Aim: To determine the prognostic risk factors of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) treated with plasma exchange (PE)-based artificial liver support system (ALSS), and create a prognostic predictive model. Methods:A total of 304 HBV-ACLF patients who received PE-based ALSS were retrospectively analyzed. Potential prognostic factors on admission associated with survival were investigated. Of note, 101 additional patients were analyzed to validate the performance of the prognostic models.Results: According to 28-day survival, a total of 207 patients who survived and 97 non-survivors were identified in the derivation group. Overall, 268 (88.2%) ACLF cases were caused by reactivation of HBV. Cox proportional hazards regression model revealed that age, total bilirubin, ln (alphafetoprotein [AFP]), encephalopathy (HE) score, sodium level, and international normalized ratio (INR) were independent risk factors of short-term prognosis. We built a model named ALSS-prognosis model (APM) to predict the 28-day survival of HBV-ACLF patients with ALSS; the model APM showed potentially better predictive performance for both the derivation and validation groups than MELD, MELD-Na, and CLIF-C ACLF score.Conclusions: Low AFP was found to be an independent risk factor for high mortality in HBV-ACLF patients treated with PE-based ALSS. We generated a new model containing AFP, namely APM, which showed potentially better prediction performance than MELD, MELD-Na, and CLIF-C ACLF score for short-term outcomes, and could aid physicians in making optimal therapeutic decisions. K E Y W O R D S AFP, ALSS, HBV-ACLF, plasma exchange Zhongyang Xie and Laurencia Violetta contributed equally to this study.

testing at regional hospitals to analyse samples from multiple facilities, and a hub-and-spoke model whereby highvolume sites conduct POC testing and serve as hubs for samples collected from other sites in their areas. Our results suggest that the strategy of POC testing at every antenatal care facility was the most expensive because of large capital costs and might be unaffordable for low-income countries. 4 Although syndromic management was the least expensive strategy, it resulted in fewer infections cured and considerable overtreatment. Among testing strategies, we found that the hub-and-spoke approach would offer the optimal cost per infection averted.Modelling analyses that incorporate system dynamics-ie, patient volume, disease burden, infrastructure, and budget effects-could inform plans to scale-up testing to improve STI management globally. Our analysis suggests strategies for reducing costs and maximising impact by strategically situating POC testing. There are additional opportunities for cost reductions, such as integrating testing into antenatal care services, maximising multiplex capacity, and using existing but underused resources, such as the GeneXpert Mycobacterium tuberculosis testing network, which could reduce capital costs and have important clinical and public health benefits.In the past 12 months, JDK has received research support, including donated supplies, from Cepheid, the manufacturer of GeneXpert. All other authors declare no competing interests.

The present study evaluated the effect of combining inhibitors (17-aaG) of heat shock protein 90 (HSP90) and autophagy (3-Ma) on apoptosis using an incomplete thermal ablation animal model. a total of 28 orthotopic mice with hepatocellular carcinoma were randomly divided into 4 groups to receive different drug interventions. Following palliative laser ablation, changes in autophagy, apoptosis and akt/mTor expression levels were assessed in tumors. compared with the controls, the 17-AAG-treated mice exhibited significantly decreased expression levels of phosphorylated (p)-akt and p-mTor with enhanced autophagy and apoptosis; no marked increases in the expression levels of p-akt and p-mTor were observed in the 3-MA-treated mice, with no significant changes in autophagy; however, apoptosis was enhanced. no significant decreases in p-Akt and p-mTOR or any increase in autophagy were observed in the mice receiving a combination of 17-aaG and 3-Ma, but they did exhibit a marked increase in apoptosis. compared with 17-aaG alone, the combination of 17-aaG and 3-Ma resulted in a marked increase in apoptosis without enhanced autophagy. in the incomplete ablation model, the effects of autophagy and apoptosis are antagonistic. The combined use of 17-AAG and 3-MA can significantly promote apoptosis and is worthy of further study.

Patients with chronic kidney disease (CKD), including dialysis and transplant patients, are at greater risk of contracting SARS-CoV-2 due to kidney dysfunction and preexisting comorbidities. To date, a specific guideline on managing these high-risk patients infected with COVID-19 has not been established. As the current management of COVID-19 comprises mainly experimental drugs, the authors aim to provide information on dosing adjustments at different stages of kidney dysfunction and notable renal side effects. We performed a nonsystematical review of currently available COVID-19 drugs exploring several different clinical trial databases and search browsers. Several antivirals and monoclonal antibodies used in COVID-19 treatment require dosage adjustments in kidney dysfunction. In a global pandemic setting, nephrologists need to consider the appropriate dosage according to the renal function and closely monitor the side effects of different drug combinations to obtain the optimum therapeutic effect while avoiding further renal damage. Further studies are required to determine the safety and efficacy of these drugs in renal patients.

Despite an increase in incident peritoneal dialysis (PD) use of 20% per year, the overall PD prevalence in Indonesia is only 1–2%, with the goal of 30% yet to be reached by 2019. In the absence of contraindications, increasing continuous ambulatory PD (CAPD) use may be an attractive option for Indonesia to reduce the high costs of end-stage kidney disease (ESKD) treatment. The implementation of CAPD in Indonesia faces several challenges, including the cost of PD, the unique archipelagic geography, limited facilities and trained medical personnel in rural areas, inadequate reimbursement rates and incentive fees, high rates of PD discontinuation, as well as insufficient knowledge regarding CAPD by the general public and health professionals. Changes in the policy of medical service incentive fees and improvements in the national health insurance system regulation over CAPD may improve the utilization of PD for ESKD patients in Indonesia. Nationwide promotional and preventive efforts on chronic kidney disease, dialysis modality education and establishment of PD training programs for medical professionals are necessary.