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Objective:To assess the efficacy and safety of trimethoprim/sulfamethoxazole (TMP/SMZ) combined with caspofungin for the treatment of acquired immunodeficiency syndrome (AIDS)patients with moderate to severe pneumocystis pneumonia (PCP) requiring mechanical ventilation.Methods:The clinical data of AIDS patients who admitted to Chongqing Public Health Medical Center from March 1, 2019 to March 1, 2021 with moderate to severe PCP requiring mechanical ventilation were retrospectively analyzed. Clinical characteristics and outcomes were compared between two groups receiving either combination therapy with TMP/SMZ and caspofungin (combination therapy group) or TMP/SMZ monotherapy (monotherapy group). The patients were divided into two subgroups according to the baseline arterial partial pressure of oxygen (PaO 2), patients with arterial PaO 2≥50 mmHg (1 mmHg=0.133 kPa) and PaO 2 <50 mmHg. The clinical efficacies of combination therapy and monotherapy in each subgroup were further compared. Chi-square and Fisher exact test were used for statistical analysis. The three-month survival was estimated by the Kaplan-Meier method, and the three-month survival rates were compared by Log-rank method. Results:A total of 83 patients were enrolled, including 23 in the monotherapy group and 60 in the combination therapy group. There was no significant difference in all-cause hospital mortalities between these two groups (34.8%(8/23) vs 23.3%(14/60), χ2=1.12, P=0.290). Kaplan-Meier survival curves indicated no significant difference in the three-month survival rates between the two groups ( χ2=0.51, P=0.477). There ware no significant differences observed in the positive clinical response rates and the mechanical ventilation rates after seven days of anti-PCP treatment between the two groups ( χ2=0.02 and 0.01, respectively, both P>0.05). In the 52 patients with PaO 2≥50 mmHg, no significant difference in all-cause hospital mortalities was observed between the monotherapy group and the combination therapy group (2/13 vs 25.6%(10/39), χ2=0.14, P=0.704). There was no statistical significance in the three-month survival rates between the two groups ( χ2=0.69, P=0.407). No significant difference was observed either in the clinical positive response rates or the mechanical ventilation rates after seven days of anti-PCP treatment between the two group( χ2=1.02 and 0.69, respectively, both P>0.05). In the 31 patients with PaO 2<50 mmHg, the all-cause hospital mortality in the combination therapy group was 19.0%(4/21), while six of the 10 patients in the monotherapy group died, and the difference was statistically significant (Fisher exact test, P=0.040). The three-month survival rate in the combination therapy group was significantly higher than that in the monotherapy group ( χ2=4.09, P=0.043). There were no significant differences in clinical positive response rate and the mechanical ventilation rate after seven days of anti-PCP treatment between the two group (Fisher exact test, both P>0.05). The overall adverse event rate in the monotherapy group was 87.0%(20/23), with an incidence of 56.5%(13/23) for both electrolyte disturbances and bone marrow suppression. The above incidences in the combination therapy group were 78.3%(47/60), 35.0%(21/60) and 53.3%(32/60), respectively, and all differences were not statistically significant ( χ2=0.34, 3.18 and 0.07, respectively, all P>0.05). Conclusions:The efficacy of combination therapy with TMP/SMZ and caspofungin is comparable to that of TMP/SMZ monotherapy in AIDS patients with moderate to severe PCP requiring mechanical ventilation. However, in AIDS patients with PCP requiring mechanical ventilation with the baseline PaO 2<50 mmHg, the efficacy of combination therapy is statistically superior to that of TMP/SMZ monotherapy. Combination therapy does not increase the risk of adverse events.
