Antimicrobial second skin using copper nanomesh.

The functional support and advancement of our body while preserving inherent naturalness is one of the ultimate goals of bioengineering. Skin protection against infectious pathogens is an application that requires common and long-term wear without discomfort or distortion of the skin functions. However, no antimicrobial method has been introduced to prevent cross-infection while preserving intrinsic skin conditions. Here, we propose an antimicrobial skin protection platform copper nanomesh, which prevents cross-infectionmorphology, temperature change rate, and skin humidity. Copper nanomesh exhibited an inactivation rate of 99.99% for Escherichia coli bacteria and influenza virus A within 1 and 10 min, respectively. The thin and porous nanomesh allows for conformal coating on the fingertips, without significant interference with the rate of skin temperature change and humidity. Efficient cross-infection prevention and thermal transfer of copper nanomesh were demonstrated using direct on-hand experiments.

Robust, self-adhesive, reinforced polymeric nanofilms enabling gas-permeable dry electrodes for long-term application.

Robust polymeric nanofilms can be used to construct gas-permeable soft electronics that can directly adhere to soft biological tissue for continuous, long-term biosignal monitoring. However, it is challenging to fabricate gas-permeable dry electrodes that can self-adhere to the human skin and retain their functionality for long-term (>1 d) health monitoring. We have succeeded in developing an extraordinarily robust, self-adhesive, gas-permeable nanofilm with a thickness of only 95 nm. It exhibits an extremely high skin adhesion energy per unit area of 159 µJ/cm2 The nanofilm can self-adhere to the human skin by van der Waals forces alone, for 1 wk, without any adhesive materials or tapes. The nanofilm is ultradurable, and it can support liquids that are 79,000 times heavier than its own weight with a tensile stress of 7.82 MPa. The advantageous features of its thinness, self-adhesiveness, and robustness enable a gas-permeable dry electrode comprising of a nanofilm and an Au layer, resulting in a continuous monitoring of electrocardiogram signals with a high signal-to-noise ratio (34 dB) for 1 wk.

Cognition of nursing translational medical research among nursing practitioners in China.

BACKGROUND: Nursing translational research (TR) begins with clinical discovery and medical research and leads to clinical application in patients. TR is key to improving nursing quality and developing the nursing profession. However, its development in China remains limited, and the reasons for this are unclear. We aim to enhance the recognition of nursing TR among nursing practitioners in China by exploring their cognition about nursing TR and associated influences. METHODS: We distributed an internet-based questionnaire to 683 nursing practitioners between February 13 and March 15, 2023. We analyzed the characteristics and cognition of nursing TR using descriptive statistics, the chi-squared test, Fisher's exact test, the Wilcoxon rank-sum test, Kruskal-Wallis H test, and stepwise logistic regression analysis. The majority (79.65%) of nursing practitioners who responded to the questionnaire were willing to participate in nursing TR. FINDINGS: Nursing practitioners with a higher educational level, stronger recognition of the importance of nursing TR, and stronger recognition of transdisciplinary nursing TR were more willing to participate in nursing TR. DISCUSSION: The results of this study can accelerate nursing practitioners' willingness to participate in nursing TR. APPLICATION TO PRACTICE: We identified strategies to promote TR: provide further education, optimize courses in higher education, disseminate information, provide guidance on the importance of nursing TR, and establish a nursing TR platform with appropriate potential collaborators.

Natural Biopolymer-Based Biocompatible Conductors for Stretchable Bioelectronics.

