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AIM: To establish a new model for predicting survival in acute-on-chronic liver failure (ACLF) patients treated with an artificial liver support system. METHODS: One hundred and eighty-one ACLF patients who were admitted to the hospital from January 1, 2012 to December 31, 2014 and were treated with an artiï¬cial liver support system were enrolled in this retrospective study, including a derivation cohort (n = 113) and a validation cohort (n = 68). Laboratory parameters at baseline were analyzed and correlated with clinical outcome. In addition to standard medical therapy, ACLF patients underwent plasma exchange (PE) or plasma bilirubin adsorption (PBA) combined with plasma exchange. For the derivation cohort, Kaplan-Meier methods were used to estimate survival curves, and Cox regression was used in survival analysis to generate a prognostic model. The performance of the new model was tested in the validation cohort using a receiver-operator curve. RESULTS: The mean overall survival for the derivation cohort was 441 d (95%CI: 379-504 d), and the 90- and 270-d survival probabilities were 70.3% and 58.3%, respectively. The mean survival times of patients treated with PBA plus PE and patients treated with PE were 531 d (95%CI: 455-605 d) and 343 d (95%CI: 254-432 d), respectively, which were significantly different (P = 0.012). When variables with bivariate significance were selected for inclusion into the multivariate Cox regression model, number of complications, age, scores of the model for end-stage liver disease (MELD) and type of artiï¬cial liver support system were defined as independent risk factors for survival in ACLF patients. This new prognostic model could accurately discriminate the outcome of patients with different scores in this cohort (P < 0.001). The model also had the ability to assign a predicted survival probability for individual patients. In the validation cohort, the new model remained better than the MELD. CONCLUSION: A novel model was constructed to predict prognosis and accurately discriminate survival in ACLF patients treated with an artiï¬cial liver support system.
Asunto(s)
Insuficiencia Hepática Crónica Agudizada/terapia , Técnicas de Apoyo para la Decisión , Hígado Artificial , Insuficiencia Hepática Crónica Agudizada/sangre , Insuficiencia Hepática Crónica Agudizada/diagnóstico , Insuficiencia Hepática Crónica Agudizada/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Bilirrubina/sangre , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Intercambio Plasmático , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Curva ROC , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
The current experimental methods, such as the motion capture system, high-speed video, plane photography and surface EMG, cannot show the details of the muscle strength, or explain the nerve-muscle coordination mechanism during human motion. Thus, computer modeling and simulation are developed and become a new method for researchers in China to study human motion, and the software LifeMOD, AnyBody, ANSYS are mainly used even if these softwares have some limitations such as less precise muscle control and relatively higher prices. Developed by Stanford University, OpenSim is an open-source platform for muscle model development, simulation and analysis of neuromuscular system based on C++ and Java. In this paper, on the basis of computer modeling and mathematics theoretical derivation, the OpenSim modeling theory and simulation steps were introduced in detail to provide some theoretical references for researches on sport biomechanics. The future research directions by using OpenSim modeling simulation to study neuromuscular mechanism of the hemiplegic gait and Parkinson gait, and to improve and perfect the rehabilitation ways of the abnormal gait were also discussed.
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Quercetin and praziquantel were used to treat mice with hepatic fibrosis due to Schistosoma japonicum infection. Quercetin treatment obviously relieved the degree of hepatic fibrosis, significantly reduced the expression of immediate early gene, tissue inhibitor of metalloproteinase 1 (TIMP 1), types I and III collagen compared to the control. The expression of c-jun mRNA, type I and type III collagen were reduced significantly compared to the group treated with praziquantel, whereas no difference in the expression of c-fos mRNA and TIMP1 between the two groups, indicating that quercetin may have better effect on schistosomal liver fibrosis than praziquantel in the long term.