BACKGROUND The increased expression of G3BP1 was positively correlated with the prognosis of liver failure.AIM To investigate the effect of G3BP1 on the prognosis of acute liver failure(ALF)and acute-on-chronic liver ...BACKGROUND The increased expression of G3BP1 was positively correlated with the prognosis of liver failure.AIM To investigate the effect of G3BP1 on the prognosis of acute liver failure(ALF)and acute-on-chronic liver failure(ACLF)after the treatment of artificial liver support system(ALSS).METHODS A total of 244 patients with ALF and ACLF were enrolled in this study.The levels of G3BP1 on admission and at discharge were detected.The validation set of 514 patients was collected to verify the predicted effect of G3BP1 and the viability of prognosis.RESULTS This study was shown that lactate dehydrogenase(LDH),alpha-fetoprotein(AFP)and prothrombin time were closely related to the prognosis of patients.After the ALSS treatment,the patient’amount of decreased G3BP1 index in difference of G3BP1 between the value of discharge and admission(difG3BP1)<0 group had a nearly 10-fold increased risk of progression compared with the amount of increased G3BP1 index.The subgroup analysis showed that the difG3BP1<0 group had a higher risk of progression,regardless of model for end-stage liver disease high-risk or low-risk group.At the same time,compared with the inflam matory marks[tumor necrosis factor-α,interleukin(IL)-1βand IL-18],G3BP1 had higher discrimination and was more stable in the model analysis and validation set.When combined with AFP and LDH,concordance index was respectively 0.84 and 0.8 in training and validation cohorts.CONCLUSION This study indicated that G3BP1 could predict the prognosis of ALF or ACLF patients treated with ALSS.The combination of G3BP1,AFP and LDH could accurately evaluate the disease condition and predict the clinical endpoint of patients.展开更多
This study outlines the essential nursing strategies employed in the care of 10 patients experiencing vascular vagal reflex, managed with artificial liver support systems. It highlights a holistic nursing approach tai...This study outlines the essential nursing strategies employed in the care of 10 patients experiencing vascular vagal reflex, managed with artificial liver support systems. It highlights a holistic nursing approach tailored to the distinct clinical manifestations of these patients. Key interventions included early detection of psychological issues prior to initiating treatment, the implementation of comprehensive health education, meticulous monitoring of vital signs throughout the therapy, prompt emergency interventions when needed, adherence to prescribed medication protocols, and careful post-treatment observations including venous catheter management. Following rigorous treatment and dedicated nursing care, 7 patients demonstrated significant improvement and were subsequently discharged.展开更多
The first ablation procedures for small hepatocellular carcinomas were percutaneous ethanol injection under ultrasound(US)guidance.Later,radiofrequency ablation was shown to achieve larger coagulation areas than percu...The first ablation procedures for small hepatocellular carcinomas were percutaneous ethanol injection under ultrasound(US)guidance.Later,radiofrequency ablation was shown to achieve larger coagulation areas than percutaneous ethanol injection and became the most used ablation technique worldwide.In the past decade,microwave ablation systems have achieved larger ablation areas than radiofrequency ablation,suggesting that the 3-cm barrier could be broken in the treatment of liver tumors.Likewise,US techniques to guide percutaneous ablation have seen important progress.Contrast-enhanced US(CEUS)can define and target the tumor better than US and can assess the size of the ablation area after the procedure,which allows immediate retreatment of the residual tumor foci.Furthermore,fusion imaging fuses real-time US images with computed tomography or magnetic resonance imaging with significant improvements in detecting and targeting lesions with low conspicuity on CEUS.Recently,software powered by artificial intelligence has been developed to allow three-dimensional segmentation and reconstruction of the anatomical structures,aiding in procedure planning,assessing ablation completeness,and targeting the residual viable foci with greater precision than CEUS.Hopefully,this could lead to the ablation of tumors up to 5-7 cm in size.展开更多
Background:Preventing heterologous protein influx in patients is important when using xenogeneic bioartificial livers(BALs)to treat liver failure.The development of transgenic porcine livers synthesizing human protein...Background:Preventing heterologous protein influx in patients is important when using xenogeneic bioartificial livers(BALs)to treat liver failure.The development of transgenic porcine livers synthesizing human proteins is a promising approach in this regard.Here,we evaluated the safety and efficacy of a transgenic porcine liver synthesizing human albumin(h ALB)and coagulation factor VII(h FVII)within a bioartificial system.Methods:Tibetan miniature pigs were randomly subjected to different interventions after surgeryinduced partially ischemic liver failure.Group A(n=4)was subjected to basic treatment;group B(n=4)was to standard medical treatment and wild-type porcine BAL perfusion,and group C(n=2)was to standard medical treatment and transgenic BAL perfusion.Biochemical parameters,coagulation status,survival time,and pathological changes were determined.Expressions of h ALB and h FVII were detected using immunohistochemistry and enzyme-linked immunosorbent assays.Results:The survival time in group A was 9.75±1.26 days;this was shorter than that in both perfused groups,in which all animals reached an endpoint of 12 days(P=0.006).Ammonia,bilirubin,and lactate levels were significantly decreased,whereas albumin and fibrinogen levels were increased after perfusion(all P<0.05).h ALB and h FVII were detected in transgenic BAL-perfused pig serum and ex vivo in the liver tissues.Conclusions:The humanized transgenic pig livers could synthesize and secrete h ALB and h FVII ex vivo in a whole organ-based bioartificial system,while maintaining their metabolism,detoxification,transformation,and excretion functions,which were comparable to those observed in wild-type porcine livers.Therefore,the use of transgenic bioartificial whole livers is expected to become a new approach in treating acute liver failure.展开更多
Artificial intelligence(AI)has experienced substantial progress over the last ten years in many fields of application,including healthcare.In hepatology and pancreatology,major attention to date has been paid to its a...Artificial intelligence(AI)has experienced substantial progress over the last ten years in many fields of application,including healthcare.In hepatology and pancreatology,major attention to date has been paid to its application to the assisted or even automated interpretation of radiological images,where AI can generate accurate and reproducible imaging diagnosis,reducing the physicians’workload.AI can provide automatic or semi-automatic segmentation and registration of the liver and pancreatic glands and lesions.Furthermore,using radiomics,AI can introduce new quantitative information which is not visible to the human eye to radiological reports.AI has been applied in the detection and characterization of focal lesions and diffuse diseases of the liver and pancreas,such as neoplasms,chronic hepatic disease,or acute or chronic pancreatitis,among others.These solutions have been applied to different imaging techniques commonly used to diagnose liver and pancreatic diseases,such as ultrasound,endoscopic ultrasonography,computerized tomography(CT),magnetic resonance imaging,and positron emission tomography/CT.However,AI is also applied in this context to many other relevant steps involved in a comprehensive clinical scenario to manage a gastroenterological patient.AI can also be applied to choose the most convenient test prescription,to improve image quality or accelerate its acquisition,and to predict patient prognosis and treatment response.In this review,we summarize the current evidence on the application of AI to hepatic and pancreatic radiology,not only in regard to the interpretation of images,but also to all the steps involved in the radiological workflow in a broader sense.Lastly,we discuss the challenges and future directions of the clinical application of AI methods.展开更多
