Evaluation of G3BP1 in the prognosis of acute and acute-on-chronic liver failure after the treatment of artificial liver support system

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.

Failure behavior and strength model of blocky rock mass with and without rockbolts

To better understand the failure behaviours and strength of bolt-reinforced blocky rocks,large scale extensive laboratory experiments are carried out on blocky rock-like specimens with and without rockbolt reinforcement.The results show that both shear failure and tensile failure along joint surfaces are observed but the shear failure is a main controlling factor for the peak strength of the rock mass with and without rockbolts.The rockbolts are necked and shear deformation simultaneously happens in bolt reinforced rock specimens.As the joint dip angle increases,the joint shear failure becomes more dominant.The number of rockbolts has a significant impact on the peak strain and uniaxial compressive strength(UCS),but little influence on the deformation modulus of the rock mass.Using the Winkler beam model to represent the rockbolt behaviours,an analytical model for the prediction of the strength of boltreinforced blocky rocks is proposed.Good agreement between the UCS values predicted by proposed model and obtained from experiments suggest an encouraging performance of the proposed model.In addition,the performance of the proposed model is further assessed using published results in the literature,indicating the proposed model can be used effectively in the prediction of UCS of bolt-reinforced blocky rocks.

Major liver resections,perioperative issues and posthepatectomy liver failure:A comprehensive update for the anesthesiologist

Significant advances in surgical techniques and relevant medium-and long-term outcomes over the past two decades have led to a substantial expansion in the indications for major liver resections.To support these outstanding results and to reduce perioperative complications,anesthesiologists must address and master key perioperative issues(preoperative assessment,proactive intraoperative anesthesia strategies,and implementation of the Enhanced Recovery After Surgery approach).Intensive care unit monitoring immediately following liver surgery remains a subject of active and often unresolved debate.Among postoperative complications,posthepatectomy liver failure(PHLF)occurs in different grades of severity(A-C)and frequency(9%-30%),and it is the main cause of 90-d postoperative mortality.PHLF,recently redefined with pragmatic clinical criteria and perioperative scores,can be predicted,prevented,or anticipated.This review highlights:(1)The systemic consequences of surgical manipulations anesthesiologistsmust respond to or prevent,to positively impact PHLF(a proactive approach);and(2)the maximal intensivetreatment of PHLF,including artificial options,mainly based,so far,on Acute Liver Failure treatment(s),to buytime waiting for the recovery of the native liver or,when appropriate and in very selected cases,toward livertransplant.Such a clinical context requires a strong commitment to surgeons,anesthesiologists,and intensivists towork together,for a fruitful collaboration in a mandatory clinical continuum.

Health-related quality of life among congestive heart failure patients with preserved and reduced ejection fraction

Objective:To determine factors that affect the health-related quality of life(HRQOL)of congestive heart failure(CHF)patients with preserved and reduced ejection fraction.Methods:A cross-sectional study design was used for this study.The stratified random sampling was applied for each subgroup.HRQOL was measured with the Minnesota Living with Hear t Failure Questionnaire.The data were analyzed using chi-square,Spearman's correlation analysis,and independent t-test.Results:A number of 67 respondents participated in the recent study.The total mean scores of HRQOL were significantly different(P=0.001)between heart failure(HF)patients with reduced and preserved ejection fractions,41.07±7.54 and 54.97±4.36,respectively.It related with the physical(mean±standard deviation[SD]=10.4±2.14;t=-10.08,95%CI=-12.46 to-8.34;P-value=0.001)and psychological(mean±SD=3.5±0.5;t=-6.68,95%CI=-4.55 to-2.45;P-value=0.001)domain.Strong correlation was found between age(r=-0.898,P<0.05),NYHA functional classes(r=-0.858,P<0.01),duration of HF(r=-0.807,P<0.01),family support(r=0.927,P<0.01),and quality of life(Qo L).Conclusions:HRQOL in HF patients with reduced ejection fraction was higher than in those with preserved ejection fraction.Family suppor t is a fur ther determinant factor that has a positive correlation to the Qo L.