Biocompatible conductors are important components for soft and stretchable bioelectronics for digital healthcare, which have attracted extensive research efforts. Natural biopolymers, compared to other polymers, possess unique features that make them promising building blocks for biocompatible conductors, such as good biocompatibility/biodegradability, natural abundance, sustainability, and capability, can be processed into various functional formats with tunable material properties under benign conditions. In this comprehensive review, we focus on the recent advances in biocompatible conductors based on natural biopolymers for stretchable bioelectronics. We first give a brief introduction of conductive components and natural polymers and summarize the recent development of biocompatible conductors based on representative natural biopolymers including protein (silk), polypeptide (gelatin), and polysaccharide (alginate). The design and fabrication strategies for biocompatible conductors based on these representative biopolymers are outlined, after the chemical structure and properties of such biopolymers are presented. Then we discuss the electronic component-biopolymer interface and bioelectronic-biological tissue (skin and internal tissues) interface, highlight various fabrication techniques of biocompatible conductors for soft bioelectronics, and introduce representative examples of utilizing natural biopolymer-based biocompatible conductors for on-skin bioelectronics, textile-based wearable electronics, and implantable bioelectronics for digital healthcare. Finally, we present concluding remarks on challenges and prospects for designing natural biopolymers for soft biocompatible conductors and bioelectronics.

Hepatocyte proliferation favours viral clearance in young children with chronic hepatitis B virus infection.

AIM: The aim of this study is to explore the correlation between hepatocyte proliferation and hepatitis B virus (HBV) clearance in young children with chronic HBV infection. METHODS: We collected liver biopsy samples and clinical data corresponding to paediatric patients with chronic HBV infection. Ki-67 expression in liver tissues was evaluated by immunohistochemical staining. RESULTS: Eighteen patients were included and were divided into two groups based on different antiviral outcomes. Group I achieved hepatitis B surface antigen (HBsAg) loss within 48 weeks. Group II did not develop seroconversion from hepatitis B e (HBe) antigen to anti-HBe after 48 weeks. There were 10 patients in Group I and 8 in Group II, respectively. Demographical data and baseline virological and biochemical characteristics in serum across Group I and Group II were not statistically different. Histologically, mean Ki-67 expression index in Group I was 15%, while the mean index in Group II was 5%. There was a significant difference between the two groups (p < 0.01). CONCLUSION: High Ki-67 expression can contribute to viral clearance in young children with chronic HBV infection. This is the first confirmation of the association between hepatocyte proliferation and HBV clearance in vivo and has implications for novel therapeutic strategies against hepatitis B.

Skin bioelectronics towards long-term, continuous health monitoring.

Skin bioelectronics are considered as an ideal platform for personalised healthcare because of their unique characteristics, such as thinness, light weight, good biocompatibility, excellent mechanical robustness, and great skin conformability. Recent advances in skin-interfaced bioelectronics have promoted various applications in healthcare and precision medicine. Particularly, skin bioelectronics for long-term, continuous health monitoring offer powerful analysis of a broad spectrum of health statuses, providing a route to early disease diagnosis and treatment. In this review, we discuss (1) representative healthcare sensing devices, (2) material and structure selection, device properties, and wireless technologies of skin bioelectronics towards long-term, continuous health monitoring, (3) healthcare applications: acquisition and analysis of electrophysiological, biophysical, and biochemical signals, and comprehensive monitoring, and (4) rational guidelines for the design of future skin bioelectronics for long-term, continuous health monitoring. Long-term, continuous health monitoring of advanced skin bioelectronics will open unprecedented opportunities for timely disease prevention, screening, diagnosis, and treatment, demonstrating great promise to revolutionise traditional medical practices.

Repeated endoscopic treatment of gastric antral vascular ectasia.

GAVE is a relatively rare acquired vascular disease. The most common treatment for GAVE is endoscopic therapy. Argon plasma coagulation（APC） is usually the first-line choice for endoscopic GAVE treatment, but its recurrence rate is high and often requires multiple repeated treatments. In this case, the GAVE patient recurred after two APC treatments. The results suggest that APC-treated patients with GAVE are prone to relapse. In conclusion, clinicians should regularly follow up patients who received APC treatment.

Clinical profiles and diagnostic challenges in 1158 children with rare hepatobiliary disorders.