The overcoming of liver cancer is a major problem urgently to be solved by the World Health Organization.The emergence of precision medicine brings hope to improving the level of diagnosis and treatment of liver cance...The overcoming of liver cancer is a major problem urgently to be solved by the World Health Organization.The emergence of precision medicine brings hope to improving the level of diagnosis and treatment of liver cancer,but it is difficult for clinicians to effectively analyze and integrate a large amount of data from multiple dimensions and angles of precision medicine,so it is difficult totthem to provide the best treatment plan for liver cancer patients.Artificial neural networks have powerful integration,analysis and autonomous learning capabilities,which can effectively improve the accuracy of diagnosis,staging,prognosis and treatment of liver cancer patients,and are of great significance to the development of precision medicine for liver cancer.Therefore,this article reviews the application status of Artificial neural networks in the field of liver cancer.展开更多
The shortage of deceased donor organs has prompted the development of alternative liver grafts for transplantation.Living-donor liver transplantation(LDLT)has emerged as a viable option,expanding the donor pool and en...The shortage of deceased donor organs has prompted the development of alternative liver grafts for transplantation.Living-donor liver transplantation(LDLT)has emerged as a viable option,expanding the donor pool and enabling timely transplantation with favorable graft function and improved long-term outcomes.An accurate evaluation of the donor liver’s volumetry(LV)and anatomical study is crucial to ensure adequate future liver remnant,graft volume and precise liver resection.Thus,ensuring donor safety and an appropriate graftto-recipient weight ratio.Manual LV(MLV)using computed tomography has traditionally been considered the gold standard for assessing liver volume.However,the method has been limited by cost,subjectivity,and variability.Automated LV techniques employing advanced segmentation algorithms offer improved reproducibility,reduced variability,and enhanced efficiency compared to manual measurements.However,the accuracy of automated LV requires further investigation.The study provides a comprehensive review of traditional and emerging LV methods,including semi-automated image processing,automated LV techniques,and machine learning-based approaches.Additionally,the study discusses the respective strengths and weaknesses of each of the aforementioned techniques.The use of artificial intelligence(AI)technologies,including machine learning and deep learning,is expected to become a routine part of surgical planning in the near future.The implementation of AI is expected to enable faster and more accurate image study interpretations,improve workflow efficiency,and enhance the safety,speed,and cost-effectiveness of the procedures.Accurate preoperative assessment of the liver plays a crucial role in ensuring safe donor selection and improved outcomes in LDLT.MLV has inherent limitations that have led to the adoption of semi-automated and automated software solutions.Moreover,AI has tremendous potential for LV and segmentation;however,its widespread use is hindered by cost and availability.Therefore,the integration of multiple specialties is necessary to embrace technology and explore its possibilities,ranging from patient counseling to intraoperative decision-making through automation and AI.展开更多
BACKGROUND: Plasma exchange (PE)-centered artificial liver support system reduced the high mortality rate of hepa titis B virus (HBV)-related acute-on-chronic liver failure (ACLF). But the data were diverse in ...BACKGROUND: Plasma exchange (PE)-centered artificial liver support system reduced the high mortality rate of hepa titis B virus (HBV)-related acute-on-chronic liver failure (ACLF). But the data were diverse in different medical centers. The present prospective nationwide study was to evaluate the effects of PE on patients with HBV-ACLF at different stages.展开更多
AIM To evaluate the efficacy and safety of the TECA-lbioartificial liver support system (BALSS) in treating canines with acute liver failure (ALF).``METHODS Ten canines with ALF induced by 80% liver resection received...AIM To evaluate the efficacy and safety of the TECA-lbioartificial liver support system (BALSS) in treating canines with acute liver failure (ALF).``METHODS Ten canines with ALF induced by 80% liver resection received BALSS treatment (BALSS group).Blood was perfused through a hollow fiber tube containing 1 1010 porcine hepatocytes. Four canines with ALF were treated with BALSS without porcine hepatocytes (control group), and five canines with ALF received drug treatment (drug group). Each treatment lasted 6 hours.``RESULTS BALSS treatment yielded beneficial effects for partial liver resection-induced ALF canines with survival and decreased plasma ammonia, ALT, AST and BIL. There was an obvious decrease in PT level and increase in PA level, and there were no changes in the count of lymphocytes, immunoglobulins (IgA, IgG and IgM) and complement (C3 and C4) levels after BALSS treatment. In contrast, for the canines with ALF in non-hepatocyte BALSS group (control group) and drug group, there were no significant changes in ammonia, ALT, AST, BIL, PT and PA levels. ALF canines in BALSS group, control group and drug group lived respectively an average time of 108.0 h _- 12.0 h, 24.0 h -+ 6.0 h and 20.4 h + 6.4 h, and three canines with ALF survived in BALSS group.``CONCLUSION TECA-I BALSS is efficacious and safe for ALF canines induced by parcial liver resection.展开更多
BACKGROUND: Orthotopic liver transplantation (OLT) is the most effective therapy for liver failure. However, OLT is severely limited by the shortage of liver donors. Bioartificial liver (BAL) shows great potential as ...BACKGROUND: Orthotopic liver transplantation (OLT) is the most effective therapy for liver failure. However, OLT is severely limited by the shortage of liver donors. Bioartificial liver (BAL) shows great potential as an alternative therapy for liver failure In recent years, progress has been made in BAL regarding genetically engineered cell lines, immortalized human hepatocytes, methods for preserving the phenotype of primary human hepatocytes, and other functional hepatocytes derived from stem cells. DATA SOURCES: A systematic search of PubMed and ISI Web of Science was performed to identify relevant studies in English language literature using the Key words such as liver failure bioartificial liver, hepatocyte, stem cells, differentiation, and immortalization. More than 200 articles related to the cell sources of hepatocyte in BAL were systematically reviewed. RESULTS: Methods for preserving the phenotype of primary human hepatocytes have been successfully developed. Many genetically engineered cell lines and immortalized human hepatocytes have also been established. Among these cell lines the incorporation of BAL with GS-HepG2 cells or alginate encapsulated HepG2 cells could prolong the survival time and improve pathophysiological parameters in an animal model of liver failure. The cBAL111 cells were evaluated using the AMC-BAL bioreactor, which could eliminate ammonia and lidocaine, and produce albumin. Importantly, BAL loading with HepLi-4 cells could significantly improve the blood biochemical parameters, and prolong the survival time in pigs with liver failure. Other functional hepatocytes differentiated from stem cells, such as human liver progenitor cells, have been successfully achieved. CONCLUSIONS: Aside from genetically modified liver cell lines and immortalized human hepatocytes, other functionalhepatocytes derived from stem cells show great potential as cell sources for BAL. BAL with safe and effective liver cells may be achieved for clinical liver failure in the near future.展开更多