Plasma exchange-centered artificial liver support system in hepatitis B virus-related acute-onchronic liver failure:a nationwide prospective multicenter study in China

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.

Effect of extracorporeal bioartificial liver support system on fulminant hepatic failure rabbits

AIM To evaluate the possibility of usingcultured human hepatocytes as a bridge betweenbioartificial liver and liver transplantation.METHODS In this experiment,the efficacy ofextracorporeal bioartificial liver support system(EBLSS)consisting of spheriodal human livercells and cultured hepatocytes supernatant wasassessed in vivo using galactosamine inducedrabbit model of fulminant hepatic failure.RESULTS There was no difference of survivalbetween the two groups of rabbits,but in thesupported rabbits serum alanineaminotransferase,total bilirubin and creatininewere significantly lower and hepatocyte necrosiswas markedly milder than those in controlanimals.In addition,a good viability of humanliver cells was noted after the experiment.CONCLUSION EBLSS plays a biologic role inmaintaining and compensating the function ofthe liver.

Effects of a bioartificial liver support system on acetaminophen induced acute liver failure canines

AIM To evaluate the safety and efficacy of the bioartificial liver support system in canines with acute liver failure (ALF). METHODS Nine canines with acute liver failure by acetaminophen induced received TECA Ⅰ bioartificial liver support system (BALSS) from Hong Kong TECA LTD Co. Blood was perfused through a hollow fiber tube containing (1 2)×10 10 the porcine hepatocytes. In contrast, another 10 canines with acute liver failure by Acetaminophen received drugs. Each treatment lasted 6 hours. RESULTS BALSS treatment resulted in beneficial effects for acetaminophen induced ALF canines with survival and with the recovery of the liver functions and tissues, and plasma ammonia decreased from 135 9μmol/L ± 17 5μmol/L to 65 7μmol/L ± 22 0μmol/L , 32 5μmol/L ± 8 8μmol/L , GPT from 97 8U/L ± 8 7U/L to 64 8U/L ± 11 9U/L , 19 0U/L ± 6 3U/L , GOT from 103 0U/L ± 16 7U/L to 75 7U/L ± 19 6U/L , 26 5U/L ± 5 0U/L , and AKP from 158 3U/L ± 12 1U/L to 114 5U/L ± 19 8U/L , 43 8U/L ± 5 6U/L during and after the treatment. In contrast, 10 ALF canines in both the drug and control groups died 1 or 2 days after treatment. CONCLUSION TECA 1 artificial liver support system is safe and efficacious for canines with acute liver failure.

Strength failure of spatial reticulated structures under multi-support excitation

Under strong earthquakes, long-span spatial latticed structures may collapse due to dynamic instability or strength failure. The elasto-plastic dynamic behaviors of three spatial latticed structures, including two double-layer cylindrical shells and one spherical shell constructed for the 2008 Olympic Games in Beijing, were quantitatively examined under multi-support excitation （MSE） and uniform support excitation （USE）. In the numerical analyses, several important parameters were investigated such as the peak acceleration and displacement responses at key joints, the number and distribution of plastic members, and the deformation of the shell at the moment of collapse. Analysis results reveal the features and the failure mechanism of the spatial latticed structures under MSE and USE. In both scenarios, the double-layer reticulated shell collapses in the ＂overflow＂ mode, and the collapse is governed by the number of invalid plastic members rather than the total number of plastic members, beginning with damage to some of the local regions near the supports. By comparing the numbers and distributions of the plastic members under MSE to those under USE, it was observed that the plastic members spread more sufficiently and the internal forces are more uniform under MSE, especially in cases of lower apparent velocities in soils. Due to the effects of pseudo-static displacement, the stresses in the members near the supports under MSE are higher than those under USE.

