ObjectiveTo investigate the changes in coagulation system in acute decompensated cirrhosis （ADC） patients with or without sepsis and the association of these changes with short-term prognosis. MethodsA prospective study was conducted among 116 ADC patients who were hospitalized in Nanfang Hospital from January 2021 to July 2023， among whom there were 86 patients with sepsis and 30 patients without sepsis， and 54 patients with sepsis alone who had no chronic liver disease were enrolled as control group. Thromboelastography （TEG） and other conventional coagulation parameters were used to comprehensively evaluate the coagulation function of patients. The data including TEG results and short-term prognosis were collected， and a correlation analysis was performed. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical data between two groups. The Spearman correlation coefficient was calculated to investigate the correlation between different variables. The Logistic regression model was used to perform the univariate and multivariate analyses. ResultsFor the ADC patients with sepsis， the lungs and bloodstream were the main infection sites， and bacteria were the main pathogenic microorganism. TEG results showed that compared with the patients with sepsis alone， the patients with ADC and sepsis had a significant reduction in median maximum amplitude （MA）， a significant increase in coagulation time （K time）， and a significant reduction in α angle （all P<0.05）； the patients with ADC and sepsis had a significantly longer reaction time （R time） than those with ADC alone （P=0.02）， and the patients with sepsis alone had a significantly longer R time than those with ADC and sepsis （P=0.04）. There was no correlation between MA and platelet count in the patients with ADC and sepsis （r=-0.133， P=0.057）， while there was a significant correlation between MA and platelet count in the patients with sepsis alone （r=0.595， P=0.001）. SOFA score was negatively correlated with MA in sepsis patients with or without ADC （r=-0.503 and -0.561， both P<0.001）， and for the patients with ADC and sepsis， R time， K time， and α angle were weakly correlated with SOFA score and had a relatively strong correlation with APTT （all P<0.05）. The patients with ADC alone all survived within 90 days， and compared with the death group， the patients with sepsis alone who survived had significantly higher values of MA and α angle （all P<0.05）； there was a significant difference in α angle on day 90 between the survival group and the death group， no matter whether the patients were comorbid with ADC or not （both P<0.01）， while for the patients with ADC and sepsis， there was no significant difference in MA value on day 90 between the survival group and the death group （P>0.05）. ConclusionFor ADC patients comorbid with sepsis， coagulation function assessment and monitoring should be taken seriously in clinical practice， and TEG parameters and SOFA score should be monitored when necessary to develop individualized treatment regimens.

Objective To investigate the changes in coagulation system in acute decompensated cirrhosis(ADC)patients with or without sepsis and the association of these changes with short-term prognosis.Methods A prospective study was conducted among 116 ADC patients who were hospitalized in Nanfang Hospital from January 2021 to July 2023,among whom there were 86 patients with sepsis and 30 patients without sepsis,and 54 patients with sepsis alone who had no chronic liver disease were enrolled as control group.Thromboelastography(TEG)and other conventional coagulation parameters were used to comprehensively evaluate the coagulation function of patients.The data including TEG results and short-term prognosis were collected,and a correlation analysis was performed.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.The Spearman correlation coefficient was calculated to investigate the correlation between different variables.The Logistic regression model was used to perform the univariate and multivariate analyses.Results For the ADC patients with sepsis,the lungs and bloodstream were the main infection sites,and bacteria were the main pathogenic microorganism.TEG results showed that compared with the patients with sepsis alone,the patients with ADC and sepsis had a significant reduction in median maximum amplitude(MA),a significant increase in coagulation time(K time),and a significant reduction in α angle(all P<0.05);the patients with ADC and sepsis had a significantly longer reaction time(R time)than those with ADC alone(P=0.02),and the patients with sepsis alone had a significantly longer R time than those with ADC and sepsis(P=0.04).There was no correlation between MA and platelet count in the patients with ADC and sepsis(r=-0.133,P=0.057),while there was a significant correlation between MA and platelet count in the patients with sepsis alone(r=0.595,P=0.001).SOFA score was negatively correlated with MA in sepsis patients with or without ADC(r=-0.503 and-0.561,both P<0.001),and for the patients with ADC and sepsis,R time,K time,and α angle were weakly correlated with SOFA score and had a relatively strong correlation with APTT(all P<0.05).The patients with ADC alone all survived within 90 days,and compared with the death group,the patients with sepsis alone who survived had significantly higher values of MA and α angle(all P<0.05);there was a significant difference in α angle on day 90 between the survival group and the death group,no matter whether the patients were comorbid with ADC or not(both P<0.01),while for the patients with ADC and sepsis,there was no significant difference in MA value on day 90 between the survival group and the death group(P>0.05).Conclusion For ADC patients comorbid with sepsis,coagulation function assessment and monitoring should be taken seriously in clinical practice,and TEG parameters and SOFA score should be monitored when necessary to develop individualized treatment regimens.