Liver failure which can be caused by viral hepatitis,alcohol,drugs,metabolic diseases,autoimmune processes or other fac tors is the end stage of chronic liver disease.Although liver transplantation is currently consid...Liver failure which can be caused by viral hepatitis,alcohol,drugs,metabolic diseases,autoimmune processes or other fac tors is the end stage of chronic liver disease.Although liver transplantation is currently considered to be the primary treatment measures of chronic liver disease.Due to donor shortages,surgical complications and immune rejection,cell therapy has been extensively studied.?Hepa tocyte transplantation and artificial liver have evolved into a simpler alternative to liver failure treatment.Artificial liver can be used as Liver replacement therapy in patients who were waiting for the liver transplantation with chronic liver disease.The ideal biological artificial liver must have the liver material metabolism,detoxification,synthesis and secretion and other functions.Nowadays bio-artificial liver has carried out a large number of clinical trials and get some progress.?This article is now discuss the status of bio-artificial liver and its re placement therapy prospects.展开更多
AIM: To assess the efficacy and safety of TECA type hybrid artificial liver support system (TECA-HALSS) in providing liver function of detoxification, metabolism and physiology by treating the patients with acute live...AIM: To assess the efficacy and safety of TECA type hybrid artificial liver support system (TECA-HALSS) in providing liver function of detoxification, metabolism and physiology by treating the patients with acute liver failure (ALF).METHODS: The porcine liver cells (1 - 2 ) x 1010 were separated from the Chinese small swine and cultured in the bioreactor of TECA-BALSS at 37.0°C and circulated through the outer space of the hollow fiber tubes in BALSS. The six liver failure patients with various degree of hepatic coma were treated by TECA-HALSS and with conventional medicines. The venous plasma of the patients was separated by a plasma separator and treated by charcoal adsorbent or plasma exchange. The plasma circulated through the inner space of the hollow fiber tubes of BALSS and mixed with the patients' blood cells and flew back to their blood circulation. Some small molecular weight substances were exchanged between theplasma and porcine liver cells. Each treatment lasted 6.0-7.0 h.Physiological and biochemical parameters were measured before, during and after the treatment.RESULTS: The average of porcine liver cells was (1.0- 3.0)x 1010 obtained from each swine liver using our modified enzymatic digestion method. The survival rate of the cells was 85% - 93% by tnypan blue stain and AO/PI fluorescent stain. After cultured in TECA-BALSS bioreactor for 6 h, the survival rate of cells still remained 70% - 85%. At the end of TECA-HALSS treatment, the levels of plasma NH3, ALT, TB and DB were significantly decreased. The patients who were in the state of drowsiness or coma before the treatment improved their appetite significantly and regained consciousness, some patients resumed light physical work on a short period after the treatment. One to two days after the treatment, the ratio of PTA increased warkedly. During the treatment, the heart rates, blood pressure, respiration condition and serum electrolytes (K+, Na+ and Cl) were stable without thrombosis and bleeding in all the six patients.CONCLUSION: TECA-HALSS treatment could be a rapid,safe and efficacious method to provide temporary liver support for patients with ALF.展开更多
BACKGROUND: Bioartificial liver support systems are becoming an effective therapy for hepatic failure. Bioreactors, as key devices in these systems, can provide a favorable growth and metabolic environment, mass excha...BACKGROUND: Bioartificial liver support systems are becoming an effective therapy for hepatic failure. Bioreactors, as key devices in these systems, can provide a favorable growth and metabolic environment, mass exchange, and immunological isolation as a platform. Currently, stagnancy in bioreactor research is the main factor restricting the development of bioartificial liver support systems. DATA SOURCES: A PubMed database search of English-language literature was performed to identify relevant articles using the keywords 'bioreactor', 'bioartificial liver', 'hepatocyte', and 'liver failure'. More than 40 articles related to the bioreactors of bioartificial livers were reviewed. RESULTS: Some progress has been made in the improvement of structures, functions, and modified macromolecular materials related to bioreactors in recent years. The current data on the improvement of bioreactor configurations for bioartificial livers or on the potential of the use of certain scaffold materials in bioreactors, combined with the clinical efficacy and safety evaluation of cultured hepatocytes in vitro, indicate that the AMC (Academic Medical Center) BAL bioreactor and MELS (modular extracorporeal liver support) BAL bioreactor system can partly replace the synthetic and metabolic functions of the liver in phase I clinical studies. In addition, it has been indicated that the microfluidic PDMS (polydimethylsiloxane) bioreactor, or SlideBioreactor, and the microfabricated grooved bioreactor are appropriate for hepatocyte culture, which is also promising for bioartificial livers. Similarly, modified scaffolds can promote the adhesion, growth, and function of hepatocytes, and provide reliable materials for bioreactors. CONCLUSIONS: Bioreactors, as key devices in bioartificial livers, play an important role in the therapy for liver failure both now and in the future. Bioreactor configurations are indispensable for the development of bioartificial livers used for liver failure, just as the modified scaffold materials available for bioreactors are favorable to the construction of effective bioartificial livers.展开更多
Bioartificial liver assist devices (BALs) offer anopportunity for critical care physicians and transplantsurgeons to stabilize patients prior to orthotopic livertransplantation. Such devices may also act as a bridgeto...Bioartificial liver assist devices (BALs) offer anopportunity for critical care physicians and transplantsurgeons to stabilize patients prior to orthotopic livertransplantation. Such devices may also act as a bridgeto transplant, providing liver support to patientsawaiting transplant, or as support for patients post liv-ing-related donor transplant. Four BAL devices thatrely on hepatocytes cultured in hollow fiber membranecartridges (Circe Biomedical HepatAssist (r), VitagenELADTM, Gerlach BELS, and Excorp Medical BLSS)are currently in various stages of clinical evalua-tion. Comparison of the four devices shows that severalunique approaches based upon the same overall systemarchitecture are possible. Preliminary results of theExcorp Medical BLSS Phase I safety evaluation at theUniversity of Pittsburgh, after treating four patients(F, 41, acetominophen-induced, two support periods;M, 50, Wilson's disease, one support period; F, 53, a-cute alcoholic hepatitis, two support periods; F, 24,chemotherapy-induced, one support period) are pre-sented. All patients presented with hypoglycemia andtransient hypotension at the start of extracorporealperfusion. Hypoglycemia was treated by IV dextroseand the transient hypotension responded positively toIV fluid bolus. Heparin anticoagulation was used onlyin the second patient. No serious or adverse eventswere noted in the four patients. Moderate biochemicalresponse to support was noted in all patients. Morecomplete characterization of the safety of the BLSSrequires completion of the Phase I safety evaluation.展开更多
BACKGROUND: For nearly three decades, extracorporeal bioartificial liver (BAL) support systems have been anticipated as promising tools for the treatment of liver failure. However, these systems are still far from cli...BACKGROUND: For nearly three decades, extracorporeal bioartificial liver (BAL) support systems have been anticipated as promising tools for the treatment of liver failure. However, these systems are still far from clinical application. This review aimed to analyze the key challenges to the development of BALs. DATA SOURCE: We carried out a PubMed search of Englishlanguage articles relevant to extracorporeal BAL support systems and liver failure. RESULTS: Extracorporeal BALs face a series of challenges. First, an appropriate cell source for BAL is not readily available. Second, existing bioreactors do not provide in vivolike oxygenation and bile secretion. Third, emergency needs cannot be met by current BALs. Finally, the effectiveness of BALs, either in animals or in patients, has been difficult to document. CONCLUSIONS: Extracorporeal BAL support systems are mainly challenged by incompetent cell sources and flawed bioreactors. To advance this technology, future research is needed to provide more insights into interpreting the conditions for hepatocyte differentiation and liver microstructure formation.展开更多
