Double plasma molecular adsorption system for Stevens–Johnson syndrome/toxic epidermal necrolysis:A case report

BACKGROUND Stevens–Johnson syndrome and toxic epidermal necrolysis(SJS/TEN)are very serious skin allergies,with an etiology related to infections and medication.Since the coronavirus disease 2019(COVID-19)pandemic,severe acute respiratory syndrome coronavirus-2 has also been considered to cause SJS/TEN.CASE SUMMARY We report the case of a woman in her thirties who took acetaminophen after contracting COVID-19.After 3 d of fever relief,she experienced high fever and presented with SJS/TEN symptoms,accompanied by intrahepatic cholestasis.Three days of corticosteroid treatment did not alleviate the skin damage;therefore,double plasma molecular adsorption system(DPMAS)therapy was initiated,with treatment intervals of 48 h.Her skin symptoms improved gradually and were resolved after seven DPMAS treatments.CONCLUSION DPMAS therapy is beneficial for abrogating SJS/TEN because plasma adsorption and perfusion techniques reduce the inflammatory mediators(e.g.,tumor necrosis factor-alpha and interleukin-10 and-12)speculated to be involved in the pathology of the skin conditions.

Plasma cascaded solid wastes for possible adsorption of NO_(2)in diesel exhaust

Extensive use of fossil fuel has led to an increase in solid and gaseous particulates in the environment,which in turn necessitated newer,effective,and economical control strategies to abate pollutants,particularly gaseous pollutants.In the current research work,focus has been placed on utilizing industry wastes to adsorb nitrogen oxides present in diesel engine exhaust,which is pre-treated by plasma.Sampled exhaust from a 5 kW diesel generator is exposed to discharge plasma where the oxidation of nitric oxide to nitrogen dioxide occurs,which is then made to flow through another reactor filled with industry wastes drawn from agriculture,foundry,utility,marine industry,etc.,comprising mulberry waste,rice husk,wheat husk,areca nut husk,sugarcane bagasse,coffee husk,foundry sand,lignite ash,red mud,and oyster shells.While the adsorption of nitrogen dioxide was observed in all the wastes,reduction of nitric oxide was observed in metallic compound-based industry wastes.At about 184 J/L,specific energy plasma cascaded industrial waste red mud yielded 98%NO_(x)removal efficiency,and that with agriculture rice husk waste yielded 53%NOx removal.TiO_(2)/Fe_(2)O_(3)present in industry wastes might have exhibited photo-catalysis in visible light resulting in the possible reduction of NO.A new pathway for recycling the waste can be expected through nitrogen dioxide adsorption,and the results are further discussed with respect to plasma-alone and cascaded plasma adsorbent systems.

Double Plasma Molecular Adsorption System with Sequential Low-dose Plasma Exchange in Patients with Hepatitis B Virus-related Acute-on-chronic Liver Failure:A Prospective Study

Background and Aims:To investigate the safety and efficacy of double plasma molecular adsorption system(DPMAS)with sequential low-dose plasma exchange(LPE)in treating early hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods:Clinical data of patients with HBVACLF were prospectively collected,including patients in a DPMAS with sequential LPE(DPMAS+LPE)group and those in a standard medical treatment(SMT)group.The primary endpoint was death or liver transplantation(LT)at 12 weeks of follow-up.Propensity-score matching was performed to control the effects of confounding factors on prognosis between the two groups.Results:After 2 weeks,total bilirubin,alanine aminotransferase,blood urea nitrogen levels,and Chinese Group on the Study of Severe Hepatitis B score,were significantly lower in the DPMAS+LPE group than those in the SMT group(p<0.05).After 4 weeks,laboratory parameters of the two groups were similar.The cumulative survival rate of the DPMAS+LPE group was significantly higher than that of the SMT group at 4 weeks(97.9%vs.85.4%,p=0.027),but not at 12 weeks(85.4%vs.83.3%,p=0.687).Cytokine levels were significantly lower in 12-week survival group than in the death-or-LT group(p<0.05).Functional enrichment analysis showed that downregulated cytokines were mainly involved in positive regulation of proliferation and activation of lymphocytes and monocytes,regulation of immune effect response,regulation of endotoxin response,and glial cell proliferation.Conclusion:DPMAS+LPE significantly improved the 4-week cumulative survival rate,and ameliorated the inflammatory response in patients.DPMAS+LPE may be a promising modality for patients with early HBV-ACLF.