BACKGROUND: Diagnosis of rare diseases possesses a great challenge in pediatric hepatology because expert knowledge in the field is extremely insufficient. The study aims to explore new findings and collect diagnostic experience from pediatric rare liver diseases. METHODS: The large-sample case analysis study included pediatric patients who had liver-involved rare diseases. All cases underwent liver biopsy and/or gene sequencing. RESULTS: A total of 1158 pediatric patients were identified. Liver-based genetic diseases were most frequent (737 cases), followed by liver damages involved in extrahepatic or systemic disorders (151 cases) and cryptogenic hepatobilliary abnormalities (123 cases). Of note, diagnoses of 16 patients were re-evaluated according to genetic results combined with clinical pointers. In addition, 101 patients who underwent gene sequencing remained undiagnosed. Of them, 55 had negative genetic findings, 30 harbored mutations that failed to meet their typically pathogenic condition, and 16 had detected variants that were inconsistent with clinical pointers. CONCLUSIONS: As a study involving known largest number of children with rare hepatobiliary disorders, it allows us to accumulate information (especially new findings) on the etiology and diagnosis of these disorders. The results can help to improve the diagnostic quality in the population. IMPACT: Liver-based genetic diseases were most frequent in clinical profiles of pediatric rare liver diseases. Some novel variants in cases with genetic diseases (for example, two variants of c.3638G>T and c.1435G>C in a patient with progressive familial intrahepatic cholestasis type 2) were identified. As a study involving known largest number of pediatric cases with rare hepatobiliary disorders, it allows us to accumulate information on the etiology and diagnosis of these disorders. The study can help to optimize the diagnostic process and significantly improve the diagnostic quality in the field of pediatric hepatology. Given that clinical variability often exists within rare genetic disease entities and not all rare disorders are genetic, clinicians should not over-depend on the genetic results in the diagnosis.

Silk-Based Advanced Materials for Soft Electronics.

Soft bioelectronics that could be integrated with soft and curvilinear biological tissues/organs have attracted multidisciplinary research interest from material scientists, electronic engineers, and biomedical scientists. Because of their potential human health-related applications, soft bioelectronics require stringent demands for biocompatible components. Silk, as a kind of well-known ancient natural biopolymer, shows unique combined merits such as good biocompatibility, programmable biodegradability, processability into various material formats, and large-scale sustainable production. Such unique merits have made silk popular for intensive design and study in soft bioelectronics over the past decade. Due to the development of fabrication techniques in material processing and progress in research, silk has been engineered into a variety of advanced materials including silk fibers/textiles, nanofibers, films, hydrogels, and aerogels. Natural and regenerated silk materials can also be transformed into intrinsically nitrogen-doped and electrically conductive carbon materials, due to their unique molecular structure and high nitrogen content. The rich morphologies and varied processing options for silk materials can furnish transformed carbon materials with well-designed structures and properties. The favorable and unique material merits of silk materials and silk-derived carbon materials offer potential applications in soft electronics. Based on commercial silk fibers/textiles and the availability of re-engineered silk materials with versatile technological formats, functional soft electronics have been explored with silk as flexible biosupports/biomatrixes or active components. These soft systems include bioresorbable electronics, ultraconformal bioelectronics, transient electronics, epidermal electronics, textile electronics, conformal biosensors, flexible transistors, and resistive switching memory devices. Silk-derived carbon materials with rationally designed morphologies and structures have also been developed as active components for wearable sensors, electronic skins, and flexible energy devices, which provide novel concepts and opportunities for soft electronics. In this Account, we highlight the unique hierarchical and chemical structure of natural silk fibers, the fabrication strategies for processing silk into materials with versatile morphologies and into electrically conductive carbon materials, as well as recent progress in the development of silk-based advanced materials (silk materials and silk-derived carbon materials) for soft bioelectronics. The design and functionality of soft electronics developed with commercial silk fibers/textiles, re-engineered silk materials, and silk-derived carbon materials as biosubstrate/matrix and active components is introduced in detail. We further discuss future challenges and prospects for developing silk-based soft bioelectronics for wearable healthcare systems. By leveraging the unique advantages of silk-based advanced materials, the design and construction strategy for flexible electronics, as well as the potential of flexible electronics for conformable and intimate association with human tissues/organs, silk-based soft bioelectronics should have a significant impact on diverse healthcare fields.