Decision-making based on artificial intelligence(AI)methodology is increasingly present in all areas of modern medicine.In recent years,models based on deep-learning have begun to be used in organ transplantation.Taki...Decision-making based on artificial intelligence(AI)methodology is increasingly present in all areas of modern medicine.In recent years,models based on deep-learning have begun to be used in organ transplantation.Taking into account the huge number of factors and variables involved in donor-recipient(DR)matching,AI models may be well suited to improve organ allocation.AI-based models should provide two solutions:complement decision-making with current metrics based on logistic regression and improve their predictability.Hundreds of classifiers could be used to address this problem.However,not all of them are really useful for D-R pairing.Basically,in the decision to assign a given donor to a candidate in waiting list,a multitude of variables are handled,including donor,recipient,logistic and perioperative variables.Of these last two,some of them can be inferred indirectly from the team’s previous experience.Two groups of AI models have been used in the D-R matching:artificial neural networks(ANN)and random forest(RF).The former mimics the functional architecture of neurons,with input layers and output layers.The algorithms can be uni-or multi-objective.In general,ANNs can be used with large databases,where their generalizability is improved.However,they are models that are very sensitive to the quality of the databases and,in essence,they are black-box models in which all variables are important.Unfortunately,these models do not allow to know safely the weight of each variable.On the other hand,RF builds decision trees and works well with small cohorts.In addition,they can select top variables as with logistic regression.However,they are not useful with large databases,due to the extreme number of decision trees that they would generate,making them impractical.Both ANN and RF allow a successful donor allocation in over 80%of D-R pairing,a number much higher than that obtained with the best statistical metrics such as model for end-stage liver disease,balance of risk score,and survival outcomes following liver transplantation scores.Many barriers need to be overcome before these deeplearning-based models can be included for D-R matching.The main one of them is the resistance of the clinicians to leave their own decision to autonomous computational models.展开更多
BACKGROUND: Molecular adsorbents recirculating sys- tem (MARS) liver support therapy is the development of albumin dialysis. This study was to assess the successful ap- plication of MARS artificial liver support thera...BACKGROUND: Molecular adsorbents recirculating sys- tem (MARS) liver support therapy is the development of albumin dialysis. This study was to assess the successful ap- plication of MARS artificial liver support therapy as a bridge to re-transplantation in two cases of long anhepatic duration. METHODS: MARS therapy was given after failure plasma- exchange ( PE) treatment, which resulted in circulatory de- rangement and acute renal dysfunction in a 36-year-old male patient. Finally his uncontrolled anhepatic condition led to a successful re-transplantation. In another 48-year- old man who was diagnosed as having primary nonfunction (PNF) during the liver transplantation, 10-hour MARS treatment contributed to smooth bridging of his anhepatic phase. RESULTS: The two anhepatic patients were bridged for 26 and 17 hours respectively to re-transplantation with MARS therapy. CONCLUSION: Our experience proves that MARS artifi- cial liver can be an effective support for long time bridging PNF until re-transplantation is available.展开更多
BACKGROUND The artificial liver support system(ALSS)is an effective treatment method for liver failure,but it requires deep venous intubation and long-term indwelling catheterization.However,the coagulation mechanism ...BACKGROUND The artificial liver support system(ALSS)is an effective treatment method for liver failure,but it requires deep venous intubation and long-term indwelling catheterization.However,the coagulation mechanism disorder of basic liver failure diseases,and deep venous thrombosis(DVT)often occur.AIM To evaluate the risk factors for DVT following use of an ALSS and establish a risk assessment score.METHODS This study was divided into three stages.In the first stage,the risk factors for DVT were screened and the patient data were collected,including ALSS treatment information;biochemical indices;coagulation and hematology indices;complications;procoagulant use therapy status;and a total of 24 indicators.In the second stage,a risk assessment score for DVT after ALSS treatment was developed.In the third stage,the DVT risk assessment score was validated.RESULTS A total of 232 patients with liver failure treated with ALSS were enrolled in the first stage,including 12 with lower limb DVT.Logistic regression analysis showed that age[odds ratio(OR),1.734;P=0.01],successful catheterization time(OR,1.667;P=0.005),activity status(strict bed rest)(OR,3.049;P=0.005),and D-dimer level(≥500 ng/mL)(OR,5.532;P<0.001)were independent risk factors for DVT.We then established a scoring system for risk factors.In the validation group,a total of 213 patients with liver failure were treated with ALSS,including 14 with lower limb DVT.When the cutoff value of risk assessment was 3,the specificity and sensitivity of the risk assessment score were 88.9%and 85.7%,respectively.CONCLUSION A simple risk assessment scoring system was established for DVT patients with liver failure treated with ALSS and was verified to have good sensitivity and specificity.展开更多
INTRODUCTIONOver the past 3 decades,various experimentalliver support systems have been studied.Early artifi-cial liver support systems included hemodialysis,ex-tracorporeal liver perfusion,human cross-circulation,cha...INTRODUCTIONOver the past 3 decades,various experimentalliver support systems have been studied.Early artifi-cial liver support systems included hemodialysis,ex-tracorporeal liver perfusion,human cross-circulation,charcoal hemoperfusion,hepatodialysis,fresh blood,plasma exchange transfusion etc.Thesesystems were developed to remove toxic substancesfrom the blood.Clinical trials showed that thesedetoxification systems could promote the recovery展开更多
文摘BACKGROUND The increased expression of G3BP1 was positively correlated with the prognosis of liver failure.AIM To investigate the effect of G3BP1 on the prognosis of acute liver failure(ALF)and acute-on-chronic liver failure(ACLF)after the treatment of artificial liver support system(ALSS).METHODS A total of 244 patients with ALF and ACLF were enrolled in this study.The levels of G3BP1 on admission and at discharge were detected.The validation set of 514 patients was collected to verify the predicted effect of G3BP1 and the viability of prognosis.RESULTS This study was shown that lactate dehydrogenase(LDH),alpha-fetoprotein(AFP)and prothrombin time were closely related to the prognosis of patients.After the ALSS treatment,the patient’amount of decreased G3BP1 index in difference of G3BP1 between the value of discharge and admission(difG3BP1)<0 group had a nearly 10-fold increased risk of progression compared with the amount of increased G3BP1 index.The subgroup analysis showed that the difG3BP1<0 group had a higher risk of progression,regardless of model for end-stage liver disease high-risk or low-risk group.At the same time,compared with the inflam matory marks[tumor necrosis factor-α,interleukin(IL)-1βand IL-18],G3BP1 had higher discrimination and was more stable in the model analysis and validation set.When combined with AFP and LDH,concordance index was respectively 0.84 and 0.8 in training and validation cohorts.CONCLUSION This study indicated that G3BP1 could predict the prognosis of ALF or ACLF patients treated with ALSS.The combination of G3BP1,AFP and LDH could accurately evaluate the disease condition and predict the clinical endpoint of patients.
