Indirect Bilirubin Concentrations Research Articles

Early Diagnosis of CNS Virus Infections from Neurological Autoimmune Diseases: A Cross-Sectional Study from China in ER Setting.

It is challenging to differentiate between central nervous system (CNS) virus infections and neurological autoimmune diseases in the emergency department. Considering their different pathogenesis, we assume they differ in neuropsychiatric symptoms and laboratory results. A total of 80 patients were included in this study, 50 with CNS virus infections and 30 with CNS autoimmune diseases, confirmed by a polymerase chain reaction (PCR) of cerebrospinal fluid (CSF). A binary logistic regression model and receiver operating characteristic (ROC) curve were employed to examine the discrimination between the two types of diseases based on neuropsychiatric symptoms and laboratory results. Compared to patients with neurological autoimmune diseases, patients with CNS virus infections had a higher incidence of abnormal behavior (p = 0.026) and abnormal sensation/thought (p = 0.029); higher total (p = 0.005), direct (p = 0.004), and indirect bilirubin (p = 0.004); and increased CSF cell (p = 0.01) and CSF white cell counts (p = 0.01). Patients with disturbance of consciousness and abnormal sensation/thought were 7.79-fold and 5.07-fold more likely to be diagnosed with CNS virus infections (OR = 7.79, p = 0.008; OR = 5.07, p = 0.032). Each unit increase in blood indirect bilirubin concentration and CSF white cell counts increased the risk of developing CNS virus infections by 1.25-fold and 1.01-fold (OR = 1.25, p = 0.016; OR = 1.01, p = 0.011). ROC analysis showed that the area under the curve was 88.0% (p < 0.001). Our study found that patients with CNS viral infections tend to have higher blood indirect bilirubin concentration, CSF leukocyte count, frequency of disorders of consciousness, and abnormal sensation and thought, which may help differentiate them from those with neurological autoimmune diseases.

Bilirubin Levels in Infancy and Their Associations with Body Weight, Levels of Iron-Related Parameters and Steroid Hormone Levels.

It is assumed that bilirubin is hormonally regulated and influences weight development by preventing weight gain. However, studies in healthy infants are limited. The present study established reference values for bilirubin and investigated whether bilirubin levels are significantly associated with body weight, levels of ferritin and transferrin as well as steroid hormone levels in a study population of three- and six-month-old healthy infants. Data from a total of 411 study visits from the LIFE Child study (Leipzig, Germany) were analyzed. Associations were examined using linear regression analyses. Besides laboratory parameters, anthropometric data were gathered. We found statistically significant associations between body weight and bilirubin levels. In girls, we observed additional associations between bilirubin levels and both ferritin and transferrin concentrations at three months of age. At six months, steroid hormone levels were significantly associated with concentrations of total and indirect bilirubin, with effects differing by sex. Our study thus confirms associations already reported from animal studies and studies in adult populations. Furthermore, we showed that these associations already exist in the first year of life, are influenced by sex and age and, further, depend on the bilirubin type. Our results provide reference values for bilirubin and assist, therefore, in interpreting bilirubin levels in infancy.

Neuropathological implication of high blood bilirubin in patients and model rats with depression

PurposeElevated bilirubin levels have been associated with major depressive disorder (MDD); however, the exact impact of bilirubin on MDD and the underlying molecular mechanisms remain unclear. Here, we explored the influence of bilirubin on MDD and sought to identify the mechanisms via which bilirubin induces depressive-like behavior. Patients and methodsForty patients who were diagnosed with MDD and received treatment with selective serotonin reuptake inhibitors (SSRIs) were included, with 43 healthy volunteers serving as controls. Clinical symptoms were evaluated using Hamilton depression rating scale-24 (HAMD-24) and the Hamilton anxiety rating scale. Serum concentrations of total bilirubin (TBIL) and indirect bilirubin (IBIL) were measured at baseline and after treatment using an automated biochemical analyzer. The connection between clinical symptoms and TBIL or IBIL was examined using Pearson correlation. Chronic restraint stress (CRS) was employed to generate a rat model of depression. TBIL, IBIL in rat serum were measured by ELISA. Reactive oxygen species (ROS) contents in rat hippocampal tissues were quantified by flow cytometry. The levels of microglial markers and the extent of neuronal damage in the rat hippocampus were assessed by immunofluorescence and transmission electron microscopy, respectively. ResultsSerum TBIL and IBIL levels were higher in patients with MDD than in the healthy controls. After treatment with SSRIs, the serum levels of TBIL and IBIL in MDD patients were significantly reduced. The levels of TBIL and IBIL were associated with HAMD-24 in MDD patients. Compared with the controls, the serum levels of TBIL, IBIL and the hippocampal ROS contents were elevated in CRS-exposed rats. Fluoxetine lowered inflammatory factor levels, mitigated oxidative stress. ConclusionOur findings indicate a possible correlation between elevated serum bilirubin and depressive symptoms. Increases in ROS levels, along with neuronal damage, may represent pathological mechanisms underlying MDD.