Silk-Derived 2D Porous Carbon Nanosheets with Atomically-Dispersed Fe-Nx -C Sites for Highly Efficient Oxygen Reaction Catalysts.

Controlled synthesis of highly efficient, stable, and cost-effective oxygen reaction electrocatalysts with atomically-dispersed Me-Nx -C active sites through an effective strategy is highly desired for high-performance energy devices. Herein, based on regenerated silk fibroin dissolved in ferric chloride and zinc chloride aqueous solution, 2D porous carbon nanosheets with atomically-dispersed Fe-Nx -C active sites and very large specific surface area (≈2105 m2 g-1 ) are prepared through a simple thermal treatment process. Owing to the 2D porous structure with large surface area and atomic dispersion of Fe-Nx -C active sites, the as-prepared silk-derived carbon nanosheets show superior electrochemical activity toward the oxygen reduction reaction with a half-wave potential (E1/2 ) of 0.853 V, remarkable stability with only 11 mV loss in E1/2 after 30 000 cycles, as well as good catalytic activity toward the oxygen evolution reaction. This work provides a practical and effective approach for the synthesis of high-performance oxygen reaction catalysts towards advanced energy materials.

Clinical Efficacy and Safety of Mechanical Ventilation Combined with Fiberoptic Bronchoalveolar Lavage in Patients with Severe Pulmonary Infection.

BACKGROUND The aim of this study was to assess the clinical efficacy and safety of mechanical ventilation combined with fiberoptic bronchoalveolar lavage in patients with severe pulmonary infection. MATERIAL AND METHODS We randomly divided 81 patients with severe pulmonary infection into a control group (n=40) and an observation group (n=41). Both groups were treated using mechanical ventilation, and observation group additionally received assistive fiberoptic bronchoalveolar lavage. RESULTS The cure rate and effectiveness rate in the observation group were higher than in the control group (P<0.05, χ²=3.2), and the incidence of ventilator-associated pneumonia in the observation group was significantly lower than that in the control group (P<0.05, χ²=9.4). The partial pressure of oxygen (PaO2) and oxygen saturation (SaO2) were higher in the observation group than in the control group (P<0.05, t=3.862, t=33.595), whereas the partial pressure of carbon dioxide (PaCO2) and respiratory rate were lower in the observation group than in the control group (P<0.05, t=3.307, t=5.043). The levels of C-reactive protein (CRP), tumor necrosis factor-a (TNF-alpha), interleukin-6 (IL-6), and interleukin-8 (IL-8) in the 2 groups were lower after treatment than before treatment (all P<0.05), and the levels in the observation group were lower than those in the control group (all P<0.05). Hospital stay, infection control window appearance time, invasive mechanical ventilation time, and total mechanical ventilation time in the observation group were shorter than those in the control group (P<0.05, t=13.990, t=8.643, t=9.717, t=8.980). CONCLUSIONS Mechanical ventilation combined with fiberoptic bronchoalveolar lavage can effectively improve the curative effects and the blood gas and inflammation indicators in patients.

Splash-Resistant and Light-Weight Silk-Sheathed Wires for Textile Electronics.

Silk has outstanding mechanical properties and biocompatibility. It has been used to fabricate traditional textiles for thousands of years and can be produced in large scale. Silk materials are potentially attractive in modern textile electronics. However, silk is not electrically conductive, thus limiting its applications in electronics. Moreover, regenerated silk is generally rigid and brittle, which hinder post processing. Here we report the fabrication of conductive silk wire in which carbon nanotube (CNT) yarns are wrapped with fluffy and flexible silk nanofiber films. The silk nanofiber film was prepared by electrospinning and then wrapped around a rotating CNT yarn in situ. The obtained silk-sheathed CNT (CNT@Silk) wire has an insulating sheath, which protects the body against electrical shock. In addition, the fabricated wires exhibit a high electrical conductivity (3.1 × 104 S/m), good mechanical strength (16 cN/tex), excellent flexibility, and high durability. More importantly, the wires have an extremely low density (2.0-7.8 × 104 g/m3), which is 2 orders of magnitude lower than that of the traditional metal wire (for example, Cu). Moreover, the wires display a good resistance to humidity, and a simple post treatment can make the wires splash-resistant, thereby expanding its applications. On the basis of these features, we demonstrate the use of the lightweight CNT@Silk wires in smart clothes, including electrochromism and near-field communication.

