT features.

BACKGROUND: This study aimed to investigate and validate machine-learning predictive models combining computed tomography and clinical data to early predict organ failure (OF) in Hyperlipidemic acute pancreatitis (HLAP). METHODS: Demographics, laboratory parameters and computed tomography imaging data of 314 patients with HLAP from the First Affiliated Hospital of Wenzhou Medical University between 2017 and 2021, were retrospectively analyzed. Sixty-five percent of patients (n = 204) were assigned to the training group and categorized as patients with and without OF. Parameters were compared by univariate analysis. Machine-learning methods including random forest (RF) were used to establish model to predict OF of HLAP. Areas under the curves (AUCs) of receiver operating characteristic were calculated. The remaining 35% patients (n = 110) were assigned to the validation group to evaluate the performance of models to predict OF. RESULTS: Ninety-three (45.59%) and fifty (45.45%) patients from the training and the validation cohort, respectively, developed OF. The RF model showed the best performance to predict OF, with the highest AUC value of 0.915. The sensitivity (0.828) and accuracy (0.814) of RF model were both the highest among the five models in the study cohort. In the validation cohort, RF model continued to show the highest AUC (0.820), accuracy (0.773) and sensitivity (0.800) to predict OF in HLAP, while the positive and negative likelihood ratios and post-test probability were 3.22, 0.267 and 72.85%, respectively. CONCLUSIONS: Machine-learning models can be used to predict OF occurrence in HLAP in our pilot study. RF model showed the best predictive performance, which may be a promising candidate for further clinical validation.

Triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio is an independent predictor of the severity of hyperlipidaemic acute pancreatitis.

BACKGROUND: The incidence of acute pancreatitis caused by hyperlipidaemia is increasing. A quick and easy diagnosis of the severity of hyperlipidaemic acute pancreatitis (HTGP) is important to improve patient prognosis and reduce mortality. Previous studies reported that insulin resistance (IR) is associated with acute pancreatitis. Our study aimed to investigate the correlation between the triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio and HTGP. METHODS: Patients' laboratory and clinical parameters were obtained from the institutional pancreatitis database. Univariate and multivariate logistic regression analyses were applied to evaluate the risk factors for the severity of HTGP and the efficacy of four clinical scoring systems: Ranson's Criteria, Acute Physiology and Chronic Health Evaluation II (APACHE II), the Bedside Index for Severity in Acute Pancreatitis (BISAP), and Marshall. RESULTS: Of 290 patients, 134 (46.2%) were diagnosed with moderately severe to severe HTGP. The TG/HDL-C ratio was higher in the moderately severe to severe HTGP subgroup than in the mild HTGP subgroup. Among the independent risk factors, such as amylase, albumin, aspartate transaminase (AST), systemic inflammatory response syndrome (SIRS), and TG/HDL-C ratio, the TG/HDL-C ratio had the highest area under the curve (AUC) (0.727, 95% CI, 0.571-0.701). In comparison with other clinical scoring systems, the TG/HDL-C ratio has a relatively preferable predictive ability. CONCLUSION: Our findings suggest that the TG/HDL-C ratio is positively correlated with HTGP severity and could be used as a simple indicator of severe HTGP.

The modified computed tomography severity index combined with low skeletal muscle mass can better predict the severity of hypertriglyceridemia-induced pancreatitis.