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Incomplete immune reconstitution remains a global challenge for human immunodeficiency virus (HIV) treatment in the present era of potent antiretroviral therapy (ART), especially for those individuals referred to as immunological non-responders (INRs), who exhibit dramatically low CD4 + T-cell counts despite the use of effective antiretroviral therapy, with long-term inhibition of viral replication. In this review, we provide a critical overview of the concept of ART-treated HIV-positive immunological non-response, and also explain the known mechanisms which could potentially account for the emergence of immunological non-response in some HIV-infected individuals treated with appropriate and effective ART. We found that immune cell exhaustion, combined with chronic inflammation and the HIV-associated dysbiosis syndrome, may represent strategic aspects of the immune response that may be fundamental to incomplete immune recovery. Interestingly, we noted from the literature that metformin exhibits properties and characteristics that may potentially be useful to specifically target immune cell exhaustion, chronic inflammation, and HIV-associated gut dysbiosis syndrome, mechanisms which are now recognized for their critically important complicity in HIV disease-related incomplete immune recovery. In light of evidence discussed in this review, it can be seen that metformin may be of particularly favorable use if utilized as adjunctive treatment in INRs to potentially enhance immune reconstitution. The approach described herein may represent a promising area of therapeutic intervention, aiding in significantly reducing the risk of HIV disease progression and mortality in a particularly vulnerable subgroup of HIV-positive individuals.
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Humans , Immune Reconstitution , CD4 Lymphocyte Count , Metformin/therapeutic use , Dysbiosis , Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , CD4-Positive T-Lymphocytes , HIV , SyndromeABSTRACT
Objective:To investigate the influence of hepatitis B virus (HBV) combined with human immunodeficiency virus (HIV) infection on the efficacy of anti-retroviral therapy (ART).Methods:The data of 269 HIV-infected patients treated in Chongqing Public Health Medical Center from September 2016 to October 2019 were collected. The patients were divided into HIV monoinfection group and HIV/HBV coinfection group. The changes in liver function, CD4 + T lymphocyte count, and HIV RNA level between the two groups were compared when ART started and at different time points (2, 4, 8, 12, 24, 36, 48, and 96 weeks) after ART started. Statistical analysis were performed by independent sample t test, rank sum test and chi-square test. Results:A total of 145 patients with HIV monoinfection and 124 patients with HIV/HBV coinfection were collected. There were no statistically significant differences in liver function indexes (aspartate aminotransferase ( t=9.566), alanine aminotransferase ( t=-4.652) and total bilirubin ( t=-25.476)) between the two groups of patients when ART started (all P>0.05). At 24, 48 and 96 weeks after ART, the CD4 + T lymphocyte counts in the HIV monoinfection group and the HIV/HBV coinfection group were (305.9±156.9)/μL vs (266.2±172.5)/μL, (388.5±226.1)/μL vs (380.8±287.4)/μL and (369.5±191.4)/μL vs (453.6±179.6)/μL, respectively. At 48, 72 and 96 weeks after ART, the CD4 + T lymphocyte count increasing values were 121.0(-52.5, 144.5)/μL vs 156.0(-35.8, 185.8)/μL, 139.0(-116.0, 176.8)/μL vs 114.5(-59.5, 229.0)/μL and -91.0(-110.0, 153.3)/μL vs -94.0(-130.8, 114.3)/μL, respectively. The differences were all not statistically significant ( t=-0.516, -0.066 and -1.414, Z=-1.715、-0.802 and -1.602, respectively, all P>0.05). At 24, 48, and 96 weeks after ART, the HIV RNA inhibition rates in the HIV monoinfection group were 89.7%(130/145), 96.6%(140/145), and 96.6%(140/145), respectively, and those in the HIV/HBV coinfection group were 87.1%(108/124), 92.7%(115/124) and 94.4%(117/124), respectively. The differences were all not statistically significant ( χ2=0.026, 0.053 and 0.017, respectively, all P>0.05). In the second and fourth weeks after ART, the abnormal liver function rates of the HIV monoinfection group were 3.4%(5/145) and 6.2%(9/145), respectively, which were lower than those in the HIV/HBV coinfection group (21.0%(26/124) and 13.7%(17/124), respectively). The differences were both statistically significant ( χ2=20.121 and 4.309, respectively, both P<0.05). However, the abnormal liver function rates in the two group in the 8th week after ART were 10.3%(15/145) and 9.7%(12/124), respectively, and those in the 12th week were 9.0%(13/145) and 9.7%(12/124), respectively, and those in the 24th week were 9.7%(14/145) and 8.9%(11/124), respectively, and those in the 36th week were 9.7%(14/145) and 10.5%(13/124), respectively, and those in the 48th week were 8.3%(12/145) and 8.1%(10/124), respectively, and those in the 96th week were 2.8%(4/145) and 0(0/124), respectively. The differences were all not statistically significant ( χ2=0.330, 0.040, 0.049, 0.051, 0.004 and 3.472, respectively, all P>0.05). Conclusion:HBV coinfection has no adverse effect on the ART effect of HIV-infected patients.