Antioxidant and phytochemical profiling of ethanol leaf extract of Ficus pachyneura and derived fractions

A total of 16, 18-weeks old chickens with mean weight 1.99±0.12 kg (1.85-2.30kg) were used to compare the serum biochemical characteristics of four chicken genotypes (breeds/strains) from south-eastern part of Nigeria. The chickens were grouped based on their genotypes (breeds/strain) in a Completely Randomized Design for the four-week study. The genotypes (breeds) considered were Black Australorp (BA), Isa Brown (IB), Noiler (NOI) and Local chicken (LC) at 4 chickens per genotype. At the end of the experiment, four (4) birds per genotype were drawn and their blood samples analysed for serum biochemical studies. The mean total cholesterol (TC), triaceylglycerol (TAG) and very low density lipoprotein cholesterol (VLDL-C) concentrations of local chicken (LC) were significantly (P &lt; 0.05) higher than the Isa brown (IB) values. Similarly, the mean blood urea nitrogen (BUN) concentrations of LC was significantly (P &lt; 0.05) higher than the Noiler value. The mean high density lipoprotein cholesterol (HDL-C) of black Australorp (BA) was significantly (P &lt; 0.05) higher than the value of Noiler but showed no significant (p &gt; 0.05) difference when compared to the values of IB and LC. There were however no significant (p &gt; 0.05) variations in the mean low density lipoprotein cholesterol (LDL-C), total bilirubin, direct bilirubin, indirect bilirubin and creatinine concentrations among all the breeds investigated. In conclusion, the results obtained in this study will be helpful in creating a baseline data on biochemical profiles of indigenous and exotic chicken breeds in Nigeria which in turn can be used for assessing the health status of these birds, improving desirable breeds/traits and designing appropriate breeding strategies for indigenous poultry birds in the country.

Exposure to Synthetic Psychoactive Substances: A Potential Cause for Increased Human Hepatotoxicity Markers.

Approximately 30 million people worldwide consume new psychoactive substances (NPS), creating a serious public health issue due to their toxicity and potency. Drug-induced liver injury is the leading cause of liver disease, responsible for 4% of global deaths each year. A systematic literature search revealed 64 case reports, in vitro and in vivo studies on NPS hepatotoxicity. Maximum elevated concentrations of aspartate aminotransferase (136 to 15 632 U/L), alanine transaminase (121.5 to 9162 U/L), total bilirubin (0.7 to 702 mg/dL; 0.04 to 39.03 mmol/L), direct (0.2-15.1 mg/dL; 0.01-0.84 mmol/L) and indirect (5.3 mg/dL; 0.29 mmol/L) bilirubin, alkaline phosphatase (79-260 U/L), and gamma-glutamyltransferase (260 U/L) were observed as biochemical markers of liver damage, with acute and fulminant liver failure the major toxic effects described in the NPS case reports. In vitro laboratory studies and subsequent in vivo NPS exposure studies on rats and mice provide data on potential mechanisms of toxicity. Oxidative stress, plasma membrane stability, and cellular energy changes led to apoptosis and cell death. Experimental studies of human liver microsome incubation with synthetic NPS, with and without specific cytochrome P450 inhibitors, highlighted specific enzyme inhibitions and potential drug-drug interactions leading to hepatotoxicity. Mild to severe hepatotoxic effects following synthetic NPS exposure were described in case reports. In diagnosing the etiology of liver damage, synthetic NPS exposure should be considered as part of the differential diagnosis. Identification of NPS toxicity is important for educating patients on the dangers of NPS consumption and to suggest promising treatments for observed hepatotoxicity.

Hepatic and renal lesions in sheep intoxicated with Urochloa hybrid Mulato II in Argentina.