BACKGROUND: Body composition parameters are associated with hypertriglyceridemia-induced pancreatitis (HTGP). This study investigated the association between the quantity of muscle assessed using computed tomography (CT) and the severity of HTGP. METHODS: The modified CT severity index (MCTSI) was calculated from admission examination data. Patients' characteristics and body composition parameters were collected. Univariate and multivariate logistic regression analyses were also performed. The receiver operating characteristic curves and corresponding area under the curves (AUC) were calculated to test the efficiency of the model. A nomogram was then constructed. RESULTS: Of the 175 included patients, 138 were male, of which 85 had moderately severe to severe HTGP. Patients with low skeletal muscle mass (LSMM) and high MCTSI were significantly more likely to have moderately severe to severe HTGP. Patients with LSMM had lower body mass index, lower HDL-C level, higher amylase level, prevalence of surgery, shorter umbilical waist circumference, and longer length of hospital stay. Univariate and multivariate logistic regression analyses confirmed that female sex, lipase, total cholesterol, LSMM-MCTSI (P = .004, odds ratio = 23.105), and albumin were risk factors. The TOTAL model that combined LSMM-MCTSI and clinical risk parameters performed best (AUCs = 0.875), followed by other models (LSMM-MCTSI: AUCs = 0.762, MCTSI: AUCs = 0.728). The Delong test revealed significant difference. Finally, a nomogram was developed to predict the severity of HTGP. CONCLUSION: The performance of MCTSI in predicting severity can be improved by considering LSMM, which is a promising strategy for the treatment of HTGP.

The visceral adiposity index predicts the severity of hyperlipidaemic acute pancreatitis.

It is important to clarify the severity of acute pancreatitis (AP) in the early stages of the disease. The visceral adiposity index (VAI), calculated using the waist circumference (WC), body mass index (BMI), triglyceride (TG) levels, and high-density lipoprotein cholesterol (HDL-c), indirectly reflects visceral adiposity function and can be used to explore its value in evaluating and predicting the severity of hyperlipidaemic acute pancreatitis (HLAP). The VAIs of 227 patients with HLAP were calculated by retrospective analysis of body parameters and laboratory indicators. The correlation between the VAI and HLAP severity, local complications, and systemic inflammatory response syndrome (SIRS) response was analysed. The VAI was significantly higher in patients with severe and moderately severe AP than in patients with mild AP (both p < 0.05). Length of hospital stay (LOS), AP severity, systemic complications, Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, and SIRS score were significantly correlated with the VAI in HLAP patients. The VAI had the highest area under the curve of receiver operating characteristics (ROC) (0.755, 95% confidence interval [CI], 0.691-0.819) for predicting AP severity. The multivariate-adjusted odds ratio (HR) for the VAI in the relationship of body parameters and the severity of HLAP was 3.818 (95% CI, 1.395-10.452). Our study shows that the VAI is a valuable indicator for predicting and assessing the severity of hyperlipidaemic acute pancreatitis. Its increase is closely related to poor prognosis in patients with HLAP.

A Radiological Nomogram to Predict 30-day Mortality in Patients with Acute Pulmonary Embolism.

RATIONALE AND OBJECTIVES: Acute pulmonary embolism (APE) is a common disease with a high mortality, especially in the short term. Computed tomographic pulmonary angiography (CTPA) is a recommended method in the diagnostic workup for APE; thus, this study aimed to establish a CTPA-based radiological nomogram to predict the 30-day mortality in patients with APE, and to further compare this model with the pulmonary embolism severity index (PESI) and simplified pulmonary embolism severity index (SPESI). MATERIALS AND METHODS: We retrospectively recruited 158 adults with confirmed APE who underwent CTPA from August 1, 2017, to August 1, 2020. These adults were stratified into two groups according to their 30-day mortality. CTPA-based variables were analyzed using univariate and multivariate analyses, independent risk factors for 30-day mortality were established, and a radiological nomogram was constructed. Subsequently, PESI and SPESI were calculated. The performance of the radiological nomogram model was compared to that of the PESI and SPESI using decision curve analysis and receiver-operating characteristic curve analysis. RESULTS: Thirty-three patients died within 30 days (30-day mortality rate, 20.9%). On logistic regression analysis, the right and left ventricular diameter ratio (odds ratio [OR] = 8.709, 95% confidence interval [CI]: 1.085-69.903, p = 0.042), ventricular septal bowing (OR = 8.085, 95% CI: 1.947-33.567, p = 0.004), chronic bronchitis (OR = 4.383, 95% CI: 1.025-18.740, p = 0.046), malignant lung lesions (OR = 17.530, 95% CI: 2.408-127.636, p = 0.005), and pneumonia (OR = 3.477, 95% CI: 1.123-10.766, p = 0.031) were identified as the independent predictors of 30-day mortality. The area under the curve of the radiological nomogram, PESI, and SPESI were 0.900 (95% CI: 0.828-0.971), 0.729 (95% CI: 0.642-0.815), and 0.718 (95% CI: 0.621-0.815), respectively. CONCLUSION: The CTPA-based radiological nomogram appeared valuable for the prediction of 30-day mortality in patients with APE, and was superior to both PESI and SPESI.