Mineral-Templated 3D Graphene Architectures for Energy-Efficient Electrodes.

3D graphene networks have shown extraordinary promise for high-performance electrochemical devices. Herein, the chemical vapor deposition synthesis of a highly porous 3D graphene foam (3D-GF) using naturally abundant calcined Iceland crystal as the template is reported. Intriguingly, the Iceland crystal transforms to CaO monolith with evenly distributed micro/meso/macropores through the releasing of CO2 at high temperature. Meanwhile, the hierarchical structure of the calcined template could be easily tuned under different calcination conditions. By precisely inheriting fine structure from the templates, the as-prepared 3D-GF possesses a tunable hierarchical porosity and low density. Thus, the hierarchical pores offer space for guest hybridization and provide an efficient pathway for ion/charge transport in typical energy conversion/storage systems. The 3D-GF skeleton electrode hybridized with Ni(OH)2 /Co(OH)2 through an optimal electrodeposition condition exhibits a high specific capacitance of 2922.2 F g-1 at a scan rate of 10 mV s-1 , and 2138.4 F g-1 at a discharge current density of 3.1 A g-1 . The hybrid 3D-GF symmetry supercapacitor shows a high energy density of 83.0 Wh kg-1 at a power density of 1011.3 W kg-1 and 31.4 Wh kg-1 at a high power density of 18 845.2 W kg-1 . The facile fabrication process enables the mass production of hierarchical porous 3D-GF for high-performance supercapacitors.

Feeding Single-Walled Carbon Nanotubes or Graphene to Silkworms for Reinforced Silk Fibers.

Silkworm silk is gaining significant attention from both the textile industry and research society because of its outstanding mechanical properties and lustrous appearance. The possibility of creating tougher silks attracts particular research interest. Carbon nanotubes and graphene are widely studied for their use as reinforcement. In this work, we report mechanically enhanced silk directly collected by feeding Bombyx mori larval silkworms with single-walled carbon nanotubes (SWNTs) and graphene. We found that parts of the fed carbon nanomaterials were incorporated into the as-spun silk fibers, whereas the others went into the excrement of silkworms. Spectroscopy study indicated that nanocarbon additions hindered the conformation transition of silk fibroin from random coil and α-helix to ß-sheet, which may contribute to increased elongation at break and toughness modules. We further investigated the pyrolysis of modified silk, and a highly developed graphitic structure with obviously enhanced electrical conductivity was obtained through the introduction of SWNTs and graphene. The successful generation of these SWNT- or graphene-embedded silks by in vivo feeding is expected to open up possibilities for the large-scale production of high-strength silk fibers.

Establishment and characterization of a metastasis model of human gastric cancer in nude mice.

BACKGROUND: A mouse model of metastasis of human gastric cancer is one of the most important tools for studying the biological mechanisms underlying human gastric cancer metastasis. In this paper, we established a mouse model of metastatic human gastric cancer in nude mice that has a higher rate of tumor formation and metastasis than existing models. METHODS: To generate the mouse model of metastatic human gastric cancer, fresh tumor tissues from patients that have undergone surgery for gastric cancer were subcutaneously implanted in the right and left groins of nude mice. When the implanted tissue grew to 1 cubic centimeter, the mice were killed, and the tumor tissues were examined and resected. The tumor tissues were implanted into nude mice and subjected to pathological examination, immunohistochemical staining, and real-time PCR for cytokeratin 8/18 (CK8/18), E-cadherin, vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1). The mice were also analyzed for metastasis in their peritoneum, abdominal cavity, and internal organs by histopathological examination. Tissues collected from these organs were examined for pathology. RESULTS: After ten generations of implantation, all mice developed tumor growth at the implanted position, 94% of the mice developed metastasis to the retroperitoneum and viscera. The implanted and metastatic tumor maintained the same histological features across all generations, and metastasis was observed in the esophagus, stomach, spleen, liver, kidney, adrenal, intestine, and pancreas. These metastatic tumors revealed no detectable expression of CK8/18, E-cadherin, VCAM-1, and ICAM-1. CONCLUSIONS: This model will serve as valuable tool for understanding the metastatic process of human gastric cancer.

