Liver replacement therapy with extracorporeal blood purification techniques current knowledge and future directions

Clinically,it is highly challenging to promote recovery in patients with acute liver failure(ALF)and acute-on-chronic liver failure(ACLF).Despite recent advances in understanding the underlying mechanisms of ALF and ACLF,standard medical therapy remains the primary therapeutic approach.Liver transplantation(LT)is considered the last option,and in several cases,it is the only intervention that can be lifesaving.Unfortunately,this intervention is limited by organ donation shortage or exclusion criteria such that not all patients in need can receive a transplant.Another option is to restore impaired liver function with artificial extracorporeal blood purification systems.The first such systems were developed at the end of the 20th century,providing solutions as bridging therapy,either for liver recovery or LT.They enhance the elimination of metabolites and substances that accumulate due to compromised liver function.In addition,they aid in clearance of molecules released during acute liver decompensation,which can initiate an excessive inflammatory response in these patients causing hepatic encephalopathy,multiple-organ failure,and other complications of liver failure.As compared to renal replacement therapies,we have been unsuccessful in using artificial extracorporeal blood purification systems to completely replace liver function despite the outstanding technological evolution of these systems.Extracting middle to high-molecular-weight and hydrophobic/protein-bound molecules remains extremely challenging.The majority of the currently available systems include a combination of methods that cleanse different ranges and types of molecules and toxins.Furthermore,conventional methods such as plasma exchange are being re-evaluated,and novel adsorption filters are increasingly being used for liver indications.These strategies are very promising for the treatment of liver failure.Nevertheless,the best method,system,or device has not been developed yet,and its probability of getting developed in the near future is also low.Furthermore,little is known about the effects of liver support systems on the overall and transplant-free survival of these patients,and further investigation using randomized controlled trials and meta-analyses is needed.This review presents the most popular extracorporeal blood purification techniques for liver replacement therapy.It focuses on general principles of their function,and on evidence regarding their effectiveness in detoxification and in supporting patients with ALF and ACLF.In addition,we have outlined the basic advantages and disadvantages of each system.

The Role of Well-Being, Spirituality, and Religiosity for Successful Aging in Late Life: A Brief Review

Much research has highlighted the aging process as a global, multi-faceted issue, focusing on modifiable factors that can improve physical health and psychosocial well-being in late life. This is particularly true for both developed and developing countries, which are likely to face long-term issues in health and psychosocial care as the aging of their population increases. Within the theoretical framework of successful aging and developmental psychology, this paper aims to review recent advances in our knowledge of middle and late-life well-being in order to better understand the role of well-being and spirituality/religiosity across adulthood. The results of the selected studies allow us to conclude that subjective, hedonic, and eudemonic well-being and religious practices are significant determinants shaping the overall psychological well-being, life satisfaction, and social functioning of the older population. Limitations and implications of the study will also be discussed.

Petawatt and exawatt class lasers worldwide

In the 2015 review paper‘Petawatt Class Lasers Worldwide’a comprehensive overview of the current status of highpower facilities of>200 TW was presented.This was largely based on facility specifications,with some description of their uses,for instance in fundamental ultra-high-intensity interactions,secondary source generation,and inertial confinement fusion(ICF).With the 2018 Nobel Prize in Physics being awarded to Professors Donna Strickland and Gerard Mourou for the development of the technique of chirped pulse amplification(CPA),which made these lasers possible,we celebrate by providing a comprehensive update of the current status of ultra-high-power lasers and demonstrate how the technology has developed.We are now in the era of multi-petawatt facilities coming online,with 100 PW lasers being proposed and even under construction.In addition to this there is a pull towards development of industrial and multi-disciplinary applications,which demands much higher repetition rates,delivering high-average powers with higher efficiencies and the use of alternative wavelengths:mid-IR facilities.So apart from a comprehensive update of the current global status,we want to look at what technologies are to be deployed to get to these new regimes,and some of the critical issues facing their development.