Mechanisms of support failure and prevention measures under double-layer room mining gobs——A case study: Shigetai coal mine

In the practice of mining shallow buried ultra-close seams,support failure tends to occur during the process of longwall undermining beneath two layers of room mining goaf(TLRMG).In this paper,the factors causing support failure are summarized into geology and mining technology.Combining column lithology and composite beam theory,the key stratum of the rock strata is determined.A finite element numerical simulation is used to analyze the overlying load distribution rule of the main roof for different plane positions of the upper and lower room mining pillars.The tributary area theory(TAT)is adopted to analyze the vertical load distribution of each pillar,and dynamic models of coal pillar instability and main roof fracture are established.Through key block instability analysis,two critical moments are established,of which critical moment A has the greater dynamic load strength.Great economic losses and safety hazards are created by the dynamic load of the fracturing of the main roof.To reduce these negative effects,a method of pulling out supports is developed and two alternative measures for support failure prevention are proposed:reinforcing stope supports in conjunction with reducing mining height,or drilling ground holes to pre-split the main roof.Based on a comprehensive consideration of economic factors and the two categories of support failure causes,the method of reinforcing stope supports while reducing mining height was selected for use on the mining site.

Upper bound solutions for supporting pressures of shallow tunnels with nonlinear failure criterion

Linear failure criterion is widely used in calculation of earth pressure acting on shallow tunnels. However, experimental evidence shows that nonlinear failure criterion is able to represent fairly well the failure of almost all types of rocks, A nonlinear Hock-Brown failure criterion is employed to estimate the supporting pressures of shallow tunnels in limit analysis framework. Two failure mechanisms are proposed for calculating the work rate of extemal force and the internal energy dissipation. A tangential line to the nonlinear failure criterion is used to formulate the supporting pressure problem as a nonlinear programming problem. The objective function formulated in this way is minimized with respect to the failure mechanism and the location of tangency point. In order to assess the validity, the supporting pressures for the proposed failure mechanisms are calculated and compared with each other, and the present results are compared with previously published solutions when the nonlinear criterion is reduced to linear criterion. The agreement supports the validity of the proposed failure mechanisms. An experiment is conducted to investigate the influences of the nonlinear criterion on collapse shape and supporting pressures of shallow tunnels.

Failure mechanism of bolting support and high-strength bolt-grouting technology for deep and soft surrounding rock with high stress

In deep underground mining, the surrounding rocks are very soft with high stress. Their deformation and destruction are serious, and frequent failures occur on the bolt support. The failure mechanism of bolt support is proposed to solve these problems. A calculation theory is established on the bond strength of the interface between the anchoring agent and surrounding rocks. An analysis is made on the influence law of different mechanical parameters of surrounding rocks on the interfacial bond strength. Based on the research, a new high-strength bolt-grouting technology is developed and applied on site. Besides, some helpful engineering suggestions and measures are proposed. The research shows that the serious deformation and failure, and the lower bond strength are the major factors causing frequent failures of bolt support. So, the bolt could not give full play to its supporting potential. It is also shown that as the integrity, strength, interface dilatancy and stress of surrounding rocks are improved, the bond strength will increase. So, the anchoring force on surrounding rocks can be effectively improved by employing an anchoring agent with high sand content, mechanical anchoring means, or grouting reinforcement. The new technology has advantages in a high strength, imposing pre-tightening force, and giving full play to the bolt supporting potential. Hence, it can improve the control effect on surrounding rocks. All these could be helpful references for the design of bolt support in deep underground mines.

