Pediatric acute liver failure (PALF) is a severe and rare clinical syndrome characterized by rapid progression and high mortality. Current main treatment strategies include medical therapy, artificial liver support, and liver transplantation. Given the limited efficacy of medical treatment and the challenges of liver transplantation, such as donor scarcity and high costs, the non-biological artificial liver (NBAL) support system has become a widely used and effective alternative in clinical practice. It provides critical time for liver function recovery or as a bridging therapy to transplantation. Common NBAL modalities include plasma exchange (PE), plasma adsorption (PA), albumin dialysis (AD), and various combination therapies. Therapeutic PE removes toxins by replacing plasma and is suitable as adjuvant therapy in liver failure; high-volume PE is used in acute liver failure but is costly. PA and double plasma molecular adsorption systems remove specific toxins while reducing plasma consumption. AD systems eliminate macromolecular toxins through different mechanisms. Hybrid blood purification therapies combine multiple modes to enhance solute clearance efficiency. Elucidating the clinical characteristics and applications of various NBAL techniques in pediatric acute liver failure may provide valuable guidance for the use of NBAL support systems in pediatric clinical practice.
Humans ; Liver Failure, Acute/therapy* ; Liver, Artificial ; Plasma Exchange/methods* ; Child

OBJECTIVE: To compare the effects of artificial liver treatment with double plasma molecular adsorption system(DPMAS) mode and traditional plasma exchange (PE) mode on platelets in patients, and to evaluate the clinical efficacy of recombinent human thrombopoietin (rhTPO) in the treatment of thrombocytopenia. METHODS: A total of fifteen patients undergoing artificial liver with DPMAS model admitted to the Fifth Affiliated Hospital of Guangzhou Medical University from January 2018 to November 2020 were selected and included in the DPMAS group, and another 15 patients receiving PE were selected and included in the PE group. The improvement of clinical symptoms, such as fatigue, jaundice, oliguria, edema, etc. before and after artificial liver treatment was compared between the two groups, and the trend of blood routine (especially platelet), coagulation function and other indexes before and after treatment were compared between the two groups. The use of rhTPO and the number of platelets were recorded during treatment. RESULTS: The improvement rate of clinical symptoms in DPMAS group was 86.67%, which was higher than that in PE group, but the difference was not statistically significant (P>0.05). There was no statistical significance in the outcome of the two groups within 90 days (P>0.05). There was no significant difference in white blood cell (WBC) and hemoglobin (HB) between the two groups after treatment (P>0.05). However, the level of platelet(PLT) in DPMAS group was significantly lower than that before treatment (P < 0.05), and was significantly lower than that in PE group (P < 0.05). After treatment, the international normalized ratio (INR) level in PE group was significantly improved (P < 0.05), but there was no significant difference in the INR level in DPMAS group (P>0.05). The patients in the DPMAS group received an average of (8.2±3.1) doses of rhTPO and (1.5±0.3) IU of platelet transfusions during hospitalization. In DMPAS group, platelets increased significantly after infusion of terbium. CONCLUSION Compared with PE mode, the artificial liver with DPMAS mode can reduce platelet levels in patients, but the application of rhTPO can stimulate platelet regeneration and increase platelet levels in the patients, thereby reducing the risk of bleeding due to platelet hypoplasia.
Blood Platelets ; Humans ; Liver, Artificial ; Plasma Exchange ; Recombinant Proteins ; Thrombocytopenia/therapy* ; Thrombopoietin

Artificial liver is one of the effective methods to treat liver failure. Patients with liver failure are critically ill and have great individualized differences. Therefore, the specific program for the treatment of liver failure with artificial liver should be individualized. The commonly used non-biological artificial liver models include simple plasmapheresis, double filtration plasmapheresis, plasma filtration with dialysis, double plasma molecular adsorption system, molecular absorbent recirculating system, hemodiafiltration, continuous venovenous hemodiafiltration, hybrid, etc. The curative effect should be properly judged from patient's symptoms, laboratory test indicators, survival rate and other aspects after artificial liver therapy.
Hemodiafiltration ; Humans ; Judgment ; Liver Failure/therapy* ; Liver, Artificial ; Plasmapheresis

Artificial intelligence (AI) refers to the use of computer programs to simulate and extend human intelligence, and has application prospects in the diagnosis and treatment of diseases. This review focuses on the research status of the screening and diagnosis of NAFLD and nonalcoholic steatohepatitis using artificial intelligence technology, electronic health record data, multi-omics prediction models, image recognition technology based on liver imaging and pathological biopsy, and new drugs research and development, with a view to provide new ideas for the diagnosis and treatment.
Artificial Intelligence ; Biopsy/methods* ; Humans ; Liver/pathology* ; Liver Cirrhosis/pathology* ; Liver Neoplasms/pathology* ; Non-alcoholic Fatty Liver Disease/pathology*