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Cases of 2019-nCoV nucleic acid and antibody (IgM and IgG total antibody) after discharge from a hospital in Chongqing were continuously monitored. It was found that 5 cases of "re-positive" phenomenon, 5 cases of antibody were positive, and there was a trend of increasing with time. "Re-Positive" may be related to the following three factors. Children with asymptomatic infection had a long time of fecal detoxification.There were two consecutive nucleic acid tests "false negative" caused by various reasons.The virus clearance in patients was not complete, and the discharge standard was not conservative enough. The analysis of the causes of "Re-Positive" patients and the discussion of its infection will help us reveal more characteristics of this virus, and to provide a new basis for the discharge standard in the constantly updated diagnosis and treatment programme.
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Objective:To investigate the drug-resistant mutations of human immunodeficiency virus-1 (HIV-1) in patients who received highly active antiretroviral therapy (HAART) from 2014 to 2018.Methods:A total of 880 patients with HIV-1 infection who had been treated with HAART for more than six months in Chongqing Infectious Disease Medical Center from May 2014 to December 2018 were enrolled. Plasma samples were collected, and one-step reverse transcription-polymerase chain reaction (PCR) and nested PCR were taken to amplify protease and reverse transcriptase regions of HIV-1 pol gene region. The obtained amplified nucleotide sequences were compared with the drug resistance database for antiviral drug resistance analysis. Viral genotyping tool software was used to analyze HIV-1 subtype distribution. The categorical variables were compared using chi-square test. Results:Among 880 patients, the plasma HIV-1 viral load was (4.12±0.63) lg copies/mL, the CD4 + T lymphocyte count was (251±124)/μL, and the median duration of antiviral therapy was 26 months. In the subtypes analysis, the circulating recombinant form (CRF) 01-AE subtype was the largest proportion of HIV-1 subtypes, accounting for 38.9%(342/880), and the CRF07-BC subtype accounted for 28.5%(251/880), B+ C subtypes accounted for 16.2%(143/880). Drug-resistant mutations were detected in 534 patients, with a total drug resistance rate of 60.7%. The drug resistance rates of nucleoside reverse transcriptase inhibitors (NRTI), non-nucleoside reverse transcriptase inhibitors (NNRTI) and protease inhibitors (PI) were 51.0%(449/880), 58.6%(516/880) and 1.7%(15/880), respectively. The drug resistances to lamivudine, emtricitabine, efavirenz, and nevirapine were serious, and the medium/high resistance rates were 46.8%(412/880), 46.8%(412/880), 51.3%(451/880), and 53.6%(472/880), respectively, while those to zidomidudine (6.0%, 53/880), etravirin (9.0%, 451/880) and PI were not serious. M184IV (47.3%), K65R (22.2%) and K70RE (12.6%) were the most frequent mutations for NRTI. K103NS (25.1%), V106A (19.7%) and V179DE (14.4%) were the most frequent mutations for NNRTI. The most common drug-resistant mutations for PI were L10FIV (7.4%) and A71IVT (6.5%). The drug resistance rate of CRF01-AE subtype (69.3%, 237/342) was higher than those of CRF07-BC subtype (49.8%, 125/251) and B+ C subtype (51.0%, 73/143), the differences were statistically significant ( χ2=22.6 and 14.6, respectively, both P<0.05). Conclusions:The incidence of drug resistance is high among HIV-1 infected patients after six-month HAART treatment in Chongqing City. The drug resistance to NNRTI is the most common, followed by NRTI, while PI is less resistant. Drug resistance is the main reason for the virological breakthrough in HIV-1 infected patients.