Objective:To compare the effectiveness and safety profile of centrifugal and membrane plasma separation model in artificial liver therapy with a dual plasma molecular adsorption system (DPMAS).Method:A retrospective study was conducted. Data of inpatients with liver failure who were treated with DPMAS therapy in the Liver Disease Center of Nanfang Hospital, Southern Medical University, from October 2022 to June 2024 were included. Clinical data such as demographic characteristics, etiology, DPMAS treatment-related indicators (including plasma separation method, vascular access, frequency of treatment, treatment duration, type of anticoagulant drugs, and membrane rupture condition), and laboratory test indicators before and after DPMAS treatment were collected. Categorical variables were compared by the χ2 test. Continuous variables were compared using a t-test or a non-parametric test between groups. Result:Data of 232 cases with liver failure who received artificial liver therapy with DPMAS were included. A total of 473 times DPMAS treatment was given. The average age was 50 years old, and males accounted for 82.3%. Centrifugal plasma separation was the initial DPMAS treatment in 176 (75.9%) cases, while membrane plasma separation was used in 56 cases (24.1%). The most common vascular access for DPMAS treatment was the internal jugular vein. The most commonly used anticoagulant was unfractionated heparin. The treatment duration of DPMAS was significantly higher with centrifugal separation than that with membrane separation ( P<0.001). Hemoglobin levels (mean before and after treatment in the centrifugal: 112.8 g/L vs. 106.3 g/L, P<0.001; mean before and after treatment in the membrane group: 108.4 g/L vs. 103.3 g/L, P<0.001), red blood cell count (mean before and after treatment in the centrifugal group: 3.7×10 9/L vs. 3.5×10 9/L, P<0.001; mean before and after treatment in the membrane group: 3.5×10 9/L vs. 3.3×10 9/L, P<0.001) and platelet count (mean before and after treatment in the centrifugal group: 134.5×10 9/L vs. 119.6×10 9/L, P<0.001; mean before and after treatment in the membrane group: 120.7 ×10 9/L vs. 97.3 ×10 9/L, P<0.001) were slightly decreased following initial DPMAS treatment in both groups. The decrease in platelets was significantly lower in centrifugal separation than that in membrane separation (median: 10.4% vs. 17.0%; P=0.003). There was no statistically significant difference observed in the proportion of puncture site bleeding in terms of plasma separation-related adverse events between the two groups, but plasma separator membrane rupture occurred two times in the DPMAS treatment. Conclusion:Centrifugal and membrane separation, both with DPMAS therapy, can cause a slight decrease in hemoglobin, red blood cell count, and platelets in patients with liver failure. Membrane separation causes a larger drop in platelets than centrifugal plasma separation. The operational convenience of medical personnel, the risk of membrane rupture, the coagulation markers, the patient's vascular condition, and other factors should be comprehensively considered when choosing the plasma separation model.

Objective:To retrospectively analyze the dual plasma molecular adsorption system (DPMAS) treatment technology and the laboratory data before and after treatment in patients with liver failure and refractory hyperbilirubinemia, so as to provide a clinical basis for the prediction and prevention of common related complications.Method:A retrospective study was conducted on 161 cases with liver failure and 68 cases with refractory hyperbilirubinemia who underwent DPMAS treatment in our department from October 2022 to July 2024. The general clinical data characteristics, DPMAS treatment status, DPMAS-related complications, and changes in important laboratory indicators before and after the initial DPMAS treatment in both patient groups were analyzed.Results:Among the 229 enrolled cases, 82.53% were male, and the median age was 50 years. The cause of liver failure was hepatitis B virus infection in 84.47%, while hepatitis B accounted for only 51.47% in the other group. There were significant differences in platelets, creatinine, coagulation function, and inflammatory factor-related indicators between the two groups at baseline. The total number of DPMAS treatments given was 471 times. The proportion of albumin used in the initial stage of treatment was significantly higher in patients with refractory hyperbilirubinemia than that in the liver failure group, while the proportion of plasma used in the liver failure group was significantly higher ( P<0.001). The most commonly used anticoagulation regimen was unfractionated heparin. A combined anticoagulation therapy regimen was used in 9.3% of the refractory hyperbilirubinemia group. The internal jugular vein was selected in nearly half of the treated cases. A peripheral vascular access pathway was the treatment option in 31.2%. The proportion of centrifugal separation was significantly higher than that of membrane separation (76.22% vs. 23.78%). The incidence rate of DPMAS-related complications was 16%. The most common complication was bleeding, including bleeding at the puncture site (accounting for 32% of the total complications) and bleeding at non-puncture sites (12%), followed by hypotension (22%), allergic reactions (13%) and infections (11%), respectively. The indexes of hemoglobin, platelets, total bilirubin, and C-reactive protein were significantly decreased within 24-48 hours after DPMAS treatment in both groups of patients. The prothrombin time and international normalized ratio were significantly increased in the liver failure group, while fibrinogen was significantly reduced. Conclusion:DPMAS clinical application is generally safe in patients with liver disease. The most common complications are bleeding, hypotension, allergic reactions, and infections, which need to be paid special attention and timely intervention to ensure the safety profile of treatment.