Hybrid artificial liver support system for treatment of severe liver failure

AIM: To construct a novel hybrid artificial liver support system (HALSS) and to evaluate its efficacy in patients with severe liver failure.METHODS: Hepatocytes were isolated from suckling pig by the modified Seglen's method. Isolated hepatocytes were cultured in a spinner flask for 24 h to form spheroids before use and the functions of spheroids were detected. HALSS consisted of a plasma separator, a hemo-adsorba and a bioreactor with hepatocytes spheroids in its extra-fiber space.HALSS was applied to 10 patients with severe liver failure.The general condition and the biochemical indexes of the patients were studied just before and after the treatment.RESULTS: The number of cells per liver was about 2-4× 1010 (mean, 3.1 ± 1.5 × 1010). The cell viabilities were more than 95%. After 24 h of spheroid culture, most hepatocytes formed spheroids. The levels of albumin and urea in the medium of spheroid culture were higher than those in supernatant of petri dish culture (P = 0.0015 and 0.0001, respectively). The capacity of albumin production and urea synthesis remained stable for more than one wk and declined rapidly after two weeks in vitro. In HALSS group, the duration of HALSS treatment was 6-10 h each time. All patients tolerated the treatment well without any fatal adverse reaction. After HALSS treatment, the general condition, psychic state, encephalopathy and hepatic function of the patients were improved. The survival rate of the HALSS group, Plasmapheresis group and control group was 30% (3/10), 20% (2/10) and 0% (0/10), respectively (P = 0.024). Two weeks after treatment, Tbil and ALT decreased and the PTA level elevated in HALSS group and pasmapheresis group (Pvalue: 0.015 vs 0.020, 0.009vs 0.012 and 0.032 vs 0.041, respectively). But there was no significant change of blood albumin concentration before and after treatment in HAlSS group and Plasmapheresis group.CONCLUSION: The HALSS established by us is effective in supporting liver function of patients with severe liver failure.

Initial support distance of a non-circular tunnel based on convergence constraint method and integral failure criteria of rock

For deep tunnel projects,selecting an appropriate initial support distance is critical to improving the self-supporting capacity of surrounding rock.In this work,an intuitive method for determining the tunnel’s initial support distance was proposed.First,based on the convergence-confinement method,a three-dimensional analytical model was constructed by combining an analytical solution of a non-circular tunnel with the Tecplot software.Then,according to the integral failure criteria of rock,the failure tendency coefficients of hard surrounding rock were computed and the spatial distribution plots of that were constructed.On this basis,the tunnel’s key failure positions were identified,and the relationship between the failure tendency coefficient at key failure positions and their distances from the working face was established.Finally,the distance from the working face that corresponds to the critical failure tendency coefficient was taken as the optimal support distance.A practical project was used as an example,and a reasonable initial support distance was successfully determined by applying the developed method.Moreover,it is found that the stability of hard surrounding rock decreases rapidly within the range of 1.0D(D is the tunnel diameter)from the working face,and tends to be stable outside the range of 1.0D.

TECA hybrid artificial liver support system in treatment of acute liver failure

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 10(10) were separated from the Chinese small swine and cultured in the bioreactor of TECA-BALSS at 37.0 degrees 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 the plasma 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 10(10) obtained from each swine liver using our modified enzymatic digestion method. The survival rate of the cells was 85%-93% by trypan 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 NH(3), 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.

Liver transplantation and artificial liver support in fulminant hepatic failure

INTRODUCTIONFulminant hepatic failure(FHF)is a severe disease with devastating consequences;the incidence is high in China.Before the availability of liver transplantation,the mortality rate was more than 80%[1,2].The advent of liver transplantation revolutionized the outcome of FHF[3,4].However,many patients were unwilling to accept liver transplantation until very late,hence most of them died because of donor shortage and urgency of the disease[5-7],To overcome he problems,we performed orthotopic liver transplantation(OLT)in combination with artificial liver support(ALS) in the treatment of FHF in the past 2 years with satisfactory results.Our experience was reported below.

Artifi cial liver support system in treatment of liverfailure after acute poisoning

BACKGROUND： Acute poisoning （AP） may cause failure of the liver and kidney, and evendeath. This study aimed to investigate the efficacy of artificial liver support system （ALSS） on thetreatment of liver failure after acute poisoning.METHODS： A total of 31 patients with liver failure caused by AP were admitted to emergency ICU,central ICU, and Department of Gastroenterology from 2005 to 2009 in Zhongshan Hospital Affi liatedto Xiamen University, China. Among them, 13 patients served as a treatment group, and used ALSS inaddition to detoxifi cation treatment and protective treatment of liver function, and the other 18 patientsserved as a control group receiving detoxifi cation treatment and protective treatment of liver function.RESULTS： In the treatment group, 10 patients （76.9%） were cured or improved, 2 died, and1 was discharged against advice. In the 18 patients in the control group, 7 （38.9%） were cured orimproved, 3 died, and 8 were discharged against advice. There was a significant difference in therates of improvement between the two groups （P〈0.05）.CONCLUSION： ALSS is a safe and effective clinical method for the treatment of acute toxicliver failure.