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Cytomegalovirus retinitis (CMVR) is the most frequently encountered ocular opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). In the absence of accurate diagnosis and effective treatment, CMVR can cause different degree of ocular injury and even blindness in AIDS patients. Therefore, the early diagnosis and timely treatment of CMVR is particularly important. This article aims to review the progress in research on the clinical manifestations, diagnosis and treatment drugs of CMVR.
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Objective To compare the clinical characteristics and outcomes of bacterial and fungal bloodstream infections in the patients with acquired immunodeficiency syndrome (AIDS). Methods The clinical data of AIDS patients complicated with bacterial or fungal bloodstream infection treated in Chongqing Public Health Medical Center from January 2016 to June 2018 were analyzed retrospectively. The two groups of patients were compared in terms of clinical symptoms, laboratory tests and outcomes. Results Significantly more patients in bacterial group (AIDS complicated with bacterial bloodstream infection) were associated with intravenous drug abuse than that in fungal group (AIDS complicated with fungal bloodstream infection) (P＜0.05). The average age of patients was older in bacterial group than in fungal group. The incidence of nausea, vomiting and skin rash in fungal group was significantly higher than that in bacterial group (P＜0.05). CD4+T cells in fungal group decreased more significantly than that in bacterial group. No significant difference was found between the two groups in sex ratio, routine blood tests, biochemical assays, and mortality. Conclusions Fungi are the main pathogen of AIDS-associated bloodstream infections. Contrast to the bacterial bloodstream infections in AIDS patients, fungal bloodstream infection is more frequently found in younger patients, and associated with higher incidence of nausea, vomiting, typical skin rash, and more remarkable decrease of CD4+T cells. Bacterial bloodstream infection is more prevalent than fungal bloodstream infection in intravenous drug abusers. No significant difference is found in the mortality between the AIDS patients complicated with bacterial bloodstream infection and those complicated with fungal bloodstream infection.
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Objective To summarize the clinical features of encephalopathy caused by Toxoplasma gondii in AIDS patients for improving clinical diagnosis and treatment of such cases. Methods The clinical data of patients with AIDS and toxoplasmic encephalopathy were collected retrospectively. The prevalence of toxoplasmic encephalopathy in AIDS patients was analyzed. The anti-toxoplasmic efficacy of trimethoprim-sulfamethoxazole (SMZ-TMP) plus azithromycin was reviewed. Results Toxoplasmic encephalopathy was reported in about 10.0％ of the AIDS patients complicated with central nervous system disorder. Headache, fever, and limb movement disorder were the most common symptoms. Head CT/MRI scan showed that 89.5％ of the patients had multiple lesions, mostly in the parietal lobe, temporal lobe and basal ganglia. Enhancement scan revealed thatcircular enhanced foci in 76.9％ of the patients, nodular enhanced foci in 59.0％ of the patients, and surrounding edema in 79.5％ of the patients. The mean CD4+ T lymphocytes was (65.8±59.3)/μL.Anti-toxoplasmic IgG was positive in 50.0％ of the patients, higher than that of IgM (11.5％) (P＜0.05). The positive rate of IgG antibody specific for Toxoplasma gondii tested by ELISA was higher than that detected by rapid colloidal gold immunoassay (P＜0.05). Increased cerebrospinal fluid pressure was found in 42.6％ of the patients. Increased protein in CSF was identified in 66.0％ of the patients. Most (84.2％) patients were improved after treatment with SMZ-TMP plus azithromycin. Conclusions Toxoplasmic encephalopathy is one common central nervous system disease in AIDS patients. The clinical symptoms are nonspecific. There are some features in imaging examination. Low count of CD4+ T lymphocytes makes patients more susceptible to Toxoplasma infection. The anti-toxoplasmic IgG antibody may be helpful for diagnosis. The results of cerebrospinal fluid examination are not specific. SMZ-TMP in combination with azithromycin promises good treatment effect.
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Cryptococcus neoformans meningitis is one of the most common opportunistic infections and causes of death in acquired immunodeficiency syndrome(AIDS)patients with HIV infection. Comprehensive treatment is the key to reduce the mortality rate of AIDS patients with Cryptococcus neoformans meningitis,which includes antifungal treatment, antiretroviral therapy and intracranial pressure management.This article reviews the current status and advanced of comprehensive therapy for Cryptococcus neoformans meningitis in AIDS patients.