Objective:To compare the effectiveness and safety profile of centrifugal and membrane plasma separation model in artificial liver therapy with a dual plasma molecular adsorption system (DPMAS).Method:A retrospective study was conducted. Data of inpatients with liver failure who were treated with DPMAS therapy in the Liver Disease Center of Nanfang Hospital, Southern Medical University, from October 2022 to June 2024 were included. Clinical data such as demographic characteristics, etiology, DPMAS treatment-related indicators (including plasma separation method, vascular access, frequency of treatment, treatment duration, type of anticoagulant drugs, and membrane rupture condition), and laboratory test indicators before and after DPMAS treatment were collected. Categorical variables were compared by the χ2 test. Continuous variables were compared using a t-test or a non-parametric test between groups. Result:Data of 232 cases with liver failure who received artificial liver therapy with DPMAS were included. A total of 473 times DPMAS treatment was given. The average age was 50 years old, and males accounted for 82.3%. Centrifugal plasma separation was the initial DPMAS treatment in 176 (75.9%) cases, while membrane plasma separation was used in 56 cases (24.1%). The most common vascular access for DPMAS treatment was the internal jugular vein. The most commonly used anticoagulant was unfractionated heparin. The treatment duration of DPMAS was significantly higher with centrifugal separation than that with membrane separation ( P<0.001). Hemoglobin levels (mean before and after treatment in the centrifugal: 112.8 g/L vs. 106.3 g/L, P<0.001; mean before and after treatment in the membrane group: 108.4 g/L vs. 103.3 g/L, P<0.001), red blood cell count (mean before and after treatment in the centrifugal group: 3.7×10 9/L vs. 3.5×10 9/L, P<0.001; mean before and after treatment in the membrane group: 3.5×10 9/L vs. 3.3×10 9/L, P<0.001) and platelet count (mean before and after treatment in the centrifugal group: 134.5×10 9/L vs. 119.6×10 9/L, P<0.001; mean before and after treatment in the membrane group: 120.7 ×10 9/L vs. 97.3 ×10 9/L, P<0.001) were slightly decreased following initial DPMAS treatment in both groups. The decrease in platelets was significantly lower in centrifugal separation than that in membrane separation (median: 10.4% vs. 17.0%; P=0.003). There was no statistically significant difference observed in the proportion of puncture site bleeding in terms of plasma separation-related adverse events between the two groups, but plasma separator membrane rupture occurred two times in the DPMAS treatment. Conclusion:Centrifugal and membrane separation, both with DPMAS therapy, can cause a slight decrease in hemoglobin, red blood cell count, and platelets in patients with liver failure. Membrane separation causes a larger drop in platelets than centrifugal plasma separation. The operational convenience of medical personnel, the risk of membrane rupture, the coagulation markers, the patient's vascular condition, and other factors should be comprehensively considered when choosing the plasma separation model.

