L. Turchetti

Predictive criteria for the outcome of patients with acute liver failure treated with the albumin dialysis molecular adsorbent recirculating system.

The aim of this study was to evaluate the improvement of prognostic parameters after treatment with the molecular adsorbent recirculating system (MARS) in patients with fulminant hepatitis (FH). The parameters conducive to a positive prognosis include: Glasgow Coma Scale (GCS) score ≥11, intracranial pressure (ICP) <15 mm Hg or an improvement of the systolic peak flow of 25–32 cm/s via Doppler ultrasound in the middle cerebral artery, lactate level <3 mmol/L, tumor necrosis factor‐α <20 pg/mL, interleukin (IL)‐6 <30 pg/mL, and a change in hemodynamic instability from hyperkinetic to normal kinetic conditions, and so define the timing (and indeed the necessity) of a liver transplant (LTx). From 1999 to 2008 we treated 45 patients with FH with MARS in the intensive care unit of our institution. We analyzed all the parameters that were statistically significant using univariate analysis and considered the patients to be candidates for inclusion in a multivariate logistic regression analysis. Thirty‐six patients survived: 21 were bridged to liver transplant (the BLT group) and 15 continued the extracorporeal method until native liver recovery (the NLR group) with a positive resolution of the clinical condition. Nine patients died before transplantation due to multi‐organ failure. We stratified the entire population into three different groups according to six risk factors (the percentage reduction of lactate, IL‐6 and ICP, systemic vascular resistance index values, GCS <9, and the number of MARS treatments): group A (0–2 risk factors), group B (3–4 risk factors), and group C (5–6 risk factors). Analyzing the prevalence of these parameters, we noted that group A perfectly corresponded to the NLR group, group B corresponded to the BLT group, and group C was composed of patients from the non‐survival group; thus, we were able to select the patients who could undergo a LTx using the predictive criteria. For patients with an improvement of neurological status, cytokines, lactate, and hemodynamic parameters, LTx was no longer necessary and their treatment continued with MARS and standard medical therapy.

Cytokine Level Modifications: Molecular Adsorbent Recirculating System Versus Standard Medical Therapy

INTRODUCTION Acute-on-chronic liver failure (ACLF) is a systemic inflammatory reaction, which is characterized by a predominantly proinflammatory cytokine profile, causing the transition from stable cirrhosis to ACLF. The aim of the present study was to evaluate the changes in several cytokines associated with inflammatory liver disease and liver regeneration among 15 ACLF patients treated with the Molecular Adsorbent Recirculating System (MARS) compared with 15 patients treated with standard medical therapy (SMT). The subjects showed various disease etiologies but similar values for Model End-stage Liver Disease scores. METHODS In the MARS group, 15 (10 male and 5 female) patients were treated with MARS (Gambro). The number of MARS applications was nine; the length of applications was 8 hours. In the SMT group; 15 (10 male and 5 female) patients were treated with SMT. The patients were monitored for 30 days from inclusion with a survival follow-up at 3 months. Statistical results were calculated with SPSS14.0 (SPSS Inc, Chicago, Ill). A P < .07 was considered significant. RESULTS In the MARS group, we observed significant changes in the levels of Interleukin (IL)-6, IL-1, IL-10, and tumor necrosis factor (TNF)-alpha in association with improved hepatocyte growth factor. Patient survival at 3 months was 60%. The SMT group showed only a significant change in TNF-alpha (P = .03). Patient survival at 3 months was 30%. CONCLUSION The MARS liver support device corrected pathophysiologies of ALF and may be used to enhance spontaneous recovery or as a bridge to transplantation.

Low-temperature H 2 O 2 -powered actuators for biorobotics: Thermodynamic and kinetic analysis

The need for novel, high performance actuators felt in several fields of robotics, such as assistive or rehabilitative robotics, is not fully satisfied by current actuation means. This fosters an intense research on novel energy transduction methods. In particular, propellant-based chemical actuators, able to directly convert chemical energy into mechanical energy, appear very promising, although their potential in robotics has not yet been deeply investigated. This work focuses on H2O2, used as propellant for actuators. This chemical was first used in robotics, with excellent results, by Goldfarb and collaborators, in 2003. H2O2 dissociation is strongly exothermic, which generates important design issues when the actuated machine operates in close proximity to the human body. In this paper it is shown that: 1) is possible to operate the decomposition process at acceptable temperature, by means of basic solutions of hydrogen peroxide; 2) for basic pH solutions, tin becomes an effective catalyst for H2O2 dissociation. A kinetic model of H2O2 dissociation in basic solutions is provided, that is in good agreement with experimental data. We show how the model can be used to gather the necessary information for the dimensioning of H2O2-based actuators.

How Does Radial Convection Influence the Performance of Membrane Module for Gas Separation Processes

A two-dimensional axial-symmetric isothermal model, based on full coupling between mass and momentum transport, has been developed to describe the separation of a binary gaseous mixture in a packed bed membrane module. Steady-state conditions have been studied. The gaseous mixture to be separated enters an annular gap between two co-axial cylinders. The inner wall of the outer cylinder is impermeable to both components, whereas a membrane, with infinite selectivity towards one of the components, is supported onto the outer wall of the inner cylinder. A radial flux of the permeating components is therefore present. The main focus was on the determination of the influence of radial convection on the performance of the separator, which has been analysed in terms of three dimensionless groups. Different transport regimes could be identified, corresponding to different values of the dimensionless groups. The impact of radial convection has been assessed by comparing model predictions with those of a fully uncoupled one-dimensional model. A discrepancy up to 20% of the recovery has been observed in industrially relevant ranges of the parameters.