Although unstable patients with infected necrosis should undergo urgent debridement, current consensus is that the initial management of infected necrosis for patients who are clinically stable should be a course of antibiotics before intervention to allow the inflammatory reaction to become better organized ( 54). If the patient remains ill and the infected necrosis has not resolved, minimally invasive necrosectomy by endoscopic, radiologic, video-assisted retroperitoneal, laparoscopic approach, or combination thereof, or open surgery is recommended once the necrosis is walled-off ( 54 , 153 , 154 , 155 , 156). Minimally invasive management of pancreatic necrosis Total parenteral nutrition should be avoided in patients with mild and severe AP. There have been multiple randomized trials showing that total parenteral nutrition is associated with infectious and other line-related complications ( 53). As enteral feeding maintains the gut mucosal barrier, prevents disruption, and prevents the translocation of bacteria that seed pancreatic necrosis, enteral nutrition may prevent infected necrosis ( 142 , 143). A recent meta-analysis describing 8 randomized controlled clinical trials involving 381 patients found a decrease in infectious complications, organ failure, and mortality in patients with severe AP who were provided enteral nutrition as compared with total parenteral nutrition ( 143). Although further study is needed, continuous infusion is preferred over cyclic or bolus administration.

Despite dozens of randomized trials, no medication has been shown to be effective in treating AP ( 32 , 53). However, an effective intervention has been well described: early aggressive intravenous hydration. Recommendations regarding aggressive hydration are based on expert opinion ( 10 , 52 , 53), laboratory experiments ( 79 , 80), indirect clinical evidence ( 62 , 63 , 81 , 82), epidemiologic studies ( 59), and both retrospective and prospective clinical trials ( 9 , 83).Factors of 108 are the integers that can divide the original number evenly. There are a total of twelve factors of 108, they are 1, 2, 3, 4, 6, 9, 12, 18, 27, 36, 54 and 108. Clinical observation and early empirical research showed that assuming a caregiving role can be stressful and burdensome. 8,9 Caregiving has all the features of a chronic stress experience: It creates physical and psychological strain over extended periods of time, is accompanied by high levels of unpredictability and uncontrollability, has the capacity to create secondary stress in multiple life domains such as work and family relationships, and frequently requires high levels of vigilance. Caregiving fits the formula for chronic stress so well that it is used as a model for studying the health effects of chronic stress. 2 Tables 1 and 2 (online at https://links.lww.com/A505 and https://links.lww.com/A506) summarize the physical and mental health effects, respectively, reported in the caregiving literature over the past three decades. A broad range of outcome measures has been examined, including cellular and organ-based physiologic measures, global physical and psychiatric health status indicators, and self-reports on health habits. These outcomes have been linked to primary stressors, such as the duration and type of care provided and the functional and cognitive disabilities of the care recipient, as well as to secondary stressors, such as finances and family conflict. As a result of these stressors, the caregiver may experience effects such as psychological distress, impaired health habits, physiologic responses, psychiatric illness, physical illness, and even death. 1,2,4,5,7,13–15 Although early unblinded trials suggested that administration of antibiotics may prevent infectious complications in patients with sterile necrosis ( 119 , 120), subsequent, better-designed trials have consistently failed to confirm an advantage ( 121 , 122 , 123 , 124 , 125). Because of the consistency of pancreatic necrosis, few antibiotics penetrate when given intravenously. The antibiotics shown to penetrate and used in clinical trials include carbapenems, quinolones, metronidazole, and high-dose cephalosporins ( 52 , 116 , 123). Since 1993, there have been 11 prospective, randomized trials with proper study design, participants, and outcome measures that evaluated the use of prophylactic antibiotics in severe AP ( 126). From this meta-analysis, the number needed to treat was 1,429 for one patient to benefit. It remains uncertain if a subgroup of patients with severe AP (such as extensive necrosis with organ failure) may benefit from antibiotics, but large studies required to determine whether any benefit exists will be difficult to perform. Based on the current literature, use of prophylactic antibiotics to prevent infection in patients with sterile necrosis (even predicted as having severe disease) is not recommended.