Objective:To retrospectively analyze the dual plasma molecular adsorption system (DPMAS) treatment technology and the laboratory data before and after treatment in patients with liver failure and refractory hyperbilirubinemia, so as to provide a clinical basis for the prediction and prevention of common related complications.Method:A retrospective study was conducted on 161 cases with liver failure and 68 cases with refractory hyperbilirubinemia who underwent DPMAS treatment in our department from October 2022 to July 2024. The general clinical data characteristics, DPMAS treatment status, DPMAS-related complications, and changes in important laboratory indicators before and after the initial DPMAS treatment in both patient groups were analyzed.Results:Among the 229 enrolled cases, 82.53% were male, and the median age was 50 years. The cause of liver failure was hepatitis B virus infection in 84.47%, while hepatitis B accounted for only 51.47% in the other group. There were significant differences in platelets, creatinine, coagulation function, and inflammatory factor-related indicators between the two groups at baseline. The total number of DPMAS treatments given was 471 times. The proportion of albumin used in the initial stage of treatment was significantly higher in patients with refractory hyperbilirubinemia than that in the liver failure group, while the proportion of plasma used in the liver failure group was significantly higher ( P<0.001). The most commonly used anticoagulation regimen was unfractionated heparin. A combined anticoagulation therapy regimen was used in 9.3% of the refractory hyperbilirubinemia group. The internal jugular vein was selected in nearly half of the treated cases. A peripheral vascular access pathway was the treatment option in 31.2%. The proportion of centrifugal separation was significantly higher than that of membrane separation (76.22% vs. 23.78%). The incidence rate of DPMAS-related complications was 16%. The most common complication was bleeding, including bleeding at the puncture site (accounting for 32% of the total complications) and bleeding at non-puncture sites (12%), followed by hypotension (22%), allergic reactions (13%) and infections (11%), respectively. The indexes of hemoglobin, platelets, total bilirubin, and C-reactive protein were significantly decreased within 24-48 hours after DPMAS treatment in both groups of patients. The prothrombin time and international normalized ratio were significantly increased in the liver failure group, while fibrinogen was significantly reduced. Conclusion:DPMAS clinical application is generally safe in patients with liver disease. The most common complications are bleeding, hypotension, allergic reactions, and infections, which need to be paid special attention and timely intervention to ensure the safety profile of treatment.

A flavoring agent and a suspension agent were prepared for extemporaneous compounding. The stability of the two agents before and after drug loading was investigated, and the taste of the suspension after extemporaneous compounding was evaluated by electronic tongue technology. The two agents remained stable under the conditions of influence factor test, accelerated test and long-term test. The appearance properties of the two agents did not change. The relative density of the flavoring agent was maintained at 1.053-1.075, and the pH was stable at 4.2-4.5. The relative density of the suspension agent was maintained at 0.999-1.022, and the pH was stable at 4.0-4.5. Seven kinds of drugs, including warfarin sodium tablets and spironolactone tablets, were mixed with these two oral solvents, and the content uniformity and stability were detected respectively. The results showed that the preparations could be evenly dispersed and the physical and chemical properties were stable. The results of taste evaluation showed that in captopril group and chloral hydrate group, the flavoring agent had the best effect on taste correction. In warfarin sodium group, rifampicin group, spironolactone group, vitamin B1 group and vitamin B2 group, the blending agents had the best effect on taste correction.

Due to persistent systemic inflammation and immunosuppressive conditions, patients with liver cirrhosis are susceptible to bacterial infection, which may progress to sepsis without proper control. Early effective antibiotic therapy is the key to improving the prognosis of patients with sepsis. This article briefly describes the pathophysiological mechanism of sepsis in patients with liver cirrhosis and the current status of the diagnosis and treatment of sepsis, and it is pointed out that metagenomic next-generation sequencing can be used to guide effective antibacterial treatment of sepsis.

Infection is the most common complication in patients with end-stage liver disease, among which abdominal infection is the most common type. There is a low positive rate of ascitic fluid culture, and abdominal infection is mainly diagnosed based on multinucleated cell count in ascites and is mainly treated by empirical antimicrobial therapy. The diagnostic criteria for abdominal infection have limited guiding significance in clinical practice, and currently there are still no new diagnostic markers that can be used in clinical practice. For the pathogenic diagnosis of abdominal infection, metagenomic next-generation sequencing is a new technique for rapid identification of pathogens of abdominal infection or overlap infection in liver cirrhosis. In terms of treatment, Chinese guidelines on the management of ascites in cirrhosis emphasize antimicrobial therapy and give no explicit recommendation for the dose of human serum albumin infusion. There are still great challenges in the diagnosis and treatment of abdominal infection in cirrhotic patients, and more studies are needed in the future to answer relevant questions and better guide clinical practice, including the optimization of the diagnosis, prevention, and treatment of abdominal infection.

Chronic liver disease has gradually become a serious health problem worldwide. Liver biopsy is the current gold standard to assess liver lesions; however, it is an invasive procedure that may cause severe complications. Therefore, there is an urgent need for an economical and rapid non-invasive detection method that can be used in clinic for diagnosis. In the past decade, protein glycosylation has become a research hotspot, and the concept of changes in serum proteoglycans structure has gradually been accepted by many researchers as an indication of liver injury. At the same time, N-linked glycans via DNA sequencing equipment-Fluorophore Assisted Carbohydrate Electrophoresis (DSA-FACE) has also brought high sensitivity and specificity diagnostic models (GlycoHepatoTest) for various chronic liver diseases, which is a new strategy for non-invasive diagnosis of liver diseases.