Progress in hepatitis B virus-related acute-on-chronic liver failure treatment in China:A large,multicenter,retrospective cohort study using a propensity score matching analysis

Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.Methods:This study retrospectively compared short-term(28/56 days)survival rates of two different nationwide cohorts(cohort I:2008-2011 and cohort II:2012-2015).Eligible HBV-ACLF patients were enrolled retrospectively.Patients in the cohorts I and II were assigned either to the standard medical therapy(SMT)group(cohort I-SMT,cohort II-SMT)or artificial liver support system(ALSS)group(cohort IALSS,cohort II-ALSS).Propensity score matching analysis was conducted to eliminate baseline differences,and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.Results:Short-term(28/56 days)survival rates were significantly higher in the ALSS group than those in the SMT group(P<0.05)and were higher in the cohort II than those in the cohort I(P<0.001).After propensity score matching,short-term(28/56 days)survival rates were higher in the cohort II than those in the cohort I for both SMT(60.7%vs.53.0%,50.0%vs.39.8%,P<0.05)and ALSS(66.1%vs.56.5%,53.0%vs.44.4%,P<0.05)treatments.The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments(P=0.046).Multivariate logistic regression analysis revealed that ALSS(OR=0.962,95%CI:0.951-0.973,P=0.038),nucleos(t)ide analogs(OR=0.927,95%CI:0.871-0.983,P=0.046),old age(OR=1.028,95%CI:1.015-1.041,P<0.001),total bilirubin(OR=1.002,95%CI:1.001-1.003,P=0.004),INR(OR=1.569,95%CI:1.044-2.358,P<0.001),COSSH-ACLF grade(OR=2.683,95%CI:1.792-4.017,P<0.001),and albumin(OR=0.952,95%CI:0.924-0.982,P=0.002)were independent factors for 28-day mortality.Conclusions:The treatment for patients with HBV-ACLF has improved in the past decade.

Multi-objective design optimization of composite submerged cylindrical pressure hull for minimum buoyancy and maximum buckling load capacity

This paper presents the design optimization of composite submersible cylindrical pressure hull subjected to 3 MPa hydrostatic pressure.The design optimization study is conducted for cross-ply layups[0_(s)/90_(t)/0_(u)],[0_(s)/90_(t)/0_(u)]s,[0_(s)/90_(t)]s and[90_(s)/0_(t)]s considering three uni-directional composites,i.e.Carbon/Epoxy,Glass/Epoxy,and Boron/Epoxy.The optimization study is performed by coupling a Multi-Objective Genetic Algorithm(MOGA)and Analytical Analysis.Minimizing the buoyancy factor and maximizing the buckling load factor are considered as the objectives of the optimization study.The objectives of the optimization are achieved under constraints on the Tsai-Wu,Tsai-Hill and Maximum Stress composite failure criteria and on buckling load factor.To verify the optimization approach,optimization of one particular layup configuration is also conducted in ANSYS with the same objectives and constraints.

Protective effect of DNA-mediated immunization with liposome-encapsulated GRA4 against infection of Toxoplasma gondii

The dense granule protein 4(GRA4) is a granular protein from Toxoplasma gondii,and is a candidate for vaccination against this parasite. In this study,the plasmid pcDNA3.1-GRA4(pGRA4) ,encoding for the GRA4 antigen,was incorporated by the dehydration-rehydration method into liposomes composed of 16 mmol/L egg phosphatidylcholine(PC) ,8 mmol/L dioleoyl phosphatidylethanolamine(DOPE) ,and 4 mmol/L 1,2-diodeoyl-3-(trimethylammonium) propane(DOTAP) . C57BL/6 mice and BALB/c mice were immunized intramuscularly three times with liposome-encapsulated pGRA4 to determine whether DNA immunization could elicit a protective immune response to T. gondii. Enzyme-linked immunosorbent assay(ELISA) of sera from immunized mice showed that liposome-encapsulated pGRA4 generated high levels of IgG antibodies to GRA4. Production of primary interferon(IFN) -γ and interleukin(IL) -2 in GRA4-stimulated splenocytes from vaccinated mice suggested a modulated Th1-type response. 72.7% of C57BL/6 mice immunized with liposome-encapsulated pGRA4 survived the challenge with 80 tissue cysts of ME49 strain,whereas C57BL/6 mice immunized with pGRA4 had only a survival rate of 54.5%. When immunized BALB/c mice were intraperitoneally challenged with 103 tachyzoites of the highly virulent RH strain,the survival time of mice immunized with liposome-encapsulated pGRA4 was markedly longer than that of other groups. Our observations show that liposome-encapsulated pGRA4 enhanced the protective effect against infection of T. gondii.