The detrimental physical effects of caregiving (Table 1) are generally less intensive than the psychological effects, regardless of whether they are assessed by global self-report instruments or physiologic mea-sures such as stress hormone levels. Although relatively few studies have focused on the association between caregiving and health habits, researchers have found evidence of impaired health behaviors, such as neglecting their own health care appointments and eating a poor-quality diet, among caregivers who provide assistance with basic activities of daily living (ADLs) like toileting and eating. 16 Currently, a multidisciplinary consensus favors minimally invasive methods over open surgery for the management of pancreatic necrosis ( 54). A recent randomized controlled trial clearly demonstrated the superiority of endoscopic debridement over surgery ( 154). Although advances in surgical, radiologic, and endoscopic techniques exist and are in development, it must be stressed that many patients with sterile pancreatic necrosis, and select patients with infected necrosis, clinically improve to a point where no intervention is necessary ( 54 , 134). The management of patients with pancreatic necrosis should be individualized, requiring consideration of all the available data (clinical, radiologic, laboratory) and using available expertise. Early referral to a center of excellence is of paramount importance, as delaying intervention with maximal supportive care and using a minimally invasive approach have both been shown to reduce morbidity and mortality. CONFLICT OF INTEREST Measures of psychological well-being (Table 2), such as depression and stress, have been the most frequently studied consequences of caregiving. This research has consistently shown relatively large effects, which are moderated by age, socioeconomic status, and the availability of informal support. Older caregivers, people of low socioeconomic status, and those with limited support networks report poorer psychological and physical health than caregivers who are younger and have more economic and interpersonal resources. 1–3 PREDICTORS OF HEALTH EFFECTS Specific author contributions: All four authors shared equally in conceiving, initiating, and writing the manuscript. The pair factors of 108 are the numbers that are multiplied in pairs resulting in an original number. The factors of 108 can be positive or negative. The pair factors of 108 can also be represented in the positive as well as in the negative pair. For example, the factor pair of 108 can be (1, 108) or (-1, -108). If we multiply the negative pair factors of 108, then it results in 108. In this article, we are going to learn the factors of 108 and also get to know about the positive and negative pair factors of 108, and the prime factorization of 108 and solved examples. What are the Factors of 108?Pancreatic necrosis is defined as diffuse or focal areas of nonviable pancreatic parenchyma > 3 cm in size or > 30% of the pancreas ( 53). Pancreatic necrosis can be sterile or infected (discussed below). In the absence of pancreatic necrosis, in mild disease the edematous pancreas is defined as interstitial pancreatitis. Although there is some correlation between infection, pancreatic necrosis, hospital length of stay, and organ failure, both patients with sterile necrosis and infected necrosis may develop organ failure ( 55 , 56). The presence of infection within the necrosis probably does not increase the likelihood of present or future organ failure. Patients with sterile necrosis can suffer from organ failure and appear as ill clinically as those patients with infected necrosis. Persistent organ failure is now defined by a Modified Marshal Score ( 6 , 8). Use this calculator to add, subtract, multiply and divide numbers in scientific notation, E notation or engineering notation. Answers are provided in three formats: scientific notation, E notation and engineering notation. You can also do operations on whole numbers, integers, and decimal numbers and get answers in scientific notation. Isolated extrapancreatic necrosis is also included under the term necrotizing pancreatitis. This entity, initially thought to be a nonspecific anatomic finding with no clinical significance, has become better characterized and is associated with adverse outcomes, such as organ failure and persistent organ failure, but these outcomes are less frequent. Extrapancreatic necrosis is more often appreciated during surgery than being identified on imaging studies. Although most radiologists can easily identify pancreatic parenchymal necrosis, in the absence of surgical intervention, extrapancreatic necrosis is appreciated less often ( 7). Predicting severe AP

We can simply evaluate the factors of 108 by the basic division method. In the division method, the factors of 108 are found by dividing 108 by different consecutive integers. If the integers divide 108 exactly and leave the remainder 0, then the integers are the factors of 108. Here, we will discuss how to find the factors of 108 using the division method.Acute pancreatitis (AP) is one of the most common diseases of the gastrointestinal tract, leading to tremendous emotional, physical, and financial human burden ( 1 , 2). In the United States, in 2009, AP was the most common gastroenterology discharge diagnosis with a cost of 2.6 billion dollars ( 2). Recent studies show the incidence of AP varies between 4.9 and 73.4 cases per 100,000 worldwide ( 3 , 4). An increase in the annual incidence for AP has been observed in most recent studies. Epidemiologic review data from the 1988 to 2003 National Hospital Discharge Survey showed that hospital admissions for AP increased from 40 per 100,000 in 1998 to 70 per 100,000 in 2002. Although the case fatality rate for AP has decreased over time, the overall population mortality rate for AP has remained unchanged ( 1). The concept that infected pancreatic necrosis requires prompt surgical debridement has also been challenged by multiple reports and case series showing that antibiotics alone can lead to resolution of infection and, in select patients, avoid surgery altogether ( 6 , 54). In one report ( 133) of 28 patients given antibiotics for the management of infected pancreatic necrosis, 16 avoided surgery. There were two deaths in the patients who underwent surgery and two deaths in the patients who were treated with antibiotics alone. Thus, in this report, more than half the patients were successfully treated with antibiotics and the mortality rate in both the surgical and nonsurgical groups was similar. The concept that urgent surgery is required in patients found to have infected necrosis is no longer valid. Asymptomatic pancreatic and/or extrapancreatic necrosis does not mandate intervention regardless of size, location, and extension. It will likely resolve over time, even in some cases of infected necrosis ( 54). Based on these studies, it was unclear whether patients with severe AP in the absence of acute cholangitis benefit from early ERCP. Therefore, Folsch et al. ( 95) organized a multicenter study of ERCP in acute biliary pancreatitis that excluded patients most likely to benefit, namely those with a serum bilirubin >5 mg/dl. Thus, patients with acute cholangitis and/or obvious biliary tree obstruction underwent early ERCP and were not included in the study. This study focused on determining the benefit of early ERCP in preventing severe AP in the absence of biliary obstruction. Although this study has been widely criticized for design flaws and the unusually high mortality of patients with mild disease (8% compared with an expected 1%), no benefit in morbidity and/or mortality was seen in patients who underwent early ERCP. From this study, it appears that the benefit of early ERCP is seen in patients with AP complicated by acute cholangitis and biliary tree obstruction, but not severe AP in the absence of acute cholangitis.