OBJECTIVES: To explore the application values of diatom artificial intelligence (AI) search system in the diagnosis of drowning. METHODS: The liver and kidney tissues of 12 drowned corpses were taken and were performed with the diatom test, the view images were obtained by scanning electron microscopy (SEM). Diatom detection and forensic expert manual identification were carried out under the thresholds of 0.5, 0.7 and 0.9 of the diatom AI search system, respectively. Diatom recall rate, precision rate and image exclusion rate were used to detect and compare the efficiency of diatom AI search system. RESULTS: There was no statistical difference between the number of diatoms detected in the target marked by the diatom AI search system and the number of diatoms identified manually (P>0.05); the recall rates of the diatom AI search system were statistically different under different thresholds (P<0.05); the precision rates of the diatom AI system were statistically different under different thresholds(P<0.05), and the highest precision rate was 53.15%; the image exclusion rates of the diatom AI search system were statistically different under different thresholds (P<0.05), and the highest image exclusion rate was 99.72%. For the same sample, the time taken by the diatom AI search system to identify diatoms was only 1/7 of that of manual identification. CONCLUSIONS Diatom AI search system has a good application prospect in drowning cases. Its automatic diatom search ability is equal to that of experienced forensic experts, and it can greatly reduce the workload of manual observation of images.
Artificial Intelligence ; Diatoms ; Drowning/diagnosis* ; Humans ; Liver ; Lung ; Microscopy, Electron, Scanning

Hepatocellular carcinoma (HCC) is the sixth most common malignancy and the fourth leading cause of cancer related death worldwide. China covers over half of cases, leading HCC to be a vital threaten to public health. Despite advances in diagnosis and treatments, high recurrence rate remains a major obstacle in HCC management. Multi-omics currently facilitates surveillance, precise diagnosis, and personalized treatment decision making in clinical setting. Non-invasive radiomics utilizes preoperative radiological imaging to reflect subtle pixel-level pattern changes that correlate to specific clinical outcomes. Radiomics has been widely used in histopathological diagnosis prediction, treatment response evaluation, and prognosis prediction. High-throughput sequencing and gene expression profiling enabled genomics and proteomics to identify distinct transcriptomic subclasses and recurrent genetic alterations in HCC, which would reveal the complex multistep process of the pathophysiology. The accumulation of big medical data and the development of artificial intelligence techniques are providing new insights for our better understanding of the mechanism of HCC via multi-omics, and show potential to convert surgical/intervention treatment into an antitumorigenic one, which would greatly advance precision medicine in HCC management.
Artificial Intelligence ; Carcinoma, Hepatocellular/therapy* ; Gene Expression Profiling ; Humans ; Liver Neoplasms/genetics* ; Prognosis

BACKGROUND: Maintenance of tracheal intubation is associated with use of sedatives, stress due to mechanical ventilation, or respiratory complications. The aim of this study is to compare the incidence of delirium between early and late extubation groups after liver transplantation (LT). METHODS: Medical records from 247 patients who received LT from January 2010 to July 2017 in a single university hospital were retrospectively reviewed. Patients were divided with 2 groups: Those who underwent early extubation after LT (E group, n = 52) and those who underwent extubation within few hours of intensive care unit (ICU) admission after surgery (C group, n = 195). The patients’ demographic data, perioperative managements and postoperative complications were collected. Early extubation was defined as performing extubation in the operating room after LT. A propensity score matching analysis was performed to reduce the effects of selection bias. RESULTS: Among them, 4/52 (7.69%) in E group and 30/195 (15.38%) in C group occurred postoperative delirium after LT, respectively (P = 0.180). After propensity score matching, there was no difference of the period of hospitalization in ICU (P = 0.961), time to discharge after surgery (P = 0.117) and incidence of delirium between groups (P = 1.000). CONCLUSIONS: Although this study is a retrospective study and limited by the small number of subjects, early extubation does not affect the incidence of delirium after LT. Therefore, further prospective studies on this were needed.
Airway Extubation ; Delirium ; Hospitalization ; Humans ; Hypnotics and Sedatives ; Incidence ; Intensive Care Units ; Intubation ; Liver Transplantation ; Liver ; Medical Records ; Operating Rooms ; Postoperative Complications ; Propensity Score ; Prospective Studies ; Respiration, Artificial ; Retrospective Studies ; Selection Bias