A flock of 48 sheep in Argentina grazing on a pasture of hybrid Urochloa (formerly Brachiaria) Mulato II (Urochloa ruziziensis × Urochloa decumbens × Urochloa brizantha) developed facial dermatitis, severe jaundice, and weakness after brief physical activity. Blood biochemistry of 3 animals revealed azotemia, elevated aspartate aminotransferase activity, and increased direct, indirect, and total bilirubin concentrations. The urine was markedly turbid and contained large concentrations of bile pigments and protein. At autopsy of 2 animals, there was severe jaundice and subcutaneous submandibular edema. The livers were enlarged, intensely yellow, and had a marked acinar pattern. Gallbladders were distended, and the kidneys were diffusely dark in one animal and yellow-green in the other. Microscopically, there was lymphoplasmacytic and histiocytic cholangiohepatitis with abundant crystals in the lumen of bile ducts and in the cytoplasm of macrophages. The proximal and distal convoluted renal tubules had protein casts in their lumens, and crystals were observed in the lumen and epithelial cells. Lectin histochemistry showed strong affinity for Arachis hypogaea agglutinin in hepatic macrophages. In the one sheep that was tested for heavy metals, copper concentrations in the liver and kidney were within the RIs. Despite the immediate change of pasture, morbidity and mortality were 100% within 3 mo. The association between the consumption of this pasture, and the clinical, biochemical, pathology, and lectin histochemistry findings confirmed intoxication with Urochloa hybrid Mulato II. To our knowledge, intoxication by this hybrid of Urochloa has not been reported previously.

Correlation of Serum Bilirubin with Clinical and Pathological Characteristics of Patients with IgA Nephropathy.

To investigate the correlations of total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL) with various clinical indicators and pathological features of patients with IgA nephropathy (IgAN). Patients diagnosed with IgAN were included and divided into low and high TBIL/DBIL/IBIL groups. Correlation analysis was performed to assess the relationships between the bilirubin indices and other clinical and pathological variables. Logistic regression was applied to identify the independent risk factors of mesangial cell proliferation (corresponding to M1 in the Oxford classification of IgAN). Totally 192 patients with IgAN were included, and the patient clinical indicators were compared between the different bilirubin subgroups. Compared to the groups with higher TBIL, DBIL, and IBIL levels, groups with lower values of these bilirubin indices exhibited a higher 24-hour urine protein (24hUP) concentration but a lower proportion of males as well as reduced total protein, albumin, haemoglobin, and glutamic-pyruvic transaminase levels (p < 0.05). Moreover, the low-DBIL group displayed higher total cholesterol, triglyceride, and low-density lipoprotein (LDL) concentrations (p < 0.05) than those in the high DBIL group. Spearman analysis further revealed that TBIL, DBIL, and IBIL were negatively correlated with 24hUP and positively correlated with haemoglobin, total protein, and albumin (p < 0.05). Additionally, DBIL exhibited negative correlations with total cholesterol, triglyceride, and LDL (p < 0.05). From a pathological perspective, M1 incidence was higher in the low TBIL and IBIL groups (both p < 0.05). Furthermore, the high IBIL group showed a lower occurrence of cellular/fibrocellular crescents (C1 (in at least one glomerulus) and C2 (in >25% of glomeruli) in the Oxford classification, p < 0.05). Lastly, the multivariate regression model suggested that IBIL was an independent protective factor for M1 (odds ratio = 0.563, 95% confidence interval = 0.344-0.921, p = 0.022). Patients with IgAN accompanied by low values of bilirubin indices exhibit worsened disease-related clinical indicators (24hUP, total protein, albumin, and haemoglobin levels). Reduced TBIL and IBIL concentrations are indicative of severe renal pathology, with IBIL being a protective factor against M1.