文摘This study outlines the essential nursing strategies employed in the care of 10 patients experiencing vascular vagal reflex, managed with artificial liver support systems. It highlights a holistic nursing approach tailored to the distinct clinical manifestations of these patients. Key interventions included early detection of psychological issues prior to initiating treatment, the implementation of comprehensive health education, meticulous monitoring of vital signs throughout the therapy, prompt emergency interventions when needed, adherence to prescribed medication protocols, and careful post-treatment observations including venous catheter management. Following rigorous treatment and dedicated nursing care, 7 patients demonstrated significant improvement and were subsequently discharged.
文摘The first ablation procedures for small hepatocellular carcinomas were percutaneous ethanol injection under ultrasound(US)guidance.Later,radiofrequency ablation was shown to achieve larger coagulation areas than percutaneous ethanol injection and became the most used ablation technique worldwide.In the past decade,microwave ablation systems have achieved larger ablation areas than radiofrequency ablation,suggesting that the 3-cm barrier could be broken in the treatment of liver tumors.Likewise,US techniques to guide percutaneous ablation have seen important progress.Contrast-enhanced US(CEUS)can define and target the tumor better than US and can assess the size of the ablation area after the procedure,which allows immediate retreatment of the residual tumor foci.Furthermore,fusion imaging fuses real-time US images with computed tomography or magnetic resonance imaging with significant improvements in detecting and targeting lesions with low conspicuity on CEUS.Recently,software powered by artificial intelligence has been developed to allow three-dimensional segmentation and reconstruction of the anatomical structures,aiding in procedure planning,assessing ablation completeness,and targeting the residual viable foci with greater precision than CEUS.Hopefully,this could lead to the ablation of tumors up to 5-7 cm in size.
基金supported by grants from the National Key R&D Program of China(2018YFC1106400 and 2018YFA0108200)the National Natural Science Foundation of China(31972926)+3 种基金the Natural Science Foundation of Guangdong Province(2014A030312013 and 2018A030313128)Guangdong Key Research and Development Plan(2019B020234003)Science and Technology Program of Guangzhou(201803010086)Guangdong Basic and Applied Basic Research Foundation(2020A1515111111)。
文摘Background:Preventing heterologous protein influx in patients is important when using xenogeneic bioartificial livers(BALs)to treat liver failure.The development of transgenic porcine livers synthesizing human proteins is a promising approach in this regard.Here,we evaluated the safety and efficacy of a transgenic porcine liver synthesizing human albumin(h ALB)and coagulation factor VII(h FVII)within a bioartificial system.Methods:Tibetan miniature pigs were randomly subjected to different interventions after surgeryinduced partially ischemic liver failure.Group A(n=4)was subjected to basic treatment;group B(n=4)was to standard medical treatment and wild-type porcine BAL perfusion,and group C(n=2)was to standard medical treatment and transgenic BAL perfusion.Biochemical parameters,coagulation status,survival time,and pathological changes were determined.Expressions of h ALB and h FVII were detected using immunohistochemistry and enzyme-linked immunosorbent assays.Results:The survival time in group A was 9.75±1.26 days;this was shorter than that in both perfused groups,in which all animals reached an endpoint of 12 days(P=0.006).Ammonia,bilirubin,and lactate levels were significantly decreased,whereas albumin and fibrinogen levels were increased after perfusion(all P<0.05).h ALB and h FVII were detected in transgenic BAL-perfused pig serum and ex vivo in the liver tissues.Conclusions:The humanized transgenic pig livers could synthesize and secrete h ALB and h FVII ex vivo in a whole organ-based bioartificial system,while maintaining their metabolism,detoxification,transformation,and excretion functions,which were comparable to those observed in wild-type porcine livers.Therefore,the use of transgenic bioartificial whole livers is expected to become a new approach in treating acute liver failure.
文摘Artificial intelligence(AI)has experienced substantial progress over the last ten years in many fields of application,including healthcare.In hepatology and pancreatology,major attention to date has been paid to its application to the assisted or even automated interpretation of radiological images,where AI can generate accurate and reproducible imaging diagnosis,reducing the physicians’workload.AI can provide automatic or semi-automatic segmentation and registration of the liver and pancreatic glands and lesions.Furthermore,using radiomics,AI can introduce new quantitative information which is not visible to the human eye to radiological reports.AI has been applied in the detection and characterization of focal lesions and diffuse diseases of the liver and pancreas,such as neoplasms,chronic hepatic disease,or acute or chronic pancreatitis,among others.These solutions have been applied to different imaging techniques commonly used to diagnose liver and pancreatic diseases,such as ultrasound,endoscopic ultrasonography,computerized tomography(CT),magnetic resonance imaging,and positron emission tomography/CT.However,AI is also applied in this context to many other relevant steps involved in a comprehensive clinical scenario to manage a gastroenterological patient.AI can also be applied to choose the most convenient test prescription,to improve image quality or accelerate its acquisition,and to predict patient prognosis and treatment response.In this review,we summarize the current evidence on the application of AI to hepatic and pancreatic radiology,not only in regard to the interpretation of images,but also to all the steps involved in the radiological workflow in a broader sense.Lastly,we discuss the challenges and future directions of the clinical application of AI methods.
