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.

Identification of coexistence of biological and non-biological aerosol particles with DAPI (4′,6-diamidino-2-phenylindole) stain

The fluorescent dye 4′,6-diamidino-2-phenylindole (DAPI) has been widely used to stain microorganisms in various environment media. We applied DAPI fluorescence enumeration to airborne microorganisms and found that non-biological particles, including organic compounds, minerals, and soot, were also visible upon exposure to UV excitation under fluorescence microscope. Using laboratory-prepared biological particles as the control, we investigated the feasibility of identifying both biological and non-biological particles in the same sample with DAPI staining. We prepared biological (bacterial, fungi, and plant detritus) and non-biological (biochar, soot, mineral, metal, fly ash, salt) particles in the laboratory and enumerated the particles and their mixture with DAPI. We found that mineral particles were transparent, and biochar, soot, metals and fly ash particles were black under a filter set at excitation 350/50 nm and emission 460/50 nm bandpass (DAPI-BP), while biological particles were blue, as expected. Particles of the water-soluble salts NaCl and (NH_(4))_(2)SO_(4) were yellow under a filter set at excitation 340–380 nm and emission 425 nm long pass (DAPI-LP). Case studies with samples of dustfall, atmospheric aerosols and surface soils could allow for the quantification of the relative number of different types of particles and particles with organic matter or salt coating as well. Fluorescence enumeration with DAPI stain is thus able to identify the co-existence of biological and non-biological particles in the air, at least to the extent of those examined in this study.