Evaluations of the effect of genetic variations on the serum renal function markers, bilirubin and lipid profile of laying domestic fowls

A total of 16, 18 weeks old chickens with mean weight 1.99±0.12 kg (1.85-2.30kg) were used to compare the serum biochemical characteristics of four chicken genotypes (breeds/strains) from south-eastern part of Nigeria. The chickens were grouped based on their genotypes (breeds/strain) in a Completely Randomized Design for the four-week study. The genotypes (breeds) considered were Black Australorp (BA), Isa Brown (IB), Noiler (NOI) and Local chicken (LC) at 4 chickens per genotype. At the end of the experiment, four (4) birds per genotype were drawn and their blood samples analysed for serum biochemical studies. The mean total cholesterol (TC), triaceylglycerol (TAG) and very low density lipoprotein cholesterol (VLDL-C) concentrations of local chicken (LC) were significantly (P &lt; 0.05) higher than the Isa brown (IB) values. Similarly, the mean blood urea nitrogen (BUN) concentrations of LC was significantly (P &lt; 0.05) higher than the Noiler value. The mean high density lipoprotein cholesterol (HDL-C) of black Australorp (BA) was significantly (P &lt; 0.05) higher than the value of Noiler but showed no significant (p &gt; 0.05) difference when compared to the values of IB and LC. There were however no significant (p &gt; 0.05) variations in the mean low density lipoprotein cholesterol (LDL-C), total bilirubin, direct bilirubin, indirect bilirubin and creatinine concentrations among all the breeds investigated. In conclusion, the results obtained in this study will be helpful in creating a baseline data on biochemical profiles of indigenous and exotic chicken breeds in Nigeria which in turn can be used for assessing the health status of these birds, improving desirable breeds/traits and designing appropriate breeding strategies for indigenous poultry birds in the country..

A Pilot Study for the Kidney Effects of Voxelotor in Sickle Cell Anemia

The kidneys are among the most commonly affected organ systems in sickle cell anemia (SCA) and an estimated 15% of deaths in patients with SCA are attributed to kidney failure (PMID 7993409). Angiotensin converting enzyme-inhibitors and angiotensin receptor blockers have been adopted to treat SCA-related chronic kidney disease (CKD) from the non-SCA literature, although demonstrated efficacy in SCA CKD has been marginal in a limited number of small, short-term studies (PMID 28589652). Therapies that directly target the pathophysiology of SCA-related kidney disease may stabilize or improve kidney function. Both the rate of hemolysis and the degree of anemia are associated with the development and progression of CKD in SCA (PMID 24329963, 21523807). Voxelotor inhibits hemoglobin polymerization in SCA red blood cells in the deoxygenated state, leading to a reduction in the rate of hemolysis and an increase in hemoglobin concentration. We conducted a pilot study to determine whether voxelotor can improve kidney function in adults with SCA (NCT 04335721). SCA (HbSS or HbSβ 0-thalassemia) patients ≥ 18 years old and with urine dipstick-defined hemoglobinuria (+ for blood &amp; ≤ 2 red blood cells/high power field), CKD stage 1 or 2 (urine albumin-to-creatinine ratio [ACR] ≥ 30 mg/g &amp; estimated glomerular filtration rate [eGFR] ≥ 60 mL/min/1.73m 2), and hemoglobin concentrations of 5.5 - 10.5 g/dL were eligible. The eGFR was calculated using the CKD-EPI 2009 creatinine-based equation without the race coefficient and the 2012 cystatin C-based equation. Patients were randomized to voxelotor 1,500mg/day for 48 weeks or standard of care, as defined by their primary SCA provider. First or second void urines were collected for urine ACR measurements. The primary endpoint was the change in urine ACR from the mean values at baseline and screening versus the mean values at 47 and 48 week visits. One patient randomized to standard of care was started on voxelotor at week 24 by his provider to improve his hemoglobin concentration. This patient is included in the voxelotor treatment group in combined analysis; the change in laboratory measures in this patient is based upon changes from the mean of values at week 12 and 24 to week 47 and 48 visits. Median and range values are provided. Between 3/2021 and 6/2022, 8 SCA patients with hemoglobinuria and urine ACR &amp;gt; 30mg/g crt observed during routine clinic visits were screened and 6 met the inclusion criteria. The median age of the enrolled cohort was 36 (27 - 63) years, 4 were male, 4 were on stable doses of hydroxyurea (median dose 1000mg/day; 500 - 1500mg/day) and 2 were on stable doses of lisinopril (5, 20mg/day) for at least 90 days before screening. Two other patients had been on lisinopril in the past but developed hyperkalemia prior to enrollment. The median values of kidney function measures at screening and baseline study visits were as follows: urine ACR, 251 (32 - 3132) and 392 (80 - 3101) mg/g crt; creatinine-based eGFR, 109 (93 - 136) and 115 (88 - 137) mL/min/1.73m 2; and cystatin C-based eGFR, 82 (61 - 141) and 85 (61 - 128) mL/min/1.73m 2, respectively. SCA patients who received voxelotor (n = 4) had a median increase in hemoglobin concentration of +0.9 g/dL (-0.4 - +2.6 g/dL) and reductions in indirect bilirubin concentration of -2.2 mg/dL (0 - -4 mg/dL) and reticulocyte % of -2.7% (-1.2 - -4.9%). Urine ACR (-59%, -21% - -100%) improved in SCA patients treated with voxelotor but worsened in those who received standard of care without voxelotor (n = 2) (+86.3%, 64 - 108%) (P=0.009) (Figure 1A). 24-hour urine protein concentrations also improved in those that received voxelotor (-45%, -25% - -100%) but increased in those who did not receive voxelotor (+122%, 113 - 131%) (P = 0.002) (Figure 1B). Changes in creatinine- and cystatin-C based eGFR from baseline were not significantly different between patients who received voxelotor and those who did not. This pilot study demonstrates that SCA patients with hemoglobinuria and early stages of CKD treated with voxelotor may have significant improvements in urine ACR and proteinuria after 24 - 48 weeks of therapy. These preliminary results support the concept that improving hemolytic anemia could be a targeted therapeutic approach to reduce biomarkers of kidney dysfunction, and they warrant larger, prospective clinical studies.

