Acute pancreatitis (AP) is an acute abdominal disease characterized by local pancreatic inflammation and complex immune dysregulation. Given the central role of inflammatory cytokines in AP pathophysiology and their potential association with disease severity, we compared plasma cytokine profiles among patients with mild, moderately severe, and severe AP. Correlation patterns among cytokines were further characterized using correlation network analysis, and machine learning approaches were applied for exploratory severity stratification. In this study, we retrospectively included 220 patients with acute pancreatitis (mild, moderately severe, or severe) and retrieved plasma cytokine measurements of eight cytokines (IL-2, IL-4, IL-6, IL-10, IL-12p70, IL-17, IFN-γ, and TNF-α). Correlation network analysis was performed to characterize severity-associated cytokine correlation patterns. Two exploratory machine learning approaches were applied, including LASSO-based multinomial logistic regression for cytokine feature selection and random forest analysis for severe versus non-severe AP stratification. Model performance was evaluated using repeated nested cross-validation, ROC-based discrimination metrics, and variable importance analysis. Cytokine network analysis showed only descriptive differences in correlation patterns across AP severity groups; however, no between-group difference in any individual cytokine–cytokine correlation remained statistically significant after false discovery rate (FDR) correction. Cytokine distributions showed partial overlap across groups, indicating limited separability using single biomarkers. LASSO regression identified a subset of cytokines associated with severity, while random forest modeling demonstrated moderate discriminative ability for severe disease classification after repeated nested cross-validation, with high specificity but limited sensitivity. Feature selection results differed between analytical approaches, but IL-6 and IL-10 were consistently highlighted as informative cytokines. These findings suggest that cytokine-based exploratory modeling may provide complementary information for AP severity stratification. This study provides a preliminary framework for investigating cytokine-based severity stratification and supports future validation studies in larger prospective cohorts.
The neutrophil percentage-to-albumin ratio (NPAR) has recently been recognized as a marker of disease severity in critically ill patients. Its utility in acute pancreatitis (AP) is not well established. Given the high mortality associated with severe AP, early risk stratification is crucial. This study aimed to examine the association between NPAR and 28-day all-cause mortality in patients with acute pancreatitis (AP) in the ICU. This retrospective cohort study extracted data from the MIMIC-IV database. The primary endpoint was 28-day all-cause mortality. The association between NPAR and mortality was evaluated using multivariable Cox regression, restricted cubic spline (RCS) analysis, and Kaplan-Meier survival analysis. Its predictive performance was assessed by the area under the receiver operating characteristic curve (AUC) and compared with individual components and the SOFA score. Machine learning models were further constructed to validate its importance. Among 532 eligible patients, 73 (13.7
Differentiating pediatric inflammatory bowel disease (IBD) from functional gastrointestinal disorders (FGID) is clinically challenging due to symptom overlap. This study aims to identify and compare distinct gut microbial and fecal bile acid profiles between these conditions to identify potential non-invasive discriminatory biomarkers for differentiating these conditions. In this case-control study, fecal samples from 33 pediatric IBD patients and 28 FGID patients were analyzed. Gut microbiota composition was assessed via 16S ribosomal RNA gene sequencing, and bile acid profiles were quantified using liquid chromatography-mass spectrometry. Statistical analyses included diversity indices, differential abundance analysis, and Spearman correlation to explore microbiota-bile acid-inflammatory marker relationships. The IBD group exhibited significantly lower gut microbial alpha diversity and distinct beta diversity compared to the FGID group. Microbiota dysbiosis in IBD was characterized by depletion of Firmicutes and the genus Blautia, and enrichment of Proteobacteria and Escherichia-Shigella. Metabolically, IBD fecal samples showed elevated primary bile acids (e.g., cholic acid) and reduced secondary bile acids (e.g., deoxycholic acid and lithocholic acid). Notably, bacteria enriched in FGID (e.g., Blautia) positively correlated with secondary bile acids, and both were inversely correlated with inflammatory markers. Pediatric IBD and FGID demonstrate significantly different and interconnected gut microbial and bile acid metabolic profiles. The identified features, including specific bacteria and bile acids, warrant further validation as a non-invasive candidate biomarker panel with potential utility in differentiating these disorders. Not applicable (This is an observational cohort study without interventional treatment).
Liver involvement is common in patients with hematologic neoplasms. Despite advances in diagnostic methods, histological examination plays an irreplaceable role. Percutaneous liver biopsy is often contraindicated, and the standard approach is transjugular liver biopsy (TJLB). The aim was to evaluate our centre’s experience with TJLB in a consecutive cohort of patients with hematologic neoplasms. We performed a retrospective analysis of all patients who underwent TJLB at our institution between 1992 and 2024 because of suspected liver involvement related to a hematologic neoplasm. Biopsies were obtained with the standard aspiration technique, using access via the right internal jugular vein. A total of 93 patients (62 men, 31 women; mean age 53.3 ± 15.6 years) underwent TJLB due to suspected hematology-related liver disease. Underlying hematological diagnoses were: lymphoma (32 patients), acute or chronic leukemia (36), myelodysplastic syndrome or other chronic disorders (23) and other conditions in 2 patients. An adequate liver tissue sample was obtained in 90 patients (97
Perforation of a duodenal diverticulum in the third (horizontal) part (D3) is an exceedingly rare surgical emergency for which operative intervention remains the mainstay of treatment. Duodenal diverticula, particularly periampullary ones, have been linked to choledocholithiasis. To our knowledge, no cases of simultaneous surgical management of a perforated horizontal (D3) duodenal diverticulum and common bile duct stones have been reported. We report the case of a 79-year-old woman who developed duodenal diverticular perforation complicated by common bile duct dilatation following lumbar spinal surgery. Emergency exploratory laparotomy confirmed perforation of a duodenal diverticulum in the third (horizontal) part (D3), which was managed by diverticular repair combined with proximal duodenostomy. Intraoperative choledochoscopy revealed choledocholithiasis with biliary dilatation, and concurrent choledochoscopic stone extraction with T-tube drainage was performed. The patient recovered uneventfully and was discharged after intensive perioperative management. This case of a 79-year-old woman illustrates several important clinical considerations. First, it highlights the potential of duodenal diverticulitis, possibly exacerbated by postoperative stress and corticosteroid exposure, to precipitate perforation of a duodenal diverticulum in the third (horizontal) part (D3)—a rare anatomical location. Second, the coexistence of a perforated duodenal diverticulum with choledocholithiasis and common bile duct dilatation is noteworthy, although the mechanism linking them in this patient remains uncertain. Third, although this report describes a successful one-stage surgical approach, we do not advocate it as a standard protocol; rather, it underscores the importance of individualized decision-making and comprehensive intraoperative assessment in rare and complex clinical scenarios. The complicated postoperative course, including multidrug-resistant infection and postsurgical gastroparesis, further emphasizes the challenges of managing elderly patients with such rare presentations.
