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ABSTRACT: Amphotericin B (0.7 mg/kg) with flucytosine is the standard treatment for cryptococcal meningitis. However, the long treatment course can induce adverse reactions in patients; therefore, reducing the dose may decrease such reactions. We performed a retrospective analysis of treatment effects and adverse reactions when amphotericin B (0.4 mg/kg or 0.7 mg/kg per day) and flucytosine were used together to treat HIV-negative patients with cryptococcal meningitis.
Retrospective analysis was conducted on inpatients at the First Affiliated Hospital, College of Medicine, Zhejiang University (January 2005 to December 2009). Low- or high-dose amphotericin B (0.4 or 0.7 mg/kg per day, respectively) plus flucytosine was used. The negative conversion rate of Cryptococcus in the cerebrospinal fluid (CSF), patient mortality, and the incidence of side effects for the two groups (low- vs. high-dose) were compared immediately after treatment and 2 and 10 weeks later. Data were analyzed by the Student's t test, chi-square tests using SPSS 12.0 statistical software.
Two weeks post-treatment, Cryptococcus negative CSF rates were 78% (18/23) in the low-dose group and 87% (13/15) in the high-dose group (P = 0.28). Ten weeks post-treatment, both groups were negative. The mortality rate was 8% (2/25) in the low-dose group and 17% (3/18) in the high-dose group (P = 0.25). There was a statistically significant difference in the incidence of adverse events between the groups, 48% (12/25) and 78% (14/18) in the low- and high-dose groups, respectively (P = 0.04). Adverse events that required a change in treatment program in the low-dose group were 12% (3/25) compared to 39% (7/18) in the high-dose group (P = 0.04).
Low-dose treatment regimens were better tolerated than high-dose ones.
Chinese medical journal 01/2012; 125(2):385-7. · 0.86 Impact Factor
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Jiang-shan Lian,
Wei Liu,
Shao-rui Hao,
Yong-zheng Guo,
Hai-jun Huang,
De-ying Chen,
Qing Xie,
Xiao-ping Pan,
Wei Xu,
Wen-xia Yuan,
Lan-juan Li, Jian-rong Huang
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ABSTRACT: Liver cirrhosis is the fatal consequence of chronic hepatitis, making early diagnosis of liver cirrhosis critical. Liver biopsy is still the standard diagnostic method for liver cirrhosis, although its use in a broad population with alcoholism or hepatitis B virus (HBV) infection remains difficult. In this study, we used a metabonomic approach to detect potential biomarkers for early diagnosis of liver cirrhosis.
Serum specimens were collected prospectively from normal control subjects (n = 22) and patients with alcoholic cirrhosis (n = 18) or HBV-induced cirrhosis (n = 19). The serum metabonome was analyzed using ultraperformance liquid chromatography (LC)/time-of-flight mass spectrometry (MS) integrated with chemometrics. The acquired LC-MS data were normalized and processed using principal component analysis (PCA) and partial least squares discrimination analysis (PLS-DA).
Significant differences in the metabonomics among the three groups were observed. Lysophosphatidyl cholines (LPCs) (LPC C16:0, LPC C18:0, LPC C18:2, LPC C18:3, LPC C20:3, LPC C20:5) were decreased in the serum of patients with hepatic cirrhosis, whereas bile acids (glycocholic acid, glycochenodeoxycholic acid), hypoxanthine, and stearamide were increased in the serum of patients with hepatic cirrhosis. These metabolites are considered "common" biomarkers for hepatic cirrhosis. Oleamide and myristamide were increased in the serum of patients with alcoholic cirrhosis but decreased in those with HBV-induced cirrhosis. These could be specific biomarkers for differential diagnosis between alcohol- and HBV-induced hepatic cirrhosis.
There are significant metabonomic differences between alcohol- and HBV-induced liver cirrhosis. Metabonomics is a top-down systems biology tool for conducting research on clinical problems.
Chinese medical journal 05/2011; 124(9):1367-73. · 0.86 Impact Factor
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Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 04/2011; 19(4):311-2.
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Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 06/2009; 17(5):330-1.
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Jian-rong Huang
Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 11/2008; 16(10):731-4.
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Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 08/2007; 15(7):551.
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Jian-rong Huang
Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 04/2007; 15(3):217-8.
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ABSTRACT: Severe viral hepatitis with high mortality is the most common cause of liver failure in China. Treatment of severe viral hepatitis by hemoperfusion was initially adopted in the late 1970s and early 1980s. Following 10 years of development in China, a plasma exchange (PE)-centered artificial liver support system (ALSS), principally dependent on PE technology was developed. Based on the condition and symptoms of each patient, PE was given alone, or combined with hemodialysis, hemofiltration, hemodiafiltration, hemoperfusion, or plasma perfusion. In the late 1990s, training courses for ALSS were developed, and ALSS began to be carried out across China. Guidelines for artificial liver therapy were formulated and published by the Artificial Liver and Liver Failure Group of the Chinese Society of Infection. In recent years, new methods have been attempted, including small pore-size plasma separators, a molecular adsorbent-based recirculating system (MARS), and a continuous albumin purification system (CAPS). According to a retrospective analysis published in 2004, ALSS therapy significantly (P < 0.001) improved the survival rate of patients with severe hepatitis compared with patients who received only medicines (43.4%, 157/362 vs. 15.4%, 55/358 in chronic patients and 78.9%, 30/38 vs. 11.9%, 5/42 in acute and subacute patients). Furthermore, ALSS has also proved valuable as a bridge to liver transplantation in the treatment of patients with end-stage severe hepatitis in China. More recently, ALSS has been used in the treatment of drug-induced liver failure, acute fatty liver during pregnancy, and other difficult-to-treat disorders in China.
Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 05/2006; 10(2):160-7. · 1.39 Impact Factor
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ABSTRACT: Plasma exchange has become an effective mode of blood purification in patients suffering from liver failure. To assist in patient recovery, we compared two plasma separators to identify a plasma separator with suitable pore sizes to remove toxic substances effectively, and retain important plasma components. The study focused on severe viral hepatitis patients. Of 206 rounds of plasma exchange, 137 were completed with the PS-06 plasma separator (membrane pore size=0.2 microm) and 69 with the EC-4A plasma separator (membrane pore size=0.03 microm). The efficacy of different plasma separators was compared using survival rate, changes in liver biochemistry, immunoglobulin, and complement parameters. The survival rate of patients treated with PS-06 was 43.3% (13 of 30 patients). For patients treated with EC-4A, two patients were bridged to liver transplantation successfully, and 57.9% (11 of 19 patients) survived. In both groups, the levels of total bilirubin, prothrombin time, and bile acid declined significantly. Compared to PS-06, EC-4A could retain significantly larger amounts of immunoglobulin and complements. Our study revealed that plasma exchange implementation with membrane pore size 0.03 microm could remove adequate bilirubin and bile acid, a class of toxins bound to plasma protein in severe viral hepatitis patients, and reduce the loss of essential plasma macromolecules.
Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 11/2005; 9(5):396-401. · 1.39 Impact Factor
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Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 08/2005; 13(7):555.
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ABSTRACT: The demand for the clinical use of hepatocytes is increasing. The aim of this study was to develop a method for procurement of high qualitative pig hepatocytes and to evaluate the state of freshly isolated and cultured hepatocytes.
The domestic extracorporeal circulating perfusion apparatus was used to isolate and harvest swine hepatocytes by the two-step perfusion method with EDTA and collagenase. The viability, function and morphology of the freshly isolated and cultured cells were evaluated and observed by the trypan blue exclusion test, biochemical measurements, phase contrast microscopy and transmission electron micrography (TEM).
The total yield of isolated hepatocytes reached to 1.5(+/-0.4)X10(10) per liver with a viability of 92(+/-5)%, and the purity of hepatocytes reached to 98%. Immediately after isolation, phase-contrast microscope and TEM showed that undamaged hepatocytes appeared bright, translucent and spherical in shape, with a characteristic well-contrasted border. After 24 hours, the concentrations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), albumin (ALB), creatinine (Cr) and blood urea nitrogen (BUN) in the fluid of culture were declined significantly.
This method of procuring swine hepatocytes could get high quality cells with active metabolic function.
Hepatobiliary & pancreatic diseases international: HBPD INT 06/2005; 4(2):249-53. · 1.08 Impact Factor
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ABSTRACT: To assess the effect of artificial liver support system (ALSS) on patients with severe viral hepatitis, who were divided into treatment group and control group.
Four hundred in-hospital patients enrolled during 1995-2003 who received ALSS therapy were studied as the treatment group. Four hundred in-hospital patients enrolled during 1986-1994 who received other medical therapies served as the control group. The methods of ALSS used included plasma exchange, hemoperfusion, hemofiltration, continuous hemodiafiltration (CHDF). The effect of ALSS treatment was studied in patients at different stages of the disease.
The cure rate of acute and subacute severe hepatitis in the treatment group was 78.9% (30/38), and was 11.9% (5/42) in the control group. The improved rate of chronic severe hepatitis in the treatment group was 43.4% (157/362), and was 15.4% (55/358) in the control group. We found that patients treated with ALSS in the early or middle stage of the disease had much higher survival rates than patients in the end stage of the disease.
ALSS is an effective and safe therapy for severe viral hepatitis.
World Journal of Gastroenterology 11/2004; 10(20):2984-8. · 2.47 Impact Factor
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Jian-rong Huang
Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 09/2003; 11(8):505.
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Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 09/2003; 11(8):453-4.
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ABSTRACT: To evaluate the efficacy of a hybrid artificial liver support system in the treatment of chronic severe hepatitis.
The hybrid artificial liver support system (HALSS) consisted of a bioreactor containing more than 5 x 10(9) porcine hepatocytes and plasma exchange device. 15 patients with chronic severe viral hepatitis were treated with the hybrid system.
All the patients experienced a reduction in symptoms, such as fatigue, abdominal distention or ascites. After each treatment serum total bilirubin decreased markedly (from 493.5 micromol/L+-139.8 micromol/L to 250.9 micromol/L+-91.3 micromol/L, t=8.695, P<0.001), while prothrombin activity increased (from 24.5%+-8.4% to 30.6%+-6.3%, t=3.325, P<0.01). There were 11 patients whose progress of hepatocytes necrosis stopped after HALSS treatment, and finally they recovered completely. Four patients died of their worsen conditions. No serious adverse events were noted in the 15 patients.
HALSS is a reliable hepatic support device for chronic severe hepatitis.
Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 08/2003; 11(8):458-60.