Basic biochemical and hematological parameters of structural hemoglobin variants in the postpartum women and their respective newborn from Manaus, Amazonas, Brazil

The present study aimed at estimating the prevalence of structural hemoglobinopathies in newborn and describing the hematological and biochemical characteristics between postpartum women (PW) and their respective newborns (NB) at a public maternity hospital in Manaus, Amazonas state, Brazil. In total, 825 NB and 820 PW were included in the study. Hematological and biochemical analysis and screening of structural hemoglobinopathies were performed and compared in groups of individuals (NICU or not; hemoglobin genotypes; gestational age and prenatal). The age of PW ranged from 13 to 44 years old (mean of 23.7 ± 6.6 years), with 45.9% pregnant for the first time and 54.1% multiparous. Reported receiving prenatal care 88% and regarding the type of delivery, 47.7% had delivered by cesarean section. Among the births, 19.4% were born premature and 8.3% were admission to the neonatal intensive care unit (NICU). The male NB represented 53.4% of the total. Sickle cell trait (FAS) was found in 16 (1.94%) and heterozygous for D hemoglobin (FAD) in 6 (0.73%) newborns. A statistically significant values was found between the previous history of miscarriage and increase of Mean corpuscular volume (MCV) (p < .001), Red blood cell distribution width (RDW) (p = .003), total and indirect bilirubin concentration (p < .001) and LDL cholesterol (p = .004). Hemoglobin levels below 13.5 g/dL was found in 66% black newborns, compared with 15% of Afro-Brazilian and 5% of whites. The frequency of structural hemoglobinopathies was higher in African-Brazilian newborn babies (78%) and those who with low birth weight had a higher frequency of NICU (35.7%). Interestingly, underage mothers had a higher frequency of NB with low birth weight and premature birth. Postpartum women who had children carriers of FAS and FAD had a higher frequency of urinary tract infection (65.2%) and moderate anemia (23.8%). This study estimated for the first time the prevalence of structural hemoglobinopathies in NB in Manaus, Amazonas, Brazil. Despite the small prevalence of, we highlight the importance of early diagnosis of hemoglobin variants, contributing to the improvement of the quality of life of PW and your NB, reinforce the need to implement educational and prevention programs to raise awareness among the population and in order to counsel parents regarding the probability of having a child with abnormal hemoglobins homozygous as HbSS or HbCC.

Vitamin E supplementation improves post-transportation systemic antioxidant capacity in yak.