Assessment of Computed Tomography-Defined Muscle and Adipose Tissue Features in Relation to Length of Hospital Stay and Recurrence of Hypertriglyceridemic Pancreatitis.

BACKGROUND: Analytic morphometric assessment has recently been proposed to be applied to the study of acute pancreatitis (AP). However, the relationship between body composition and the outcomes of hypertriglyceridemic pancreatitis (HTGP) is still unclear. The aim of this study was to evaluate body composition in relation to the length of hospital stay (LOS) and recurrence of HTGP. METHODS: Patient characteristics, admission examination data, body composition parameters, LOS, and recurrence within 1 year were collected from the institutional pancreatitis database and follow-up records. Logistic regression analysis was used to identify risk factors for LOS and recurrence of HTGP. RESULTS: Of the 196 included patients, 158 (80.6%) were men and 53 (27.0%) were sarcopenic. The average LOS was 15.83±10.02 days. The recurrence rate of HTGP was 36.7%. Multivariate analysis with multiple linear regression suggested that subcutaneous adipose tissue (SAT) area (p=0.019) and high-density lipoprotein-cholesterol (HDL-C) (p=0.001) were independently associated with the LOS for HTGP after adjusting for age and sex. The multivariate adjusted hazard ratios for SAT area and HDL-C, with respect to the relationship between body parameters and LOS, were 1.008 (95% confidence interval [CI], 1.001-1.015) and 0.090 (95% CI, 0.022-0.361), respectively. No significant differences were observed between the AP and recurrent AP (RAP) groups in terms of characteristics, admission examination data, and body composition parameters. CONCLUSION: SAT area and HDL-C are associated with LOS in patients with HTGP. The body composition of patients at the first symptom onset of HTGP cannot predict recurrence.

The association of parameters of body composition and laboratory markers with the severity of hypertriglyceridemia-induced pancreatitis.

BACKGROUND: Hypertriglyceridemia has arisen as the third leading cause of acute pancreatitis. This study aimed at exploring the association between the severity of hypertriglyceridemia-induced pancreatitis (HTGP) and computed tomography (CT)-based body composition parameters and laboratory markers. METHODS: Laboratory and clinical parameters were collected from 242 patients with HTGP between 2017 and 2020. Severity of HTGP was evaluated by original or modified CT severity index. Body composition parameters such as area and radiodensity of muscle, subcutaneous adipose tissue and visceral adipose tissue were calculated by CT at the level of third lumbar vertebra. Parameters were compared between mild and moderately severe to severe HTGP. Uni-variate and multi-variate Logistic regression analyses were employed to assess the risk factors of the severity of HTGP. RESULTS: Seventy patients (28.9%) presented with mild HTGP. Body mass index, waist circumference and all CT-based body composition parameters differed between male and female patients. None was associated with the severity of HTGP, neither in males nor in females. Receiver operating characteristic curves showed that areas under the curves of apolipoprotein A-I and albumin to predict the severity of HTGP were 0.786 and 0.759, respectively (all P < 0.001). Uni-variate and further multi-variate Logistic regression analysis confirmed that low serum albumin (< 35 g/L, P = 0.004, OR = 3.362, 95%CI = 1.492-8.823) and apolipoprotein A-I (< 1.1 g/L, P < 0.001, OR = 5.126, 95%CI = 2.348-11.195), as well as high C-reactive protein (> 90 mg/L, P = 0.005, OR = 3.061, 95%CI = 1.407-6.659) and lipase (P = 0.033, OR = 2.283, 95%CI = 1.070-4.873) were risk factors of moderately severe to severe HTGP. Levels of albumin, apolipoprotein A-I, C-reactive protein and lipase were also associated with the length of hospital stay (all P < 0.05). Besides, low serum albumin, low-density lipoprotein cholesterol and high radiodensity of subcutaneous adipose tissue were significant risk factors of pancreatic necrosis in patients with HTGP (all P < 0.05). CONCLUSIONS: Low serum albumin and apolipoprotein A-I, and high C-reactive protein and lipase upon admission were associated with a more severe type of HTGP and longer hospital stay for these patients. Albumin and apolipoprotein A-I may serve as novel biomarkers for the severity of HTGP. However, none of the body composition parameters was associated with the severity of HTGP.

