The Effect of Molecular Adsorbent Recirculating System in Patients With Liver Failure: A Case Series of 44 Patients

BACKGROUND

Liver failure is associated with a high mortality rate, with many patients requiring transplant for definitive treatment. The Molecular Adsorbent Recirculating System (MARS) is a nonbiologic system that provides extracorporeal support. Literature on MARS therapy is mixed: outcomes support MARS therapy for patients with isolated acute liver failure, but data on patients with chronic disease is varied. Several case studies report success using MARS as a bridging treatment for patients awaiting transplant. The purpose of this case series is to present the outcomes of 44 patients who underwent MARS therapy for liver failure, 19 of whom used MARS therapy as a bridging therapy to transplant.

METHODS

This study retrospectively identified 44 patients who underwent MARS therapy for liver failure at Mayo Clinic, Jacksonville, between January 2014 and April 2021. Variables of interest included changes in laboratory markers of hepatic functioning, number and length of MARS therapy sessions, transplantation status, and mortality.

RESULTS

Following MARS therapy, there were improvements in mean serum bilirubin, ammonia, urea, creatinine, International Normalized Ratio, alanine aminotransferase, and aspartate aminotransferase levels. Twenty-seven patients (61.36%) survived the hospital stay; 17 (38.63%) died in the hospital. The majority of surviving patients (n = 19; 73.07%) received liver transplant. Six did not require transplant (22.22%). All but 1 patient who received MARS as a bridging treatment to transplant survived the follow-up period (n = 18; 94.74%).

CONCLUSIONS

Outcomes of these 44 cases suggest that MARS improves liver failure-associated laboratory parameters and may be effective therapy as a bridge to liver transplant.

Novel repurposing of a Laerdal Airway trainer to simulate aerosolisation

COVID-19 has claimed over 200 000 lives in the USA and put healthcare workers at risk. Healthcare workers have an increased exposure risk from aerosol-generating procedures such as endotracheal intubation. New barrier designs such as the acrylic box and horizontal plastic drape have emerged to reduce exposure to airborne particles. Particle generating models are needed to test aerosol generating procedure (AGP) barrier designs. To achieve this, an aerosol model that generates a visible and measurable increase in particles which SARS-CoV-2 could travel on and that can also be intubated was created. The model was created using a Laerdal Airway Management Trainer (Laerdal Medical, Stavanger, Norway) combined with a nebuliser and Ambu bag-valve resuscitator (Ambu, Columbia, Maryland, USA). Nebulised Glo Germ (Glo Germ, Moab, Utah, USA) dissolved in saline solution was moved through the tubing and out of the mannequin’s mouth with compression of the Ambu bag. This nebulisation was visualised under ultraviolet light and the quantity of particles between 0.3 and 10.0 μm was measured with a particle counter. Nebulisation was visible exiting the mouth of the mannequin. Nebulised Glo Germ was visualised under ultraviolet light moving in the ambient air. Particles in the size range of 0.3–0.5 µm increased by 20-fold and 1–10 µm increased by 10 252%. SARS-CoV-2 can travel on aerosol and droplet particles and particle generating models are needed to visualise and measure exposure areas and the path particles take during AGPs. We used existing medical and simulation supplies to create a particle simulator.

Infrared Observations of the Jovian System from Voyager 2

Infrared spectra obtainedfrom Voyager 2 have provided additional data on the Jovian system, complementing those obtained from Voyager 1. The abundance ratio of ethane to acetylene in Jupiter's atmosphere appears to be about three times larger in the polar regions than at lower latitudes. A decidedly hemispherical asymmetry exists, with somewhat higher ratios prevailing in northern latitudes. An overall increase in the abundance ratio by a factor of about 1.7 appears to have occurred between the Voyager 1 and 2 encounters. Global brightness temperature maps of Jupiter at 226 and 602 cm(-1) exhibit a large amount of local- and planetary-scale structure, as well as temporal variability. Although heterogeneous cloud structure and ammonia concentration in the lower troposphere may contribute to the appearance of the 226-cm(-1) map, the detail in the 602-cm(-1) maps probably represents the actual horizontal thermal structure near the tropopause and suggests that dynamical heating and cooling processes are important. Low-latitude surface temperatures on the Galilean satellites rangefrom approximately 80 K on the dark sides to 155 K at the subsolar point on Callisto. Below a thin insulating layer, the thermal inertia of Callisto is somewhat greater than that of Earth's moon. Upper limits on the infrared optical depth of the Jovian ring rangingfrom approximately 3 x 10(-4) at 250 cm(-1) to 3 x 10(-3) at 600 cm(-1) have been found.

Discovery of Currently Active Extraterrestrial Volcanism

The infrared spectroscopy and radiometry investigation has obtained spectra of Jupiter and its satellites between approximately 180 and 2500 cm(-1) with a spectral resolution of 4.3 cm(-1). The Jupiter spectra show clear evidence of H(2), CH(4) C(2)H(2), C(2)H(6), CH(3)D, NH(3), PH(3), H(2)O, and GeH(4). A helium concentration of 0.11 +/- 0.03 by volume is obtained. Meridional temperature cross sections show considerable structure. At high latitudes, the stratosphere is warmer in the north than in the south. The upper troposphere and lower stratosphere are locally cold over the Great Red Spot. Amalthea is warmer than expected. Considerable thermal structure is observed on Io, including a relatively hot region in the vicinity of a volcanic feature.

Apollo 16 Geochemical X-ray Fluorescence Experiment: Preliminary Report

The lunar surface was mapped with respect to magnesium, aluminum, and silicon as aluminum/ silicon and magnesium/ silicon intensity ratios along the projected ground tracks swept out by the orbiting Apollo 16 spacecraft. The results confirm the observations made during the Apollo 15 flight and provide new data for a number of features not covered before. The data are consistent with the idea that the moon has a widespread differentiated crust (the highlands). The aluminum/ silicon and magnesium/ silicon concentration ratios correspond to those for anorthositic gabbros through gabbroic anorthosites or feldspathic basalts. The x-ray results suggest the occurrence of this premare crust or material similar to it at the Descartes landing site.

Apollo 15 Geochemical X-Ray Fluorescence Experiment: Preliminary Report

Although only part of the information from the x-ray fluorescence geochemical experiment has been analyzed, it is clear that the experiment was highly successful. Significant compositional differences among and possibly within the maria and highlands have been detected. When viewed in the light of analyzed lunar rocks and soil samples, and the data from other lunar orbital experiments (in particular, the Apollo 15 gamma-ray spectroscopy experiment), the results indicate the existence of a differential lunar highland crust, probably feldspathic. This crust appears to be related to the plagioclase-rich materials previously found in the samples from Apollo 11, Apollo 12, Apollo 14, Apollo 15, and Luna 16.