Air filtration in the free molecular flow regime: a review of high-efficiency particulate air filters based on carbon nanotubes.

Air filtration in the free molecular flow (FMF) regime is important and challenging because a higher filtration efficiency and lower pressure drop are obtained when the fiber diameter is smaller than the gas mean free path in the FMF regime. In previous studies, FMF conditions have been obtained by increasing the gas mean free path through reducing the pressure and increasing the temperature. In the case of carbon nanotubes (CNTs) with nanoscale diameters, it is possible to filtrate in the FMF regime under normal conditions. This paper reviews recent progress in theoretical and experimental studies of air filtration in the FMF regime. Typical structure models of high-efficiency particulate (HEPA) air filters based on CNTs are introduced. The pressure drop in air filters operated in the FMF regime is less than that predicted by the conventional air filtration theory. The thinnest HEPA filters fabricated from single-walled CNT films have an extremely low pressure drop. CNT air filters with a gradient nanostructure are shown to give a much better filtration performance in dynamic filtration. CNT air filters with a hierarchical structure and an agglomerated CNT fluidized bed air filter are also introduced. Finally, the challenges and opportunities for the application of CNTs in air filtration are discussed.

Acute liver failure associated with traditional Chinese medicine: report of 30 cases from seven tertiary hospitals in China*.

OBJECTIVES: Up to now, limited cases with acute liver failure caused by traditional Chinese medicine have been reported, and thus this topic has been scarcely discussed. This study aims to report such cases from China. DESIGN: A retrospective study. SETTING: Clinical investigation among seven tertiary hospitals in different areas of China. PATIENTS: From January 2007 to December 2012, patients with acute liver failure induced by traditional Chinese medicinal herbs were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 30 patients were finally identified, including six men and 24 women. The average age was 39.7 years. The median period from initial symptoms to the development of hepatic encephalopathy was 13 days. Nine patients (30%) had accepted herbal therapies due to their skin disorders before the onset of acute liver failure. Eighteen patients (60%) eventually died, 10 of whom died of heavy bleeding. No patients received liver transplantation. CONCLUSIONS: The model of safety monitoring for traditional Chinese materia medica should be established. For those critically ill patients with herb-induced acute liver failure, coagulopathy is a vital problem in critical care. Additionally, the rate of liver transplantation for acute liver failure in China needs to be improved.

Characterization of ß2-microglobulin expression in different types of breast cancer.