This study was aimed to evaluate the effects of post-transportation vitamin E (VE) supplementation on health condition, blood biochemical parameters, blood antioxidant indices and blood metabolomics in yak. Five yaks were used in this study. After 2100 km of highway transportation from Riwoqe county to Rongchang County, Chongqing, blood was collected immediately after arrival and these samples served as the baseline (control, CON_VE). A VE injection (40 mg/kg) was then performed and blood samples were collected 10 days later. Injection of VE led to lower serum VE concentration. Relative to the CON_VE, VE injection led to greater concentrations of creatinine and lower concentrations of glutamate pyruvic transaminase, alkaline phosphatase, aspartate aminotransferase, total bilirubin, indirect bilirubin, direct bilirubin, UREA and glucose. Compared with CON_VE, VE injection led the lower serum level of malondialdehydeand greater serum level of glutathione s-transferase, glutathione peroxidase, glutathione reductase and glutathione peroxidase 4. Based on metabolomics analysis, 119 differentially altered serum metabolites (P<0.05 and VIP>1.0) were identified with VE injection relative to CON_VE. VE injection resulted in changes of lysophosphatidylethanolamine, lysophosphatidylcholine, phosphocholine, choline, malate, citrate, α-Oxo-glutarate, phenylalanine, 3-Phenylpropanoic acid and 3-(3-Hydroxyphenyl) propanoic acid. These metabolites are associated with lipid metabolism, tricarboxylic acid cycle and oxidative stress. Overall, our study indicates that VE injection can alleviate transportation stress in yak partly through protecting liver and kidney, and improving antioxidant defense systems.

Transient increases in glutamate dehydrogenase (GLDH) activity occur in neonatal foals.

Liver analyte measurement is important in the evaluation of sick animals. Liver injury in horses is recognized by increased glutamate dehydrogenase (GLDH), sorbitol dehydrogenase (SDH), and aspartate aminotransferase (AST) activities, whereas biliary pathology is identified by increased alkaline phosphatase and γ-glutamyl transferase (GGT) activities or bilirubin concentrations. We have observed high GLDH, but not SDH, activities in neonatal foals admitted for conditions other than liver disease. Only one previous study have evaluated GLDH activity over time in healthy neonatal foals; however, SDH activity was not measured. We aimed to evaluate changes in liver analytes in neonatal foals over time. We measured serum liver analytes (GLDH, SDH, GGT, AST, total, direct, and indirect bilirubin) and creatine kinase activity of 11 clinically healthy foals before and at various times after suckling until 46 days of age. Analytes were also measured in colostrum and mare serum. Median GLDH activities increased after birth to peak at 3-4 days of age (106 U/L, reference interval, 0-8U/L). Median SDH activities had a lower peak at 3-4 days (15 U/L, reference interval, 0-11 U/L) and were frequently discordant with GLDH. There was no association between foal and mare serum or colostral enzyme activities. AST activity plateaued at 5-6 days, whereas GGT activity and total and indirect bilirubin concentrations peaked at 14 and 3-4 days of age, respectively. Transient increases in GLDH, SDH, and GGT activities and total and indirect bilirubin concentrations occur in clinically healthy neonatal foals and do not necessarily indicate relevant liver disease.

Effect of Sodium Fluoride on Glycemic Index and Liver Functions in Rats

From a health standpoint, fluoride (F) is a vital element for humans. It had harmful effects on numerous organs when consumed in high dosages. Fluoride poisoning has been linked to liver damage. The purpose of this study was to see how sodium fluoride (Naf) affected liver function and the glycemic index in adult male albino rats. Fourteen (14) adult male Wistar albino rats were randomly and evenly divided into two groups and given the following treatments for thirty (30) days: G1 Group (Control group), were given distilled water and fed a balanced diet, G2 rats were administered water that contained 100 ppm Naf. The animals were fasted for 8-12 hours before being anesthetized and blood samples were taken by heart puncture technique at zero day (zero time) and (30) day. The following parameters were measured using the serum. The glycemic index contains (glucose, insulin, and insulin resistance), as well as liver function tests such as serum activity of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma glutamyl transferase (GGT), as well as direct, indirect and total bilirubin concentration. The livers and pancreas were quickly delivered, meticulously dissected out, prepped, and viewed under a light microscope. The results demonstrated that 30 days of exposure to Naf in drinking water produced liver damage manifested by significant increases in blood ALT, AST, and GGT activity as well as significant elevation in serum bilirubin (direct, indirect and total) concentration compared to control group. A significant rise in blood glucose levels and a fall in blood insulin levels and IR were detected at the end of the experiments in Naf treated group when compared to the control. Histopathological changes in Naf treated group was observed in hepatic and pancreatic tissue manifested by generalised degeneration and necrosis of hepatocytes, in addition, to severe degeneration of acinar and pancreatic islet cells. In conclusion, the findings of this investigation revealed Naf therapy-induced liver damage and a change in the glycemic index in adult male rats.