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Objective To investigate the impact of human immunodeficiency virus(HIV) infection on clinical characteristics and short term outcome of tuberculous meningitis (TBM).Methods One hundred and fifty-one cases of TBM patients were retrospectively collected from Chongqing Public Health Medical Center between January 2015 and December 2015.Among them,61 were infected with HIV (HIV/TBM group) and 90 were without HIV infection (TBM group).Clinical manifestations,whether complicated by pulmonary tuberculosis,cerebrospinal fluid parameters and CD4+ T lymphocyte counts and their clinical outcomes were compared.Chi square test,t test and non-parameter test were used.Results The incidences of fever,headache,vomiting and meningeal irritation sign in HIV/TBM group were 80.3％ (49),90.2％ (55),47.5％ (29) and 8.2％ (5),respectively,and those in TBM group were 88.9％ (80),88.9％ (80),47.8％ (43) and 17.8％ (16),all of which showed no significant differences (x2=2.141,0.062,0.001 and 2.787,respectively,all P＞0.05).HIV-infected patients had higher percentage of altered consciousness (34.4 ％ vs 16.7 ％,x2 =6.316,P＜0.05),whereas patients without HIV infection had higher percentages of night sweating and pulmonary tuberculosis than those with HIV infection (60.0％ vs31.1％,x2=12.120;97.8％ vs73.8％,x2=19.958,both P＜0.05).The mean value of cerebrospinal pressures in patients with HIV infection was 218.4 mmH2O (1 mmH2O =0.009 8 kPa),which was significantly lower than that of patients without HIV infection (263.6 mmH2O)(t=-2.240,P＜0.05).The median CD4+ T cell counts in HIV/TBM group was 62 (1-540) cells/μL,while that in TBM group was 291 (16 1 689) cells/μL,with significant difference (Z=-7.994,P＜0.01).There was no statistical difference in CSF parameters,imaging findings and in-hospital mortality between two groups (all P＞0.05).Conclusions HIV infected TBM patients are more likely to have altered consciousness,and less likely to have high CSF pressure and pulmonary tuberculosis.Patients with HIV/TBM eoinfection have comparable CSF parameters,head imaging findings and short-term outcomes compared with TBM patients without HIV infection.
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Objective To describe the disease spectrum,morbidity,mortality and prognostic factors of acquired immune deficiency syndrome (AIDS) patients complicated with central nervous system (CNS) infections.Methods The data of 4 426 AIDS patients from February 2013 to February 2017 in Chongqing public health medical center were collected,among which 499 cases had CNS infection.The morbidity and mortality of CNS infections were calculated.Association between different CNS infections and CD4+T cell counts was analyzed.Prognostic factors for the outcome of hospitalization were also studied.Mann-Whitney U test was used for continuous variables.Univariate and multivariate analyses were performed by logistic regression analysis.Results The morbidity of CNS infections in AIDS patients was 11.27％ (499/4 426).The most prevalent CNS infections were tuberculous meningitis (4.50％),cryptococcal meningitis (3.25 ％) and CNS infections with unknown etiology (1.11 ％).The mortality rate was 18.84％ (94/499),among which tuberculous meningitis accounted for 35 cases (17.59％),cryptococcal meningitis 23 cases (15.79％) and CNS infections with unknown etiology 19 cases (38.76％).The average CD4-T cell count level in those who died were significantly lower than that in those who survived (Z=2.51,P =0.001).Visual impairment,nuchal rigidity,positive pathologic reflexes,consciousness disturbance,CD4+T cell counts＜50 cells/μL and HIV RNA≥5 lg copies/mL at baseline were independent prognostic factors for mortality.Conclusions The morbidity and mortality of CNS infections are high among AIDS patients in Chongqing,and those patients with severe immunosuppression are usually affected.Older age,consciousness disturtance and severe immunosuppression are three independent risk factors for mortality.