基金National Natural Science Foundation of China(No.81860790)Guangxi Science and Technology Project(No.AB20297002)+4 种基金Natural Science Foundation of Guangxi(No.2020gxNSFAA297160)Natural Science Foundation of Guangxi(No.2018gXNSFBA050050)Guangxi First-class Discipline of Integrated Chinese and Western Medicine(No.2019XK159)Graduate Education Innovation Program(No.YCBXJ2021020)Special Fund for Guangxi Special Experts[Guangxi Talent Pass Word(2019)No.13]。
文摘The overcoming of liver cancer is a major problem urgently to be solved by the World Health Organization.The emergence of precision medicine brings hope to improving the level of diagnosis and treatment of liver cancer,but it is difficult for clinicians to effectively analyze and integrate a large amount of data from multiple dimensions and angles of precision medicine,so it is difficult totthem to provide the best treatment plan for liver cancer patients.Artificial neural networks have powerful integration,analysis and autonomous learning capabilities,which can effectively improve the accuracy of diagnosis,staging,prognosis and treatment of liver cancer patients,and are of great significance to the development of precision medicine for liver cancer.Therefore,this article reviews the application status of Artificial neural networks in the field of liver cancer.
基金Supported by Part by The Coordenação de Aperfeiçoamento de Pessoal de Nível Superior–Brasil(CAPES).
文摘The shortage of deceased donor organs has prompted the development of alternative liver grafts for transplantation.Living-donor liver transplantation(LDLT)has emerged as a viable option,expanding the donor pool and enabling timely transplantation with favorable graft function and improved long-term outcomes.An accurate evaluation of the donor liver’s volumetry(LV)and anatomical study is crucial to ensure adequate future liver remnant,graft volume and precise liver resection.Thus,ensuring donor safety and an appropriate graftto-recipient weight ratio.Manual LV(MLV)using computed tomography has traditionally been considered the gold standard for assessing liver volume.However,the method has been limited by cost,subjectivity,and variability.Automated LV techniques employing advanced segmentation algorithms offer improved reproducibility,reduced variability,and enhanced efficiency compared to manual measurements.However,the accuracy of automated LV requires further investigation.The study provides a comprehensive review of traditional and emerging LV methods,including semi-automated image processing,automated LV techniques,and machine learning-based approaches.Additionally,the study discusses the respective strengths and weaknesses of each of the aforementioned techniques.The use of artificial intelligence(AI)technologies,including machine learning and deep learning,is expected to become a routine part of surgical planning in the near future.The implementation of AI is expected to enable faster and more accurate image study interpretations,improve workflow efficiency,and enhance the safety,speed,and cost-effectiveness of the procedures.Accurate preoperative assessment of the liver plays a crucial role in ensuring safe donor selection and improved outcomes in LDLT.MLV has inherent limitations that have led to the adoption of semi-automated and automated software solutions.Moreover,AI has tremendous potential for LV and segmentation;however,its widespread use is hindered by cost and availability.Therefore,the integration of multiple specialties is necessary to embrace technology and explore its possibilities,ranging from patient counseling to intraoperative decision-making through automation and AI.
基金supported by grants from the National Science and Technology Major Project(2012ZX10002004)Scientific Research Fund of Zhejiang Provincial Education Department(Y201328037)the opening foundation of the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases and Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases,First Affiliated Hospital,Zhejiang University School of Medicine(2015KF04)
文摘BACKGROUND: Plasma exchange (PE)-centered artificial liver support system reduced the high mortality rate of hepa titis B virus (HBV)-related acute-on-chronic liver failure (ACLF). But the data were diverse in different medical centers. The present prospective nationwide study was to evaluate the effects of PE on patients with HBV-ACLF at different stages.
文摘AIM To evaluate the efficacy and safety of the TECA-lbioartificial liver support system (BALSS) in treating canines with acute liver failure (ALF).``METHODS Ten canines with ALF induced by 80% liver resection received BALSS treatment (BALSS group).Blood was perfused through a hollow fiber tube containing 1 1010 porcine hepatocytes. Four canines with ALF were treated with BALSS without porcine hepatocytes (control group), and five canines with ALF received drug treatment (drug group). Each treatment lasted 6 hours.``RESULTS BALSS treatment yielded beneficial effects for partial liver resection-induced ALF canines with survival and decreased plasma ammonia, ALT, AST and BIL. There was an obvious decrease in PT level and increase in PA level, and there were no changes in the count of lymphocytes, immunoglobulins (IgA, IgG and IgM) and complement (C3 and C4) levels after BALSS treatment. In contrast, for the canines with ALF in non-hepatocyte BALSS group (control group) and drug group, there were no significant changes in ammonia, ALT, AST, BIL, PT and PA levels. ALF canines in BALSS group, control group and drug group lived respectively an average time of 108.0 h _- 12.0 h, 24.0 h -+ 6.0 h and 20.4 h + 6.4 h, and three canines with ALF survived in BALSS group.``CONCLUSION TECA-I BALSS is efficacious and safe for ALF canines induced by parcial liver resection.
基金supported by grants from the Chinese High-Tech Research & Development (863) Program (2011AA020104)Science Fund for Creative Research Groups of the National Natural Science Foundation of China (81121002)+1 种基金the Fundamental Research Funds for the Central Universitiesthe Technology Group Project for Infectious Disease Control of Zhejiang Province (2009R50041)
文摘BACKGROUND: Orthotopic liver transplantation (OLT) is the most effective therapy for liver failure. However, OLT is severely limited by the shortage of liver donors. Bioartificial liver (BAL) shows great potential as an alternative therapy for liver failure In recent years, progress has been made in BAL regarding genetically engineered cell lines, immortalized human hepatocytes, methods for preserving the phenotype of primary human hepatocytes, and other functional hepatocytes derived from stem cells. DATA SOURCES: A systematic search of PubMed and ISI Web of Science was performed to identify relevant studies in English language literature using the Key words such as liver failure bioartificial liver, hepatocyte, stem cells, differentiation, and immortalization. More than 200 articles related to the cell sources of hepatocyte in BAL were systematically reviewed. RESULTS: Methods for preserving the phenotype of primary human hepatocytes have been successfully developed. Many genetically engineered cell lines and immortalized human hepatocytes have also been established. Among these cell lines the incorporation of BAL with GS-HepG2 cells or alginate encapsulated HepG2 cells could prolong the survival time and improve pathophysiological parameters in an animal model of liver failure. The cBAL111 cells were evaluated using the AMC-BAL bioreactor, which could eliminate ammonia and lidocaine, and produce albumin. Importantly, BAL loading with HepLi-4 cells could significantly improve the blood biochemical parameters, and prolong the survival time in pigs with liver failure. Other functional hepatocytes differentiated from stem cells, such as human liver progenitor cells, have been successfully achieved. CONCLUSIONS: Aside from genetically modified liver cell lines and immortalized human hepatocytes, other functionalhepatocytes derived from stem cells show great potential as cell sources for BAL. BAL with safe and effective liver cells may be achieved for clinical liver failure in the near future.
