Acute-on-Chronic Liver Failure (ACLF): The ‘Kyoto Consensus’-Steps From Asia

Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the APASL ACLF Research Consortium (AARC) was formed in 2012. The AARC database has prospectively collected nearly 10,500 cases of ACLF from various countries in the Asia-Pacific region. This database has been instrumental in developing the AARC score and grade of ACLF, the concept of the \u27Golden Therapeutic Window\u27, the \u27transplant window\u27, and plasmapheresis as a treatment modality. Also, the data has been key to identifying pediatric ACLF. The European Association for the Study of Liver-Chronic Liver Failure (EASL CLIF) and the North American Association for the Study of the End Stage Liver Disease (NACSELD) from the West added the concepts of organ failure and infection as precipitants for the development of ACLF and CLIF-Sequential Organ Failure Assessment (SOFA) and NACSELD scores for prognostication. The Chinese Group on the Study of Severe Hepatitis B (COSSH) added COSSH-ACLF criteria to manage hepatitis b virus-ACLF with and without cirrhosis. The literature supports these definitions to be equally effective in their respective cohorts in identifying patients with high mortality. To overcome the differences and to develop a global consensus, APASL took the initiative and invited the global stakeholders, including opinion leaders from Asia, EASL and AASLD, and other researchers in the field of ACLF to identify the key issues and develop an evidence-based consensus document. The consensus document was presented in a hybrid format at the APASL annual meeting in Kyoto in March 2024. The \u27Kyoto APASL Consensus\u27 presented below carries the final recommendations along with the relevant background information and areas requiring future studies

Small biomolecule sensors based on an innovative MoS₂–rGO heterostructure modified electrode platform: a binder-free approach

Hydrothermally synthesized MoS2–rGO nanoflowers can simultaneously sense ascorbic acid (AA), dopamine (DA) and uric acid (UA) with good separating peak-to-peak potentials.</p

Mind the gap – using clinical audit to minimise medication information errors at hospital discharge

Aims and methodWe conducted a retrospective audit of 100 discharge summaries to evaluate the accuracy of medication recording and the recording of as required (PRN) prescribing, and to see whether or not general practitioners were advised on how long to continue the latter. After a formal guideline was introduced we conducted a re-audit.ResultsThere was an improvement in summaries recording medication correctly (from 64 to 83%). The number of summaries with one or more missing medications halved and PRN sedative prescribing reduced from 18 to 3%, but provision of advice on the latter did not improve.Clinical implicationsAccurate recording of medication in the discharge summary is an important element of the transfer of patient care to the general practitioner. Medication errors may pose serious health risks and undermine patient confidence in the service. The clinical audit and interventions implemented helped to reduce errors in medication recording in discharge summaries.</jats:sec

Dual Functionalized CuMOF-Based Composite for High-Performance Supercapacitors

Herein, we utilized our previously reported highly porous CuMOF, {[Cu2(L)­(H2O)2]·(5DMF)·(4H2O)}n, decorated with amine and trifluoromethyl functional groups for energy storage application. This robust framework in CuMOF enhances the chemical and thermal stabilities as well as improves the interfacial binding interactions. The poor conductivity of CuMOF usually restricts its practical utility in energy storage systems, due to which rGO was introduced along with CuMOF to form a CuMOF/rGO composite (1) through a facile ultrasonication technique. The synergistic effects between CuMOF and rGO induce a dramatic enhancement in specific capacitance (462 F g–1 at 0.8 A g–1) of 1 with a cycle life of 93.75% up to 1000 cycles. The results highlight 1 as an emerging contestant for next generation supercapacitors