Failure Assessment of Aero-engine Support Structure due to Blade-off

Aero-engine blade-off event could cause serious malfunction and endanger flight safety,which is an important issue widely concerned for a long period.This paper presents a comprehensive review on the regulation requirements,the major research methods and status at home and abroad.Firstly,the relevant certification regulations and standards about aero-engine structure safety due to blade-off event were overviewed and the research gaps between the abroad and the domestic were compared.Then,the simulation and experimental methodologies on aero-engine supporting structures undertake abnormal load due to blade-off event were discussed as major issue.Finally,the safety certification verification technology system for aero-engine support structures during blade-off event was proposed.

Failure Prediction for Scientific Workflows Using Nature-Inspired Machine Learning Approach

Scientific workflows have gained the emerging attention in sophisti-cated large-scale scientific problem-solving environments.The pay-per-use model of cloud,its scalability and dynamic deployment enables it suited for executing scientific workflow applications.Since the cloud is not a utopian environment,failures are inevitable that may result in experiencingfluctuations in the delivered performance.Though a single task failure occurs in workflow based applications,due to its task dependency nature,the reliability of the overall system will be affected drastically.Hence rather than reactive fault-tolerant approaches,proactive measures are vital in scientific workflows.This work puts forth an attempt to con-centrate on the exploration issue of structuring a nature inspired metaheuristics-Intelligent Water Drops Algorithm(IWDA)combined with an efficient machine learning approach-Support Vector Regression(SVR)for task failure prognostica-tion which facilitates proactive fault-tolerance in the scheduling of scientific workflow applications.The failure prediction models in this study have been implemented through SVR-based machine learning approaches and the precision accuracy of prediction is optimized by IWDA and several performance metrics were evaluated on various benchmark workflows.The experimental results prove that the proposed proactive fault-tolerant approach performs better compared with the other existing techniques.

Machine Learning and Artificial Neural Network for Predicting Heart Failure Risk

Heart failure is now widely spread throughout the world.Heart disease affects approximately 48%of the population.It is too expensive and also difficult to cure the disease.This research paper represents machine learning models to predict heart failure.The fundamental concept is to compare the correctness of various Machine Learning(ML)algorithms and boost algorithms to improve models’accuracy for prediction.Some supervised algorithms like K-Nearest Neighbor(KNN),Support Vector Machine(SVM),Decision Trees(DT),Random Forest(RF),Logistic Regression(LR)are considered to achieve the best results.Some boosting algorithms like Extreme Gradient Boosting(XGBoost)and Cat-Boost are also used to improve the prediction using Artificial Neural Networks(ANN).This research also focuses on data visualization to identify patterns,trends,and outliers in a massive data set.Python and Scikit-learns are used for ML.Tensor Flow and Keras,along with Python,are used for ANN model train-ing.The DT and RF algorithms achieved the highest accuracy of 95%among the classifiers.Meanwhile,KNN obtained a second height accuracy of 93.33%.XGBoost had a gratified accuracy of 91.67%,SVM,CATBoost,and ANN had an accuracy of 90%,and LR had 88.33%accuracy.

Roadway failure and support in a coal seam underlying a previously mined coal seam

The influence of an upper,mined coal seam on the stability of rock surrounding a roadway in a lower coal seam is examined.The technical problems of roadway control are discussed based on the geological conditions existing in the Liyazhuang Mine No.2 coal seam.The stress distribution and floor failure in the lower works after mining the upper coal is studied through numerical simulations.The failure mechanism of the roof and walls of a roadway located in the lower coal seam is described.The predicted deformation and failure of the roadway for different distances between the two coal seams are used to design two ways of supporting the lower structure.One is a combined support consisting of anchors with a joist steel tent and a combined anchor truss.A field test of the design was performed to good effect.The results have significance for the design of supports for roadways located in similar conditions.