基金Guangdong Obers Blood Purification Academician Work station(2013B090400004)Construction of collaborative platform for clinical research and clinical research of blood purifica tion(201604020175)+4 种基金Guangzhou entrepreneurial leader talent/LCY201215Guangdong University blood purification technology and Engineering Research Center(GCZX-A1104)Guangdong Provincial Center for clinical engineering of blood purification(507204531040)Guangzhou Devel op ment Zone entrepreneur ship leading talent project(2017-L153)Science and technology plan project of Guangdong industrial high and new technology field(2013B010203019)
文摘Liver failure which can be caused by viral hepatitis,alcohol,drugs,metabolic diseases,autoimmune processes or other fac tors is the end stage of chronic liver disease.Although liver transplantation is currently considered to be the primary treatment measures of chronic liver disease.Due to donor shortages,surgical complications and immune rejection,cell therapy has been extensively studied.?Hepa tocyte transplantation and artificial liver have evolved into a simpler alternative to liver failure treatment.Artificial liver can be used as Liver replacement therapy in patients who were waiting for the liver transplantation with chronic liver disease.The ideal biological artificial liver must have the liver material metabolism,detoxification,synthesis and secretion and other functions.Nowadays bio-artificial liver has carried out a large number of clinical trials and get some progress.?This article is now discuss the status of bio-artificial liver and its re placement therapy prospects.
基金Supported by the Research Initiation Fund for Returned Students from Overseas,Ministry of Education,No.94001
文摘AIM: To assess the efficacy and safety of TECA type hybrid artificial liver support system (TECA-HALSS) in providing liver function of detoxification, metabolism and physiology by treating the patients with acute liver failure (ALF).METHODS: The porcine liver cells (1 - 2 ) x 1010 were separated from the Chinese small swine and cultured in the bioreactor of TECA-BALSS at 37.0°C and circulated through the outer space of the hollow fiber tubes in BALSS. The six liver failure patients with various degree of hepatic coma were treated by TECA-HALSS and with conventional medicines. The venous plasma of the patients was separated by a plasma separator and treated by charcoal adsorbent or plasma exchange. The plasma circulated through the inner space of the hollow fiber tubes of BALSS and mixed with the patients' blood cells and flew back to their blood circulation. Some small molecular weight substances were exchanged between theplasma and porcine liver cells. Each treatment lasted 6.0-7.0 h.Physiological and biochemical parameters were measured before, during and after the treatment.RESULTS: The average of porcine liver cells was (1.0- 3.0)x 1010 obtained from each swine liver using our modified enzymatic digestion method. The survival rate of the cells was 85% - 93% by tnypan blue stain and AO/PI fluorescent stain. After cultured in TECA-BALSS bioreactor for 6 h, the survival rate of cells still remained 70% - 85%. At the end of TECA-HALSS treatment, the levels of plasma NH3, ALT, TB and DB were significantly decreased. The patients who were in the state of drowsiness or coma before the treatment improved their appetite significantly and regained consciousness, some patients resumed light physical work on a short period after the treatment. One to two days after the treatment, the ratio of PTA increased warkedly. During the treatment, the heart rates, blood pressure, respiration condition and serum electrolytes (K+, Na+ and Cl) were stable without thrombosis and bleeding in all the six patients.CONCLUSION: TECA-HALSS treatment could be a rapid,safe and efficacious method to provide temporary liver support for patients with ALF.
基金supported by grants from the National High Technolgoy Research and Development(863)Program of China(2006AA02A140)the National Natural Science Foundation of China(30630023)Zhejiang Health Science Foundation(2007A081)
文摘BACKGROUND: Bioartificial liver support systems are becoming an effective therapy for hepatic failure. Bioreactors, as key devices in these systems, can provide a favorable growth and metabolic environment, mass exchange, and immunological isolation as a platform. Currently, stagnancy in bioreactor research is the main factor restricting the development of bioartificial liver support systems. DATA SOURCES: A PubMed database search of English-language literature was performed to identify relevant articles using the keywords 'bioreactor', 'bioartificial liver', 'hepatocyte', and 'liver failure'. More than 40 articles related to the bioreactors of bioartificial livers were reviewed. RESULTS: Some progress has been made in the improvement of structures, functions, and modified macromolecular materials related to bioreactors in recent years. The current data on the improvement of bioreactor configurations for bioartificial livers or on the potential of the use of certain scaffold materials in bioreactors, combined with the clinical efficacy and safety evaluation of cultured hepatocytes in vitro, indicate that the AMC (Academic Medical Center) BAL bioreactor and MELS (modular extracorporeal liver support) BAL bioreactor system can partly replace the synthetic and metabolic functions of the liver in phase I clinical studies. In addition, it has been indicated that the microfluidic PDMS (polydimethylsiloxane) bioreactor, or SlideBioreactor, and the microfabricated grooved bioreactor are appropriate for hepatocyte culture, which is also promising for bioartificial livers. Similarly, modified scaffolds can promote the adhesion, growth, and function of hepatocytes, and provide reliable materials for bioreactors. CONCLUSIONS: Bioreactors, as key devices in bioartificial livers, play an important role in the therapy for liver failure both now and in the future. Bioreactor configurations are indispensable for the development of bioartificial livers used for liver failure, just as the modified scaffold materials available for bioreactors are favorable to the construction of effective bioartificial livers.
