Current Evidence for Extracorporeal Liver Support Systems in Acute Liver Failure and Acute-on-Chronic Liver Failure
Abstract Artificial (nonbiological) extracorporeal liver support devices aim to remove albumin-bound and water-soluble toxins to restore and preserve hepatic function and mitigate or limit the progression of multiorgan failure while hepatic recovery or liver transplant occurs. The following beneficial effects have been documented: improvement of jaundice, amelioration of hemodynamic instability, reduction of portal hypertension, and improvement of hepatic encephalopathy. The only randomized prospective multicenter controlled trial to show an improvement in transplant-free survival was for high-volume plasmapheresis. Biological (cell-based) extracorporeal liver support systems aim to support the failing liver through detoxification and synthetic function and warrant further study for safety and benefit.
Video delivery in a mobile ad-hoc network that can be deployed by members of an emergency service in an incident zone is an appealing tool for emergency and rescue services, but has not been studied yet. In order to design and test a suitable solution, we have generated realistic evaluation scenarios by modeling fireman action plans and GPS traces from real situations. We propose an overlay network solution with routing and reliability mechanisms. The Emergency Overlay Routing (EOR) protocol is a reactive protocol integrated into a store-carry-forward architecture. It selects ferry nodes to transport video data from a camera in the Incident Area to the Incident Chief’s node, looking for the minimum delay, but reliable, candidate. We also propose a simple credit based mechanism (RTCP+) to improve the communication reliability. The evaluation of the whole system shows a great improvement against previous results and promising expectations.