Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

A Prediction Model for Separation Anxiety: The Role of Attachment Styles and Internalizing Symptoms in Italian Young Adults

Following recent literature, which stresses the importance of broadening the conceptualization of mental functioning in youth, this paper investigated the relations between indicators of attachment styles, internalizing symptoms, and separation anxiety in 379 non-referred Italian university students, as captured by the relationship questionnaire, the experiences in close relationships-revised, the Personality Assessment Inventory (PAI), and the adult separation anxiety-27. Psychometric properties of all measures were scrutinized and a confirmatory factor analysis was conducted to support the soundness of a one-factor model representing indicators of all PAI internalizing symptoms: Anxiety, Anxiety-related disorders, Depression, Somatization, and Suicidal ideation. Then, a multivariate analysis was performed in order to test a model of relation linking attachment styles, internalizing symptoms, and separation anxiety scores. Results supported the mediation role of Internalizing symptoms in the association between preoccupied attachment and separation anxiety scores. Preoccupied attachment towards the romantic partner, as compared to attachment towards family and friends, played a more relevant role in predicting internalizing symptoms and separation anxiety scores. Findings corroborate the combined use of the over-mentioned indicators as a screening battery for the dimensional assessment of the interplay among these variables in young adults. Implications and limitations of the study are presented and discussed

Patient distribution according to the TNM 7th edition and the new staging system.

<p>Patient distribution according to the TNM 7th edition and the new staging system.</p