Liver failure is a familiar clinical severe liver disease syndrome with a very high mortality rate. Over the years, scholars from around the world have been exploring the definition, etiology, classification, types, diagnosis and treatment, and prognostic judgment of liver failure. Reflecting changes, that have transpired in recent years at home and abroad relevant to clinical evidence, this guideline updates the information previously published by the Chinese Society of Infectious Diseases, Chinese Medical Association, Liver Failure and Artificial Liver Group, Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, Guidelines for Diagnosis and Treatment of Liver Failure (2012 Edition).
Gastroenterology ; Humans ; Liver Diseases ; Liver Failure/therapy* ; Liver, Artificial ; Practice Guidelines as Topic ; Prognosis

BACKGROUND AND OBJECTIVE: Stroke volume variation (SVV) has high sensitivity and specificity in predicting fluid responsiveness. However, sinus rhythm (SR) and controlled mechanical ventilation (CV) are mandatory for their application. Several studies suggest a limited applicability of SVV in intensive care unit (ICU) patients. We hypothesized that the applicability of SVV might be different over time and within certain subgroups of ICU patients. Therefore, we analysed the prevalence of SR and CV in ICU patients during the first 24 h of PiCCO-monitoring (primary endpoint) and during the total ICU stay. We also investigated the applicability of SVV in the subgroups of patients with sepsis, cirrhosis, and acute pancreatitis. METHODS: The prevalence of SR and CV was documented immediately before 1241 thermodilution measurements in 88 patients. RESULTS: In all measurements, SVV was applicable in about 24%. However, the applicability of SVV was time-dependent: the prevalence of both SR and CV was higher during the first 24 h compared to measurements thereafter (36.1% vs. 21.9%; P<0.001). Within different subgroups, the applicability during the first 24 h of monitoring ranged between 0% in acute pancreatitis, 25.5% in liver failure, and 48.9% in patients without pancreatitis, liver failure, pneumonia or sepsis. CONCLUSIONS The applicability of SVV in a predominantly medical ICU is only about 25%-35%. The prevalence of both mandatory criteria decreases over time during the ICU stay. Furthermore, the applicability is particularly low in patients with acute pancreatitis and liver failure.
Adult ; Aged ; Analysis of Variance ; Blood Pressure ; Female ; Fluid Therapy ; Hemodynamics ; Humans ; Intensive Care Units ; Liver Failure ; physiopathology ; therapy ; Male ; Middle Aged ; Monitoring, Physiologic ; methods ; statistics & numerical data ; Pancreatitis ; physiopathology ; therapy ; Prospective Studies ; Respiration, Artificial ; Sepsis ; physiopathology ; therapy ; Stroke Volume

To investigate the incidence of postoperative abnormal liver function test (aLFT) for the children with heart surgery, and to analyze the clinical characteristics and risk factors.
 Methods: A total of 143 children younger than 18 years old who underwent heart surgery in 2017 were enrolled in this study. The liver function were examined one day preoperation and consecutive 5 days after operation. The clinical data of perioperative period were recorded and the risk factors for aLFT were analyzed.
 Results: There were 43/143 (30%) cases had aLFT, including 5/143 (3.5%) acute liver injury (ALI). In the 6 liver function tests, total bilirubin, and glutamic-oxalacetic aminotransferase and glutamic-pyruvic aminotransferase increased to the peak at the first day and the second day after operation, respectively, and albumin declined to the lowest level at the fourth day after operation. aLFT happened most common at the first day after operation(22/43, 51.2%). The patients in the aLFT(+) group had smaller body size, more proportion of the risk adjustment for congenital heart sugery-1 (RACHS-1) score ≥ 3 and cyanosis, longer cardiopulmonary bypass (CPB) time, higher postoperative cardiac troponin (cTnI) value, higher inotropic score (IS), more transfusion, and longer mechanical ventilation time than those in the aLFT(-) group. The aLFT(+) group had longer ICU and hospital time, higher morbidity and mortality than those in the aLFT(-) group (P<0.05). Logistic regression showed that RACHS-1≥3, cyanosis, CPB time, cTnI, IS, transfusion, and mechanical ventilation time were the risk factors for aLFT. Multiple factor analysis showed the mechanical ventilation time was an independent risk factor for aLFT (P<0.05).
 Conclusion: aLFT is common in children after congenital heart operation, which could deteriorate to poor outcome. The mechanical ventilation time is an independent risk factor for aLFT.
Adolescent ; Cardiac Surgical Procedures ; Child ; Child, Preschool ; Heart Defects, Congenital ; surgery ; Humans ; Liver ; injuries ; pathology ; Logistic Models ; Postoperative Complications ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Treatment Outcome