Imaging Features of Sclerosing Epithelioid Fibrosarcoma of the Pancreas: A Case Report.

Background: Sclerosing epithelioid fibrosarcoma (SEF) is an extremely rare fibrosarcoma variant. There is no complete imaging data on SEF involving the pancreas. Herein we report the computed tomography (CT) and magnetic resonance imaging (MRI) data of a patient with SEF that primarily involved the pancreas. Case Presentation: A 64-year-old man was found to have a solid mass in the tail of the pancreas on unenhanced CT. He had no constitutional symptoms. Contrast-enhanced abdominal CT and MRI were performed, and the results of the latter provided the diagnosis of a pancreatic neuroendocrine tumor. Laparoscopic distal pancreatectomy and splenectomy were performed. Anatomopathological examination and immunohistochemistry confirmed that the tumor was a SEF of the pancreas. The patient had no signs of recurrence or metastasis during a 12-months follow-up. Conclusion: We report an extremely rare case of SEF in the pancreas and its characterization with CT and MRI.

Comparative Decellularization and Recellularization of Normal Versus Streptozotocin-Induced Diabetes Mellitus Rat Pancreas.

Decellularized (DC) organs/tissues offer a promising scaffold for regenerative bioengineering. However, it is not clear whether the diabetic mellitus (DM) pancreas can be used in decellularized and recellularized bioengineering. For assessment of these questions, murine pancreatic scaffolds of normal, type 1DM (T1DM) and type 2 DM (T2DM) pancreas were generated using a perfusion decellularization technique and assessed by histology, scanning electron microscopy, immunohistochemistry, and enzyme-linked immunosorbent assay (ELISA). The capacity of DC pancreatic scaffolds to support attachment and proliferation of human umbilical vein endothelial cells (HUVECs) and MIN-6 ß cells was also assessed. Our results showed that DC pancreatic scaffolds were successfully produced from T1DM and T2DM pancreas and maintained their extracellular matrix (ECM) composition, 3D ultrastructure, and various cytokines. All of the pancreatic scaffolds were sufficiently cytocompatible and were able to support proliferation and adhesion of HUVECs and MIN-6 ß cells. The preliminary results support the biological utility of diabetes mellitus pancreatic scaffolds and pave the way for further investigations to assess the potential ability of using diabetes mellitus pancreas as scaffolds for recellularization and eventual medical applications.

Interfacial Electronic Structures of Photodetectors Based on C8BTBT/Perovskite.

Comprehensive measurements of ultraviolet photoemission spectroscopy, X-ray photoemission spectroscopy, X-ray diffraction, and atomic force microscopy are adopted to investigate the corelevance of energy level alignment, molecular orientation, and film growth of Au/C8BTBT/perovskite interfaces. A small energy offset of valence band maximum of 0.06 eV between perovskite and C8BTBT makes hole transportation feasible. About 0.65 eV upward shift of energy levels is observed with the deposition of the Au film on C8BTBT, which enhances hole transportation to the Au electrode. The observations from the interface analysis are supported by a prototype photodetector of Au (80 nm)/C8BTBT (20 nm)/perovskite (100 nm) that exhibits excellent performances whose responsivity can reach up to 2.65 A W-1, 4 times higher than the best CH3NH3PbI3 photodetectors.

