六安市人民医院引进最先进德国产MARS人工肝支持系统

六安市人民医院感染科引进了世界上最先进的德国产MARS人工肝支持系统，该设备可完成人工肝支持系统的各种治疗模式，是抢救危重型肝炎及肝功能衰竭的最有效方法。     

分子吸附再循环人工肝治疗重度肝损害的临床观察和护理

目的探讨分子吸附再循环(以下简称MARS)人工肝支持系统治疗重度肝损害的疗效和护理。方法选取10例急性重度肝损害病人作为实验组,选取10例慢性乙型重症肝炎病人作为对照组,总计行78例次MARS人工肝治疗,分别对代表肝脏损害程度的指标ALT、TBIL、NH_3给予治疗后比较。结果MARS人工肝对于急、慢性重度肝损害引起的血清毒素累积均有显著的清除作用,对急性重度肝损害引起的ALT、TBIL、NH_3升高的清除作用两组差异有统计学意义(P<0.01);对慢性肝病基础上的重度损害引起的ALT升高的作用两组差异有统计学意义(P<0.05),对TBRL、NH_3升高的作用两组差异无统计学意义(P>0.05)。结论MARS人工肝可以有效地清除急、慢性重度肝损害引起的脂溶性、水溶性代谢毒素,减轻肝脏的负担,改善临床症状,延缓病情的进展。     

MARS人工肝支持系统的应用和研究进展

重型肝炎及肝功能衰竭(简称肝衰竭)在我国十分常见,对其治疗目前仍以内科综合治疗为主,但常因病情进展快,病死率一直居高不下。人工肝支持系统治疗是一疗效确切、安全的治疗方法,已在我国多家医院应用。分子吸附循环系统(MARS)是一种选择性清除白蛋白结合毒素(ABT),具有高生物相容性、高选择性、无细胞操作等特点的新型的人工肝支持系统,国内外大量资料表明其在临床方面有较为确切的疗效。本文针对MARS系统的基本原理、临床应用研究作一系统回顾。     

MARS人工肝支持系统的应用和研究进展

重型肝炎及肝功能衰竭(简称肝衰竭)在我国十分常见，对其治疗目前仍以内科综合治疗为主，但常因病情进展快，病死率一直居高不下。人工肝支持系统治疗是一疗效确切、安全的治疗方法，已在我国多家医院应用。分子吸附循环系统(MARS)是一种选择性清除白蛋白结合毒素(ABT)，具有高生物相容性、高选择性、无细胞操作等特点的新型的人工肝支持系统，国内外大量资料表明其在临床方面有较为确切的疗效。本文针对MARS系统的基本原理、临床应用研究作一系统回顾。     

人工肝设备和技术的进展与临床评价

人工肝脏技术是人体重要的器官支持治疗，有望成为重型肝炎肝衰竭及其它一些肝病最常用和最有效的治疗方法之一。由于肝脏在人体代谢的中枢地位、复杂性及肝病的多发性，使得人工肝支持系统比其它任何人工器官更具发展潜力和挑战性。本文综述了几种主要人工肝技术的进展与临床应用情况，并对人工肝脏治疗存在的困难及发展方向进行了讨论和展望。     

生物人工肝反应器的平台——带有具沟的酶基质

人工肝支持系统是目前公认治疗各种急性肝功能衰竭的最有效方法。从20世纪50年代国外开始进行人工肝的研究以来，到目前为止，人工肝支持系统研究取得了很大的进展。其中生物型人工肝（bioartificial liver，EBLSS）的研究最为瞩目。EBI。SS不仅具有肝特异性的解毒功能，而且具有物质代谢和生物合成转化功能，是人工肝历史上最先进的支持系统。     

六安市人民医院人工肝新技术填补市内一项空白

近日,六安市人民医院感染科连续成功实施二人次人工肝新技术治疗重型肝炎,获得预期疗效。此项技术填补了该院在重型肝炎治疗方面的空白,同时达到市内领先水平。六安市人民医院自2014年5月份引进世界上最先进的德国产MARS人工肝支持系统后,选派医护人员外出培训学习,用所学新技术应用于临床。人工肝支持系统是借助体外机械、化学或生物性装置,暂时及部分代替肝脏功能,协助治疗肝功能不全、肝衰竭或相关肝脏疾病的方法。     

生物人工肝用肝细胞源的研究进展

生物人工肝支持系统是目前公认的治疗因各种原因所致暴发型肝衰竭最有前途的方法，已在动物实验及临床应用中取得了确切疗效。肝细胞作为生物人工肝的主要生物成分，在该系统中扮演举足轻重的角色，本文就近年来作为生物人工肝用肝细胞的研究进展作了综述。     