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This study was aimed to establish a suitable consistency evaluation system according to the existing problems in the quality evaluation of traditional Chinese medicine (TCM) for the development of Chinese medicine industry.Based on the particularity of TCM,combined with the advanced technology of TCM quality evaluation through the construction of TCM quality consistency evaluation system,this study explored a new quality evaluation method for seeking new breakthrough.The results showed that a new quality evaluation model of TCM using multiple indexes,which included "trait evaluation + chemical evaluation + biological evaluation" to achieve the consistency of TCM by effective combinations.It was concluded that the exploration provided some references for the evaluation of quality consistency of TCM.
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Objective To investigate primary anti-tuberculosis drug resistance in patients with acquired immunodeficiency syndrome (AIDS) and tuberculosis in Chongqing area.Methods Clinical data of 119 patients with AIDS and tuberculosis were retrospectively collected.Anti-tuberculosis drug resistance rates were analyzed according to drug susceptibility testing, and their correlations with CD4+ T lymphocytes counts, initially treatment or retreatment and clinical forms of tuberculosis were also analyzed.Comparison between groups was analyzed by x2 test.Results Thirty-eight patients (31.9%) showed anti-tuberculosis drug resistance among the 119 patients with completed results of drug susceptibility testing results.The percentages of mono-resistance, poly-resistance, multi-drug resistance (MDR) and extensive drug resistance (XDR) were 11.7%, 7.6%, 6.7% and 5.9%, respectively.The resistance rate of isoniazid (22.7%, 28/119) was the highest among first-line anti-tuberculosis drugs and that of pasiniazide (11.0%, 14/119) was the highest among second-line drugs.Drug resistance rates among patients with different levels of CD4+ T lymphocytes counts did not differ significantly (the cut-off of CD4+ T lymphocytes count was 50/μL: x2=0.545, P=0.461;cut-off value was 100/μL: x2=0.652, P=0.420).Patents with milliary pulmonary tuberculosis had a significantly higher drug resistance rate (64.0%) than those with secondary pulmonary tuberculosis (27.6%).Conclusions The prevalence of anti-tuberculosis drug resistance prior to anti-tuberculosis treatment initiation is high among AIDS patients with tuberculosis in Chongqing area.Patients with milliary pulmonary tuberculosis tend to have higher anti-tuberculosis drug resistance, but drug resistance does not appear to correlate with CD4+ T lymphocytes counts.
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Objective To investigate the efficacy and safety of adefovir dipivoxil(ADV)for chronic hepatitis B(CHB)patients with lamivudine(LMD)resistance.MethodsA total of 247 LMDresistant CHB patients were included in this multi-center,randomized(1:1),double-blinded and LMDcontrolled clinical trial.All subjects were swithed to open-labelled ADV treatment after 12-week doubleblinded stage.Serum HBV DNA and ALT levels were monitored and safety assessments were conducted at 12th and 48th week during the treatment.Results At 12th week.mean reduction of ALT in trial group was 35.9 U/L,and the reduction of HBV DNA was 3.01 log10 copies/mL.The reductions of HBV DNA in 61.8%(76/123)subjects were more than 2 log10 copies/mL.While in the control group,ALT raised 2.8 U/L in average,and the reduction of HBV DNA was 0.78 log10 copies/mL.The reductions of HBV DNA in 17.7%(22/124)subjects were more than 2 log10 copies/mL.At 48th week,mean reduction of ALT in trial group was 59.7 U/L,and the reduction of HBV DNA was 4.70 log10 copies/mL.The reductions of HBV DNA in 87.0%(107/123)subjects were more than 2 log10 copies/mL.While in the control group,mean reduclion of ALT was 56.6 U/L,and the reduction of HBV DNA was 4.43 log10 eopies/mL.The reductions of HBV DNA in 85.5%(106/124)subjects were more than 2 log10 copies/mL.No severe adverse effect related to the investigational product was observed in both groups.Conclusion ADV is safe and effective in the treatment of LMD-resistant CHB patients with virological and biochemical improvements.