文摘Bioartificial liver assist devices (BALs) offer anopportunity for critical care physicians and transplantsurgeons to stabilize patients prior to orthotopic livertransplantation. Such devices may also act as a bridgeto transplant, providing liver support to patientsawaiting transplant, or as support for patients post liv-ing-related donor transplant. Four BAL devices thatrely on hepatocytes cultured in hollow fiber membranecartridges (Circe Biomedical HepatAssist (r), VitagenELADTM, Gerlach BELS, and Excorp Medical BLSS)are currently in various stages of clinical evalua-tion. Comparison of the four devices shows that severalunique approaches based upon the same overall systemarchitecture are possible. Preliminary results of theExcorp Medical BLSS Phase I safety evaluation at theUniversity of Pittsburgh, after treating four patients(F, 41, acetominophen-induced, two support periods;M, 50, Wilson's disease, one support period; F, 53, a-cute alcoholic hepatitis, two support periods; F, 24,chemotherapy-induced, one support period) are pre-sented. All patients presented with hypoglycemia andtransient hypotension at the start of extracorporealperfusion. Hypoglycemia was treated by IV dextroseand the transient hypotension responded positively toIV fluid bolus. Heparin anticoagulation was used onlyin the second patient. No serious or adverse eventswere noted in the four patients. Moderate biochemicalresponse to support was noted in all patients. Morecomplete characterization of the safety of the BLSSrequires completion of the Phase I safety evaluation.
基金supported by grants from the National Natural Science Foundation of China (30630023)the Science Fund for Creative Research Groups of the National Natural Science Foundation of China (81121002)
文摘BACKGROUND: For nearly three decades, extracorporeal bioartificial liver (BAL) support systems have been anticipated as promising tools for the treatment of liver failure. However, these systems are still far from clinical application. This review aimed to analyze the key challenges to the development of BALs. DATA SOURCE: We carried out a PubMed search of Englishlanguage articles relevant to extracorporeal BAL support systems and liver failure. RESULTS: Extracorporeal BALs face a series of challenges. First, an appropriate cell source for BAL is not readily available. Second, existing bioreactors do not provide in vivolike oxygenation and bile secretion. Third, emergency needs cannot be met by current BALs. Finally, the effectiveness of BALs, either in animals or in patients, has been difficult to document. CONCLUSIONS: Extracorporeal BAL support systems are mainly challenged by incompetent cell sources and flawed bioreactors. To advance this technology, future research is needed to provide more insights into interpreting the conditions for hepatocyte differentiation and liver microstructure formation.
基金supported by a grant from Mutua Madrile?a XVIII Convovatoria de ayudas a la investigación。
文摘Decision-making based on artificial intelligence(AI)methodology is increasingly present in all areas of modern medicine.In recent years,models based on deep-learning have begun to be used in organ transplantation.Taking into account the huge number of factors and variables involved in donor-recipient(DR)matching,AI models may be well suited to improve organ allocation.AI-based models should provide two solutions:complement decision-making with current metrics based on logistic regression and improve their predictability.Hundreds of classifiers could be used to address this problem.However,not all of them are really useful for D-R pairing.Basically,in the decision to assign a given donor to a candidate in waiting list,a multitude of variables are handled,including donor,recipient,logistic and perioperative variables.Of these last two,some of them can be inferred indirectly from the team’s previous experience.Two groups of AI models have been used in the D-R matching:artificial neural networks(ANN)and random forest(RF).The former mimics the functional architecture of neurons,with input layers and output layers.The algorithms can be uni-or multi-objective.In general,ANNs can be used with large databases,where their generalizability is improved.However,they are models that are very sensitive to the quality of the databases and,in essence,they are black-box models in which all variables are important.Unfortunately,these models do not allow to know safely the weight of each variable.On the other hand,RF builds decision trees and works well with small cohorts.In addition,they can select top variables as with logistic regression.However,they are not useful with large databases,due to the extreme number of decision trees that they would generate,making them impractical.Both ANN and RF allow a successful donor allocation in over 80%of D-R pairing,a number much higher than that obtained with the best statistical metrics such as model for end-stage liver disease,balance of risk score,and survival outcomes following liver transplantation scores.Many barriers need to be overcome before these deeplearning-based models can be included for D-R matching.The main one of them is the resistance of the clinicians to leave their own decision to autonomous computational models.
文摘BACKGROUND: Molecular adsorbents recirculating sys- tem (MARS) liver support therapy is the development of albumin dialysis. This study was to assess the successful ap- plication of MARS artificial liver support therapy as a bridge to re-transplantation in two cases of long anhepatic duration. METHODS: MARS therapy was given after failure plasma- exchange ( PE) treatment, which resulted in circulatory de- rangement and acute renal dysfunction in a 36-year-old male patient. Finally his uncontrolled anhepatic condition led to a successful re-transplantation. In another 48-year- old man who was diagnosed as having primary nonfunction (PNF) during the liver transplantation, 10-hour MARS treatment contributed to smooth bridging of his anhepatic phase. RESULTS: The two anhepatic patients were bridged for 26 and 17 hours respectively to re-transplantation with MARS therapy. CONCLUSION: Our experience proves that MARS artifi- cial liver can be an effective support for long time bridging PNF until re-transplantation is available.
基金Supported by China Public Health Alliance,No.GWLM202031.
文摘BACKGROUND The artificial liver support system(ALSS)is an effective treatment method for liver failure,but it requires deep venous intubation and long-term indwelling catheterization.However,the coagulation mechanism disorder of basic liver failure diseases,and deep venous thrombosis(DVT)often occur.AIM To evaluate the risk factors for DVT following use of an ALSS and establish a risk assessment score.METHODS This study was divided into three stages.In the first stage,the risk factors for DVT were screened and the patient data were collected,including ALSS treatment information;biochemical indices;coagulation and hematology indices;complications;procoagulant use therapy status;and a total of 24 indicators.In the second stage,a risk assessment score for DVT after ALSS treatment was developed.In the third stage,the DVT risk assessment score was validated.RESULTS A total of 232 patients with liver failure treated with ALSS were enrolled in the first stage,including 12 with lower limb DVT.Logistic regression analysis showed that age[odds ratio(OR),1.734;P=0.01],successful catheterization time(OR,1.667;P=0.005),activity status(strict bed rest)(OR,3.049;P=0.005),and D-dimer level(≥500 ng/mL)(OR,5.532;P<0.001)were independent risk factors for DVT.We then established a scoring system for risk factors.In the validation group,a total of 213 patients with liver failure were treated with ALSS,including 14 with lower limb DVT.When the cutoff value of risk assessment was 3,the specificity and sensitivity of the risk assessment score were 88.9%and 85.7%,respectively.CONCLUSION A simple risk assessment scoring system was established for DVT patients with liver failure treated with ALSS and was verified to have good sensitivity and specificity.
文摘INTRODUCTIONOver the past 3 decades,various experimentalliver support systems have been studied.Early artifi-cial liver support systems included hemodialysis,ex-tracorporeal liver perfusion,human cross-circulation,charcoal hemoperfusion,hepatodialysis,fresh blood,plasma exchange transfusion etc.Thesesystems were developed to remove toxic substancesfrom the blood.Clinical trials showed that thesedetoxification systems could promote the recovery