The effect of anterior projection of aneurysm dome on the rupture of anterior communicating artery aneurysms compared with posterior projection.

OBJECTIVE: Recent studies have shown that anterior projection aneurysms are associated with increased risk of rupture of anterior communicating artery (ACoA) aneurysms. We aimed to determine differences in patient characteristics and aneurysm morphologies between the anterior projection and posterior projection aneurysm groups and to determine morphological predictors of rupture of the anterior projection aneurysms. MATERIALS AND METHODS: December 2007 to February 2015, 503 consecutive patients with single ACoA aneurysms were included in this report. The ACoA aneurysms were dichotomized as the anterior and posterior projection groups. Multivariate regression models were used to determine differences in patient and aneurysm characteristics between the 2 groups and to determine predictors of rupture in the anterior projection aneurysms. RESULTS: 363 (72.2%) patients had anterior projection aneurysms and 140 (27.8%) had posterior projection aneurysms. In univariate analysis, the anterior projection aneurysms were associated with a larger aneurysm size, a higher aneurysm height, a higher perpendicular height, a larger aspect ratio, and a larger size ratio. The multivariate analysis showed that the anterior projection aneurysms were independently associated with a larger size ratio compared with the posterior projection aneurysms. A larger size ratio and a smaller vessel size were independently associated with rupture status in the anterior projection aneurysms. CONCLUSIONS: Compared with posterior projection aneurysms, the anterior projection aneurysms have a higher risk of rupture probably because of significant differences in aneurysm morphologies. A larger size ratio and a smaller vessel size may be helpful to predict the risk of rupture in the anterior projection aneurysms.

Investigation of the dynamic bending properties of MoS2 thin films by interference colours.

A non-contact method for the observation of the elastic deformation of 2D molybdenum disulfide (MoS2) thin films using an ordinary optical microscope is reported. A pulsed laser is used to rapidly increase the bending deformation of the MoS2 thin films via heating. The bending angle of the MoS2 thin films shows high stability, changing only 5% in forty days without external forces. However, the bending angle of the MoS2 thin films substantially decreases after being wetted with the volatile polar solvent tetrahydrofuran (THF), because of its low surface tension. By removing the nano-Newton scale forces on the MoS2 thin films, the bending angle increases significantly within 4 minutes, and this feature of the thin films shows great potential for use in the fabrication of micro-force sensors. This is the first attempt to study the mechanical properties of 2D materials by optical methods. Further utilization of industrially manufactured MoS2 thin films for detecting micro-force qualitatively on the basis of their excellent bending properties would significantly reduce the production costs of micro-force sensors.

[Digital anatomy of the perforator flap in the thigh].

OBJECTIVE: To provide algorithmic morphological data that enables safe elevation of the flow-through perforator flap, chimeric perforator flap in the thigh. METHODS: 15 fresh cadavers were injected with a modified lead oxide-gelatin mixture for three-dimensional reconstruction using a spiral computed tomography scanner and specialized volume-rendering software (MIMICS). All of specimens were then dissected by layers. Angiography and photography were used to document the precise course, size, location, and type of individual perforators in the thigh region. The surface areas of cutaneous territories and perforator zones were measured and calculate with Photoshop and Scion Image. RESULTS: The main artery supplying the thigh is femoral artery. There are (41 +/- 4.0) perforators whose outer diameters > or = 0.5 mm. These perforators have a superficial pedicle length of (4.2 +/- 1.7) cm. The average outer diameter is (0.8 +/- 0.1) mm. Each perforator supplies an average area of (44 +/- 6.4) cm2. There are lots of truly anastomoses among perforaors to form a subcutaneous network in the thigh. CONCLUSIONS: The volume rendering technique is very useful for showing the subcutaneous network and preoperative flap design. The thigh appears to have the greatest potential for harvesting new or modified perforator flaps, especially, flow-through perforator flap or chimeric perforator flap.