BACKGROUND: Βeta-2-microglobulin (ß2-M) has been demonstrated as a growth factor and signaling molecule in breast cancer and leukemia. The purpose of the study is to characterize ß2-M expression in molecular subtypes of breast cancer, thereby investigating the mechanism of ß2-M action in breast cancer. METHODS: ß2-M and B-Cell Lymphoma/Leukemia 2 (Bcl-2) transcript expression levels in breast cancer tissue and the corresponding normal tissue were quantified using real-time PCR. The protein expression levels of ß2-M, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), tumor protein 53 (p53) and Ki67 were determined by immunohistochemical (IHC) staining. Following silencing of the ß2-M by siRNA, the levels of Bcl-2, ER, PR and HER-2 transcripts and the protein expression levels in human breast cancer cells were measured by real-time PCR and western blotting, respectively. RESULTS: The expression of ß2-M transcripts demonstrated no significant differences between the four breast cancer molecular subtypes and no significant correlations with age, clinical stage or lymph node metastasis. ß2-M transcript expression demonstrated a positive correlation when compared to Bcl-2 transcript expression (P<0.05). The ß2-M protein expression was significantly higher in breast cancer when compared with benign breast tumors (P<0.01), and have no significant correlation with age, clinical stage or lymph node metastasis. There was a significant difference demonstrated in ß2-M protein expression in the four breast cancer molecular subtypes (P<0.05), and between the ER+ and ER- groups (P<0.01); however, no significant difference was demonstrated between the HER-2+ and HER-2- groups. ß2-M protein expression had a negative correlation with ER protein expression (P<0.01), a positive correlation with p53 protein expression (P<0.01), and no correlation with Ki67 protein expression. ß2-M silencing significantly inhibited Bcl-2 mRNA expression, but did not inhibit ER, PR and HER-2 mRNA expression in MCF-7 cells (ER+, PR+ and HER-2-). In addition, Bcl-2 and HER-2 mRNA expression were significantly up-regulated in MDA-MB-231 cells (ER-, PR- and HER-2-), which is consistent with the silencing effect seen at the protein level. CONCLUSIONS: ß2-M expression demonstrated a significant difference in the four breast cancer molecular subtypes, and may be related to apoptosis regulation in breast cancer.

Acute liver failure caused by severe acute hepatitis B: a case series from a multi-center investigation.

BACKGROUND: Few data can be available regarding acute liver failure (ALF) caused by severe acute hepatitis B up to now. This study aims to report such cases from China. FINDINGS: We conducted a multi-center investigation on ALF from 7 tertiary hospitals in different areas of China. A total of 11 patients with ALF caused by severe acute hepatitis B were finally identified. In these patients, there were 10 male and 1 female patients. As a serious complication, apparent hemorrhage occurred in 9 patients. Eventually, in these 11 patients, 4 survived and 7 died. 4 died of heavy bleeding, 2 died of systemic inflammatory response syndrome and 1 died of irreversible coma. No patients received liver transplantation. CONCLUSIONS: ALF caused by severe acute hepatitis B is worthy of formal studies based on its rarity and severity.

Acute liver failure in Chinese children: a multicenter investigation.

BACKGROUND: Currently, no documentation is available regarding Chinese children with acute liver failure (ALF). This study was undertaken to investigate etiologies and outcomes of Chinese children with ALF. METHODS: We retrospectively enrolled 32 pediatric patients with ALF admitted in five hospitals in different areas of China from January 2007 to December 2012. The coagulation indices, serum creatinine, serum lactate dehydrogenase, blood ammonia and prothrombin activity were analyzed; the relationship between these indices and mortality was evaluated by multivariate analysis. RESULTS: The most common causes of Chinese children with ALF were indeterminate etiology (15/32), drug toxicity (8/32), and acute cytomegalovirus hepatitis (6/32). Only 1 patient (3.13%) received liver transplantation and the spontaneous mortality of Chinese children with ALF was 58.06% (18/31). Patients who eventually died had higher baseline levels of international normalized ratio (P=0.01), serum creatinine (P=0.04), serum lactate dehydrogenase (P=0.01), blood ammonia (P<0.01) and lower prothrombin activity (P=0.01) than those who survived. Multivariate analysis showed that the entry blood ammonia was the only independent factor significantly associated with mortality (odds ratio=1.069, 95% confidence interval 1.023-1.117, P<0.01) and it had a sensitivity of 94.74%, a specificity of 84.62% and an accuracy of 90.63% for predicting the death. Based on the established model, with an increase of blood ammonia level, the risk of mortality would increase by 6.9%. CONCLUSIONS: The indeterminate causes predominated in the etiologies of ALF in Chinese children. The spontaneous mortality of pediatric patients with ALF was high, whereas the proportion of patients undergoing liver transplantation was significantly low. Entry blood ammonia was a reliable predictor for the death of pediatric patients with ALF.