优质护理结合人工肝治疗仪对重型肝炎患者肝功能及遵医行为的影响

目的探究优质护理结合人工肝治疗仪在重型肝炎患者中的应用效果。方法选取2016年7月至2018年9月在医院就诊的76例重型肝炎患者,按照随机数字表法分为两组,各38例。两组均给予人工肝治疗仪治疗,对照组治疗期间实施常规护理干预,观察组在对照组基础上实施优质护理干预,比较两组干预前后肝功能指标水平及遵医行为。结果干预后,观察组总胆红素(TBIL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)水平均低于对照组,遵医行为评分高于对照组,差异有统计学意义(P<0.05)。结论优质护理结合人工肝治疗仪在重型肝炎患者中的应用效果显著,可改善患者的遵医行为,促进患者肝功能改善。     

人工肝技术临床应用的护理要点及展望

我国人工肝技术的研究及应用起步较晚，但发展非常迅速，特别是在临床应用方面，目前全国已有上百家医院开展了不同的人工肝临床治疗。随着人工肝工作的不断发展和推广，作为人工肝工作重要组成部分的人工肝护理，也日益受到重视。但由于人工肝在我国仍处于起步和发展阶段，不同地区、不同单位之间在设备条件、开展方法及技术水平等方面存在较大差别，本文就常用人工肝技术的护理要点进行总结，供从事人工肝护理的护士学习参考。     

'Artificial support in case of hepatic failure'; a report from the Dutch Health Council

Acute liver failure has a high mortality (40-95%) depending on the cause. Emergency liver transplantation is the only way to improve survival: a one-year survival of 5o-6o%. In the past, many different modalities of artificial liver support have been studied. None of them appeared to be able to improve survival compared to maximal intensive care treatment. Two rather recent approaches are the development of a bioartificial liver (BAL), charged with billions of porcine liver cells, and albumin dialysis (MARS). A signalling report has been sent to the Dutch Minister of Health to resume the current position of BAL and MARS in the treatment of severe liver failure. The outcome is that no firm conclusions can yet be drawn as to the applicability of these modalities. Only two small-scale controlled clinical trials have been published on the MARS technique and the only published large-scale controlled clinical trial of a BAL in acute liver failure is not conclusive. On theoretical grounds, BAL treatment has more potential than MARS since a BAL will replace not only the failing hepatic detoxification but also the synthetic and metabolic functions. So far, no evidence has been found for transmission ofporcine pathogens to patients despite numerous phase 1 studies of bioartificial livers charged with porcine hepatocytes. More well-designed controlled clinical trials are needed. Therefore, the Dutch moratorium on xenotransplantation should be revised.     

Multivariate adaptive regression splines: a powerful method for detecting disease-risk relationship differences among subgroups

In a wide variety of medical research scenarios one is interested in the question whether regression curves differ for subgroups in the sample. Examples are gender differences in the effect of drug treatment or the study of genotype-environment interactions. To address this question exploratory techniques are often required because detailed knowledge concerning the shape of the regression curves and how that shape differs across subgroups is lacking. In this article we explored the power of two such exploratory techniques: multivariate adaptive regression splines (MARS) and least squares curve fitting using polynomials. For this purpose simulations were performed using linear, logistic, and complex non-linear curves. The power obtained from MARS was on average 1.4 times higher than with polynomials. It was shown that power was higher even if the regression curve was linear, that gains increased with the complexity of the curve, and that for highly non-linear curves model-free methods such as MARS might be the only alternative.     

Management of prenatal care information: integration of the problem list and clinical comments

To improve the functionality of our MAternal Record System (MARS), we reviewed the clinical problems entered into the MARS database from approximately 2800 patient records and interviewed representative clinicians about their use of the Clinical Comments and Problem List sections of MARS. Problems were assigned a unique term that corrected for spelling, spacing, synonyms, and abbreviation variations. Analysis of these terms suggested design changes that would increase the number of unique entries into the Problem List, including (1) modifications in the automated problem entry functions within MARS and (2) integration of the Problem List and Clinical Comments sections.     

The pervading influence of alcoholic liver disease in hepatology

Rising levels of alcohol consumption in the UK are leading to substantial increases in morbidity and mortality from liver disease. Drinking is starting at an earlier age with binging an increasing common pattern, and women are overtaking men in the consumption. Manifestations of liver damage range from fatty liver to end-stage cirrhosis, but it is the increasing number of cases presenting with an acute alcoholic hepatitis (AAH) that are the cause for greatest concern. Development of well-validated prognostic scoring systems (Maddrey Modified Discriminant Function, Glasgow Alcohol Score) makes it possible to select those patients with AAH who are most likely to respond to corticosteroids. The results of early pilot studies of a number of anti-TNF agents are encouraging and with infliximab, reduction in portal pressure has been demonstrated to be consequent on controlling inflammatory processes in the liver. For those deteriorating to the stage of liver failure, artificial liver support with MARS is of value in correcting major pathophysiological disturbances and as a bridge to liver transplantation, the results of which both for end-stage alcoholic cirrhosis and for AAH--of which there is limited experience, are excellent. Even as the stringent regulatory measures needed to control rising alcohol consumption are introduced by government, the burden of liver disease in the UK will remain high for years to come.     