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Objective To investigate the screening and evaluating methods of positive recombinant clones for small fragments such as LoxP sequence. Methods Synthesized LoxP and vector complementary sequence were used as the upper and lower primer respectively, and colonies were used directly as the templates of polymerase chain reaction (PCR). The presence of 784 bp strap in electrophoresis was seen as positive. The positive recombinant clones screened by PCR were evaluated contrastively by restriction endonuclease digestion and verified by DNA sequence analysis. Results Among the six colonies randomly screened by PCR, three showed positive straps and one was verified by DNA sequence analysis. However, the electrophoresis only showed unclear and clouding straps when the three positive recombinant clones were evaluated by restriction endonuclease digestion. Conclusion Self-primer colony PCR is a high-speed, convenient, economic and effective method for screening and evaluating of positive clones recombinated by small fragments such as LoxP sequence.
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Objective To investigate the efficacy and mechanism of compound glycyrrhizin on patients with serious hepatitis. Methods Thirty patients who were hospitalized from August 2005 to June 2007 with diagnosed with serious hepatitis were enrolled into treatment group and treated by compound glycyrrhizin injection ( 80 to 100 ml per day,for 3 consecutive weeks) and common supporting medicines,while the other 30 patients in control group were treated only with same supporting medicines. Mortality,biochemical parameters, plasma levels of endotoxin and inflammatory factors in patients of both groups were observed during the treatment. Results By the end of three-week of treatment,8 patients in the treatment group died with the mortality of 26. 7% ( 8 /30) . Thirteen patients died in the control group and the mortality was 43. 3% ( 13 /30) . Serum ALT and AST levels in treatment group were significantly lower than those of control group during the treatment. The average level of serum total bilirubin and plasma prothrombin time in treatment group was lower than those of control group by end of the third treatment week. The level of TNF-alpha in treatment group was lower than that of control group during treatment. The levels of plasma endotoxin and interleukin-6 in treatment group were significantly lower than those of the control group at the second and third treatment week. Conclusion Compound glycyrrhizin improves the biochemical parameters of patients with serious hepatitis,and probably,improves the survival of patients with severe hepatitis. The implying mechanism might be that compound glycyrrhizin declines plasma endotoxin levels and lessen cytokine-induced secondary hepatic injuries.
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The key materials for bioartificial liver (BAL) construction include biomaterials and scaffolding materials. The former mainly refers to hepatocytes, nonparenchymal cells, etc. The latter mainly refers to films and other scaffolding materials, the properties of which correlate directly with hepatocyte growth and functions, and thus are related to the support effects of BAL. Several kinds of scaffolding materials frequently used for BAL construction in recent years are reviewed in this article.
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Biocompatible Materials , Liver, Artificial , Membranes, Artificial , Polyurethanes , Polyvinyls , Tissue EngineeringABSTRACT
<p><b>OBJECTIVE</b>To establish a rat model for hepatic oval cell proliferation and to observe the relationship between 2-acetaminofluorene (AAF) dosage and oval cell proliferation in the rat liver.</p><p><b>METHODS</b>Male Wistar rats weighing 150 g received daily oral gavage of AAF for 4 days before operation and up to 7 days after operation. Two-thirds hepatectomy was performed on the 5th day and the gavage was not performed on the day of operation. AFF was given with the dosage of 2.5 mg/kg, 5 mg/kg, 10 mg/kg, 15 mg/kg, and 20 mg/kg body weight. Animals in control group were given saline. Three rats from each group were killed every 2~3 days after hepatectomy and liver slices were fixed and processed for routine histology and immunohistochemistry.</p><p><b>RESULTS</b>Hepatic oval cells were not observed in the liver of controls and only a few were detected in the liver of 2.5 mg/kg and 5 mg/kg groups. However, obvious oval cell proliferation was seen in the liver of 10 mg/kg, 15 mg/kg, and 20 mg/kg groups. Hepatic oval cells were stained positive for cytokeratin 19, OV6, vimentin and proliferating cell nuclear antigen (PCNA).</p><p><b>CONCLUSIONS</b>Satisfactory rat models for hepatic oval cell proliferation can be obtained using our scheme when AAF is dosed at 10~20 mg/kg body weight.</p>