Physical health. Factors linked to the caregiver's physical health include the care recipient's behavior problems, cognitive impairment, and functional disabilities; the duration and amount of care provided; vigilance demands (such as constantly having to watch a person with Alzheimer's disease to prevent self-harm); and caregiver and patient coresidence. 1,2,4,7,13 Feelings of distress and depression associated with caregiving also negatively affect the caregiver's physical health. In studies with large population-based samples, about one third of caregivers report neither strain nor negative health effects. 21 Particularly in the early stages of caregiving, negative effects may not occur. 16,22 Even when caregiving demands become more intense and result in high levels of distress and depression, caregivers often cite positive aspects of the experience. They report that caregiving makes them feel good about themselves and as if they are needed, gives meaning to their lives, enables them to learn new skills, and strengthens their relationships with others. 23 E notation is also known as exponential notation. E notation is the same as scientific notation where a decimal number between 1 and 10 is multiplied by 10 raised to some power. In E notation the "times 10 raised to a power" is replaced with the letter e in either uppercase or lowercase. The number after the "e" indicates how many powers of 10. In this example calculation we're adding 1.225e5 and 3.655e3: The rationale for early aggressive hydration in AP arises from observation of the frequent hypovolemia that occurs from multiple factors affecting patients with AP, including vomiting, reduced oral intake, third spacing of fluids, increased respiratory losses, and diaphoresis. In addition, researchers hypothesize that a combination of microangiopathic effects and edema of the inflamed pancreas decreases blood flow, leading to increased cellular death, necrosis, and ongoing release of pancreatic enzymes activating numerous cascades. Inflammation also increases vascular permeability, leading to increased third space fluid losses and worsening of pancreatic hypoperfusion that leads to increased pancreatic parenchymal necrosis and cell death ( 84). Early aggressive intravenous fluid resuscitation provides micro- and macrocirculatory support to prevent serious complications such as pancreatic necrosis ( 10). Patients with normal or near-normal bile duct and liver tests have a lower likelihood of a common bile duct stone and/or other pathology (stricture, tumor). In these patients, diagnostic ERCP has largely been replaced by EUS or MRCP as the risk of post-ERCP pancreatitis is greater in a patient with normal caliber bile duct and normal bilirubin (odds ratio 3.4 for post-ERCP pancreatitis) as compared with a patient who is jaundiced with a dilated common bile duct (odds ratio 0.2 for post-ERCP pancreatitis) ( 99). Furthermore, MRCP and EUS are as accurate as diagnostic ERCP and pose no risk of pancreatitis ( 98).In the absence of alcohol or gallstones, caution must be exercised when attributing a possible etiology for AP to another agent or condition. Medications, infectious agents, and metabolic causes such as hypercalcemia and hyperparathyroidism are rare causes, often falsely identified as causing AP ( 35 , 36 , 37). Although some drugs such as 6-mercaptopurine, azathioprine, and DDI (2′,3′-dideoxyinosine) can clearly cause AP, there are limited data supporting most medications as causative agents ( 35). Primary and secondary hypertriglyceridemia can cause AP; however, these account for only 1–4% of cases ( 36). Serum triglycerides should rise above 1,000 mg/dl to be considered the cause of AP ( 38 , 39). A lactescent (milky) serum has been observed in as many as 20% of patients with AP, and therefore a fasting triglyceride level should be re-evaluated 1 month after discharge when hypertriglyceridemia is suspected ( 40). Although most do not, any benign or malignant mass that obstructs the main pancreatic can result in AP. It has been estimated that 5–14% of patients with benign or malignant pancreatobiliary tumors present with apparent IAP ( 41 , 42 , 43). Historically, adenocarcinoma of the pancreas was considered a disease of old age. However, increasingly patients in their 40s—and occasionally younger—are presenting with pancreatic cancer. This entity should be suspected in any patient >40 years of age with idiopathic pancreatitis, especially those with a prolonged or recurrent course ( 27 , 44 , 45). Thus, a contrast-enhanced CT scan or MRI is needed in these patients. A more extensive evaluation including endoscopic ultrasound (EUS) and/or MRCP may be needed initially or after a recurrent episode of IAP ( 46). Idiopathic AP You can think of constants or exact values as having infinitely many significant figures, or at least as many significant figures as the least precise number in your calculation. Use the appropriate number of significant figures when you input exact values in this calculator. In this example you would want to enter 2.00 for the constant value so that it has the same number of significant figures as the radius entry. The resulting answer would be 4.70 which has 3 significant figures. Additional Resources