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The liver is the only organ which can regenerate and, thus, potentially negate the need for transplantation in acute liver failure (ALF). Cerebral edema and sepsis are leading causes of mortality in ALF. Both water-soluble and protein-bound toxins have been implicated in pathogenesis of various ALF complications. Ammonia is a surrogate marker of water-soluble toxin accumulation in ALF and high levels are associated with higher grades of hepatic encephalopathy, raised intracranial pressure, and mortality. Therefore, extracorporeal therapies aim to lower ammonia and maintain fluid balance and cytokine homeostasis. The most common and easily available modality is continuous kidney replacement therapy (CKRT). Early initiation of high-volume CKRT utilizing an anticoagulation regimen minimizing treatment downtime and delivering the prescribed dose is highly desirable. Ideally, extracorporeal liver-assist devices (ECLAD) should perform both synthetic and detoxification functions of the liver. ECLAD may temporarily replace lost liver function and serve as a bridge, either to spontaneous recovery or liver transplantation. Various bioartificial and biologic liver-assist devices are described in specialty literature, including molecular adsorbent recirculating system (MARS), single pass albumin dialysis (SPAD), and total plasma exchange (TPE); however, clinicians commonly use modalities easily available in intensive care units. There is a lack of standardization of indications for ECLAD, availability of different extracorporeal devices with varied technical approaches, and, of note, the differences in doses of ECLAD provided in clinical practice. We review the practicalities and evidence regarding these four artificial liver support devices in pediatric ALF.

The present study reports an alternative method of functionalizing the optical fiber Surface Plasmon Resonance (SPR) sensing probe with antibodies for label-free detection of bovine serum albumin (BSA) protein. In this novel approach, the gold coated fiber was first modified with Molybdenum disulfide (MoS 2 ) nanosheets followed by its bio-functionalization with Anti-BSA antibodies. The developed technique not only allowed the amplification of the SPR signals by synergic effects of MoS 2 and gold metallic thin film but also enabled a direct and chemical-free attachment of representative antibodies through hydrophobic interactions. The sensitivity of the MoS 2 modified sensing probe with detection limit of 0.29 µg/mL was improved as compared to the fiber optic SPR biosensor without MoS 2 overlayer (Detection limit  for BSA was 0.45 μg/mL). The developed biosensor has good specificity, and environmental stability. Accordingly, the proposed design of the MoS 2 based SPR optical biosensor can offer the development of a simplified optical device for the monitoring of various biomedical and environmental parameters.

The present work explores the synergistic impact of mullite-based thermal barrier coatings (TBCs) and varying compression ratios (CRs) on the performance, combustion, and emission behavior of a single-cylinder, four-stroke variable compression ratio (VCR) diesel engine operated with Scum Oil Methyl Ester (SOME) diesel fuel blends. Mullite ceramic (3Al 2 O 3 ·2SiO 2 ) was applied via plasma spraying onto engine components including the piston crown, cylinder head, and intake/exhaust valves to minimize thermal losses. Experimental tests were carried out at CRs of 16.0, 17.5, and 19.0 using conventional diesel and blends of SOME (B20, B40, B60, B80, and B100 samples) in both coated and uncoated engine setups. The coated engine exhibited its best performance at CR 19, recording a BTE improvement of 7.51% for diesel and 5.75% for B20, alongside BSFC reductions of 14.28% and 9.09%, respectively, compared to the uncoated configuration. Additional enhancements were observed in terms of peak in-cylinder pressure, heat release rate, combustion efficiency, and reduced ignition delay and combustion duration. Emission measurements showed notable decreases in CO, HC, and smoke11.41%, 10.56%, and 9.43% for B20, and 6.16%, 7.10%, and 8.84% for diesel while only slight increases in NO x and CO 2 emissions were recorded. These findings highlight the effectiveness of combining biodiesel and thermal barrier coatings in achieving improved efficiency and lower emissions, with the B20 blend at CR 19 showing the most favorable results for sustainable diesel engine operation.

During the coronavirus disease 2019 (COVID-19) global pandemic, there has been a need to develop surge capacity. Since the disease is uncommon in children, working on a paediatric intensive care unit (PICU) has required an expansion of roles and responsibilities outside established confines. The most drastic change in practice involved having to care for both critically ill adults and children side by side on the PICU. Redeployment to work on an adult critical care unit as required was similarly momentous. Based on our experience of managing this surge in one of the UK’s worst hit tertiary hospitals, we are sharing our reproducible approaches that benefitted trainees. This will be relevant to paediatricians globally who are assisting in critical care strategies and future pandemic planning.