The Benefits of Telephone-Access Medical Consultation

A major disadvantage of rural medical practice is the limited reserve of consultative options. To determine the perceived clinical utility and educational impact of the West Virginia University Medical Access and Referral System (MARS), a 24-hour prompt telephone-consultation service, a mailed questionnaire was administered to 303 West Virginia clinicians who had used MARS for infectious disease problems. The overall questionnaire response rate was 62 percent. Callers included family practitioners (35%), medical specialists (32%), surgical specialists (13%), pediatricians (11%), obstetricians (5%), and nonphysicians (4%). Major referral questions posed were therapeutic (60%), diagnostic (48%), and epidemiologic (10%) in nature. On a scale of 1 (not useful) to 5 (very useful), survey responders rated the overall clinical usefulness of MARS as either a 4 (22%) or 5 (76%). Callers felt that MARS consultation assisted in accurate case diagnosis in 80 percent of cases, and aided in successful therapeutic management of 96 percent of cases. An educational benefit was reported by 96 percent of responders. Physicians located in more rural, underserved areas tended to use MARS to a greater degree than colleagues in more populated, medically accessible areas (P < 0.005). These findings suggest that an academic telephone-access consultation program can be a clinically relevant and educational consultative tool for practicing clinicians, especially those located in rural areas.     

Common Disease Analysis Using Multivariate Adaptive Regression Splines (MARS): Genetic Analysis Workshop 12 Simulated Sequence Data

A newly developed modern analytic approach, Multivariate Adaptive Regression Splines (MARS), was used to identify both genetic and non‐genetic factors involved in the etiology of a common disease. We tested this method on the simulated data provided by the Genetic Analysis Workshop (GAW) 12 in problem 2 for the isolated population. MARS simultaneously analyzes all inputs, in this case DNA sequence variants and non‐genetic data, and selectively prunes away variables contributing insignificantly to fit by internal cross‐validation to arrive at a generalizable predictive model of the response. The relevant factors identified, by means of an importance value computed by MARS, were assumed to be associated with risk to the disease. The application of a series of subsequent models identified the quantitative traits and a single major gene contributing directly to risk liability using five sets of 7,000 individuals. © 2001 Wiley‐Liss, Inc.     

Dosimetry in MARS spectral CT: TOPAS Monte Carlo simulations and ion chamber measurements

Spectral computed tomography (CT) is an up and coming imaging modality which shows great promise in revealing unique diagnostic information. Because this imaging modality is based on X-ray CT, it is of utmost importance to study the radiation dose aspects of its use. This study reports on the implementation and evaluation of a Monte Carlo simulation tool using TOPAS for estimating dose in a pre-clinical spectral CT scanner known as the MARS scanner. Simulated estimates were compared with measurements from an ionization chamber. For a typical MARS scan, TOPAS estimated for a 30 mm diameter cylindrical phantom a CT dose index (CTDI) of 29.7 mGy; CTDI was measured by ion chamber to within 3% of TOPAS estimates. Although further development is required, our investigation of TOPAS for estimating MARS scan dosimetry has shown its potential for further study of spectral scanning protocols and dose to scanned objects.     

Using multivariate adaptive regression splines to QSAR studies of dihydroartemisinin derivatives

QSAR models for analogs of antiplasmodial artemisinin compounds were established, based on atomic net charges by using multivariate adaptive regression splines (MARS) in comparison with some other methods such as multiple linear regression, alternating conditional expectations and projection pursuit regression. The established models were then evaluated by an Anova decomposition procedure so that the effects of each predictor (additive or interaction) could be viewed graphically, facilitating the interpretation of the underlying relationship. It was found that the QSARs derived from the MARS method are the most satisfactory predictive models, and that the artemisinin pharmacophore identification is in agreement with previous experimental findings.     

Residual-based tree-structured survival analysis.

Extensions of various non-parametric regression techniques (for example, additive models, trees, MARS) have been devised for right censored survival data. These approaches directly handle the difficulties posed by censoring. However, it is possible to bypass these difficulties by utilizing standard non-parametric regression procedures applied with (say) martingale residuals as outcome. Analytic correspondences between the direct and residual-based approaches have been established for additive models while more qualitative comparisons have been provided for MARS. Here we develop such correspondences for tree-structured regression. In particular, we provide an analytic relationship between logrank and martingale residual sum-of-squares split functions that explains the widely observed similarity of the resultant trees. Further investigation is provided by simulation and an illustrative example using time to AIDS with data deriving from a Western Australian HIV cohort study.