Efficacy of artificial liver support system in severe immuneassociated hepatitis caused by camrelizumab:A case report and review of the literature

BACKGROUND Immune checkpoint inhibitors(ICIs)can lead to immune-related hepatitis(IRH)and severe liver damage,which is life-threatening in the absence of specific treatment.CASE SUMMARY A 75-year-old man was admitted to our hospital complaining of loss of appetite,yellow urine,and abnormal liver function for the past 2 wk.Three months prior to admission,he was treated with two rounds of capecitabine in combination with camrelizumab for lymph node metastasis of esophageal cancer.Although liver function was normal before treatment,abnormal liver function appeared at week 5.Capecitabine and camrelizumab were discontinued.Ursodeoxycholic acid and methylprednisolone 40 mg daily were administered.Liver function continued to deteriorate.Prothrombin time and international normalized ratio were 19 s and 1.8,respectively.The patient was diagnosed with acute liver failure.A pathological analysis of liver biopsy indicated a strongly positive immunohistochemical staining of T8+cells,thereby suggesting that drug-induced liver injury was related to IRH caused by camrelizumab.Subsequently,we performed sequential dual-molecule plasma adsorption system(DPMAS)treatment with plasma exchange(PE).After two rounds of treatment,the patient's appetite significantly improved,the yellow color of urine reduced,and liver function improved(total bilirubin level decreased)after five rounds of treatment.Liver function normalized 4 wk after discharge.CONCLUSION The use of sequential DPMAS with PE can reduce liver injury and systemic toxic reactions by clearing inflammatory mediators and harmful substances from blood,and regulate immune cell activity,which may be effective in the treatment of severe ICI-induced IRH.

Efficacy and Economic Evaluation of Nonbiological Artificial Liver Therapy in Acute-on-chronic Hepatitis B Liver Failure

Background and Aims:Nonbiological artificial liver(NBAL)is frequently used as a first-line treatment for hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF).This study aimed to compare the therapeutic efficacy and cost-effectiveness ratio(CER)of comprehensive medical treatment,plasma exchange(PE),and double plasma molecular adsorption system(DPMAS)plus half-dose PE(DPMAS+PE)in patients with HBV-ACLF.Methods:A total of 186 patients with HBV-ACLF randomly received comprehensive medical treatment,PE,or DPMAS+PE and were prospectively evaluated.Patients were divided into four subgroups based on the pretreatment prothrombin activity(PTA):Group I(PTA>40%),group II(PTA 30–40%),group III(PTA 20–30%),and group IV(PTA<20%).The main outcome measures were 28 day effectiveness;90 day liver transplantation-free survival;change of biochemical parameters;and CER.Results:DPMAS+PE treatment was associated with significantly higher 28 day effectiveness and 90 day liver transplantation-free survival compared with PE treatment in patients with group I liver failure.Clearance of serum total bilirubin(TBIL),AST,and creatinine(Cr)were significantly higher in the DPMAS+PE group than in the PE group.For subjects with group I liver failure,DPMAS+PE treatment had advantages of lower CER values and better cost-effectiveness.Conclusions:Compared with comprehensive medical treatment and PE alone,DPMAS with halfdose sequential PE treatment more effectively improved TBIL,AST,and Cr in HBV-ACLF patients,improved 28 day effectiveness and 90 day survival rates in patients with group I liver failure,and was more cost effective.DPMAS+PE is a viable NBAL approach for treatment of HBV-ACLF.