Sepsis-associated acute kidney injury (SA-AKI) is common in critically ill patients and is strongly associated with adverse outcomes, including an increased risk of chronic kidney disease, cardiovascular events and death. The pathophysiology of SA-AKI remains elusive, although microcirculatory dysfunction, cellular metabolic reprogramming and dysregulated inflammatory responses have been implicated in preclinical studies. SA-AKI is best defined as the occurrence of AKI within 7 days of sepsis onset (diagnosed according to Kidney Disease Improving Global Outcome criteria and Sepsis 3 criteria, respectively). Improving outcomes in SA-AKI is challenging, as patients can present with either clinical or subclinical AKI. Early identification of patients at risk of AKI, or at risk of progressing to severe and/or persistent AKI, is crucial to the timely initiation of adequate supportive measures, including limiting further insults to the kidney. Accordingly, the discovery of biomarkers associated with AKI that can aid in early diagnosis is an area of intensive investigation. Additionally, high-quality evidence on best-practice care of patients with AKI, sepsis and SA-AKI has continued to accrue. Although specific therapeutic options are limited, several clinical trials have evaluated the use of care bundles and extracorporeal techniques as potential therapeutic approaches. Here we provide graded recommendations for managing SA-AKI and highlight priorities for future research.Sepsis-associated acute kidney injury (SA-AKI) is linked with poor outcomes in critically ill patients. This Consensus Statement from the Acute Disease Quality Initiative discusses the definition, epidemiology and pathophysiology of SA-AKI, fluid, resuscitation and extracorporeal therapies, and the role of biomarkers in risk stratification and diagnosis.

L-cysteine conjugated molybdenum disulphide (MoS 2 ) nanosheets have been covalently attached to a gold coated surface plasmon resonance (SPR) optical fiber to prepare a robust and stable sensor. Owing to the multifunctionality of the deposited nanosheet conjugate, the antibodies are also covalently conjugated in the subsequent step to realize the design of a SPR optical fiber biosensor for the two important bioanalytes namely, Ferritin and Immunoglobin G (IgG). The different stages of the biosensor preparation have been characterized and verified with microscopic and spectroscopic techniques. A uniform and stable deposition of the L-cysteine/MoS 2 nanosheets has allowed the biosensor to be reused for multiple times. Unlike the peeling-off of the MoS 2 coatings from the gold layer reported previously in the case of physically adsorbed nanomaterial, the herein adopted strategy addresses this critical concern. It has also been possible to use the single SPR fiber for both Ferritin and IgG bioassay experiments by regenerating the sensor and immobilizing two different antibodies in separate steps. For ferritin, the biosensor has delivered a linear sensor response (SPR wavelength shifts) in the concentration range of 50–400 ng/mL, while IgG has been successfully sensed from 50 to 250 µg/mL. The limit of detection for Ferritin and IgG analysis have been estimated to be 12 ng/mL and 7.2 µg/mL, respectively. The biosensors have also been verified for their specificity for the targeted molecule only. A uniform and stable deposition of the nanomaterial conjugate, reproducibility, regeneration capacity, a good sensitivity, and the specificity can be highlighted as some of key features of the L-cysteine/MoS 2 optical fiber biosensor. The system can be advocated as a useful biosensor setup for the sensitive biosensing of Ferritin and IgG.

In the context of emerging electric devices, the demand for advanced energy storage materials has intensified. These materials must encompass both surface and diffusion-driven charge storage mechanisms. While diffusion-driven reactions offer high capacitance by utilizing the bulk of the material, their effectiveness diminishes at higher discharge rates. Conversely, surface-controlled reactions provide rapid charge/discharge rates and high power density. To strike a balance between these attributes, we devised a tri-composite material, TiO 2 /Carbon/MoS 2 (T10/MoS 2 ). This innovative design features a highly porous carbon core for efficient diffusion and redox-active MoS 2 nanosheets on the surface. Leveraging these characteristics, the T10/MoS 2 composite exhibited impressive specific capacitance (436 F/g at 5 mV/s), with a significant contribution from the diffusion-controlled process (82%). Furthermore, our symmetrical device achieved a notable energy density of ~ 50 Wh/kg at a power density of 1.3 kW/kg. This concept holds promise for extending the approach to other Metal–Organic Framework (MOF) structures, enabling enhanced diffusion-controlled processes in energy storage applications.

It is critical for hospitals to accurately predict patient length of stay (LOS) and mortality in real-time. We evaluate temporal convolutional networks (TCNs) and data rebalancing methods to predict LOS and mortality. This is a retrospective cohort study utilizing the MIMIC-III database. The MIMIC-Extract pipeline processes 24 hour time-series clinical objective data for 23,944 unique patient records. TCN performance is compared to both baseline and state-of-the-art machine learning models including logistic regression, random forest, gated recurrent unit with decay (GRU-D). Models are evaluated for binary classification tasks (LOS > 3 days, LOS > 7 days, mortality in-hospital, and mortality in-ICU) with and without data rebalancing and analyzed for clinical runtime feasibility. Data is split temporally, and evaluations utilize tenfold cross-validation (stratified splits) followed by simulated prospective hold-out validation. In mortality tasks, TCN outperforms baselines in 6 of 8 metrics (area under receiver operating characteristic, area under precision-recall curve (AUPRC), and F-1 measure for in-hospital mortality; AUPRC, accuracy, and F-1 for in-ICU mortality). In LOS tasks, TCN performs competitively to the GRU-D (best in 6 of 8) and the random forest model (best in 2 of 8). Rebalancing improves predictive power across multiple methods and outcome ratios. The TCN offers strong performance in mortality classification and offers improved computational efficiency on GPU-enabled systems over popular RNN architectures. Dataset rebalancing can improve model predictive power in imbalanced learning. We conclude that temporal convolutional networks should be included in model searches for critical care outcome prediction systems.