Successful Pregnancy Outcome in Mares: The Potential Role of Body Conditional Score, Age and Biochemical Parameter's Adjustments

The objective of this research was to evaluate the changes in body condition score (BCS), age and the main biochemical parameters in pregnant Spanish Purebred mares. A total of 45 pregnant Spanish broodmares has been studied, classified in three different groups: group A (n=15), aging 14-18 years old and BCS lower than 4 of 10, group B (n=15), with ages of 4 to 8 years and a BCS of 5-6/10, and group C (n=15), aging between 6 and 11 years and a BCS of 8 of 10. Three pregnancy periods were considered: the 1st period, from the 1st to the 3rd, the 2nd from the 4th to the 6th, and the last period, from the 7th month of pregnancy to delivery. Blood samples were taken every month along the pregnancy. The following plasma biochemical parameters were measured: triglycerides, total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, total, direct and indirect bilirubin, aspartate aminotransferase, lactate dehydrogenase, γ-glutamyl transferase, alkaline phosphatase, total plasma proteins, albumin, glucose, urea and creatinine. Pregnancy in the Spanish broodmare induced hyperlipidemia with hypertriglyceridemia and increased plasma concentrations of total, direct and indirect bilirubin (P < .05). Older pregnant mares showed biochemical changes probably consistent with decreased organ functionality (P < .05). Obesity did not influence lipidic metabolism during pregnancy (P > .05).

ROLE OF CORD BLOOD BILIRUBIN IN THE PREDICTION OF PATHOLOGICAL HYPERBILIRUBINEMIA IN PRETERM INFANTS

Background: Neonatal hyperbilirubinemia is a common clinical problem. Approximately 60% term babies and 80% preterm babies will develop clinically apparent jaundice encountered during the first week of life. Excessive indirect bilirubin concentration can cross the blood-brain barrier and result in death or other severe neurological sequelae. Objectives: To determine the value of cord blood bilirubin to predict pathological hyperbilirubinemia in preterm. Materials and method: A prospective cohort study was carried out on 122 neonates under 37 week at Hue University of Medicine and Pharmacy Hospital, Hue, Vietnam from 4/2018 to 8/2020. Cord blood bilirubin was estimated after birth. Neonates were followed up daily for 7 days for hyperbilirubinemia. Serum bilirubin levels in peripheral blood were estimated from 24 to 36 hours after birth and when the baby developed clinical jaundice. Results: Cord blood bilirubin is a fairly predictor of pathological hyperbilirubinemia in preterm with AUC (95%CI) 0.752 (0.667-0.837). When level of total cord bilirubin is higher than 35.6 μmol/L, preterm babies developed pathological hyperbilirubinemia with a 43,3% sensitivity and 96.4% specfically and +LR 11.9. Conclusion: Cord blood bilirubin may help predict pathological hyperbilirubinemia in preterm Key words: Neonate, preterm, hyperbilirubinemia, cord blood bilirubin.

Voxelotor in adolescents and adults with sickle cell disease (HOPE): long-term follow-up results of an international, randomised, double-blind, placebo-controlled, phase 3 trial

For decades, patients with sickle cell disease have had only a limited number of therapies available. In 2019, voxelotor (1500 mg), an oral once-daily sickle haemoglobin polymerisation inhibitor, was approved in the USA for the treatment of sickle cell disease in patients aged 12 years and older on the basis of HOPE trial data. To further describe the applicability of voxelotor as a treatment for this chronic illness, we report the long-term efficacy and safety of this drug at 72 weeks of treatment; the conclusion of the placebo-controlled HOPE trial. HOPE is an international, randomised, double-blind, placebo-controlled, phase 3 trial done at 60 clinical sites in Canada, Egypt, France, Italy, Jamaica, Kenya, Lebanon, Netherlands, Oman, Turkey, the USA, and the UK. Patients (aged 12-65 years) with confirmed sickle cell disease, a haemoglobin concentration of 5·5-10·5 g/dL at enrolment, and who had between one and ten vaso-occlusive crisis events in the previous 12 months were enrolled. Patients receiving regularly scheduled transfusion therapy, who had received a transfusion in the previous 60 days, or who had been admitted to hospital for a vaso-occlusive crisis in the previous 14 days were excluded. Patients were randomly assigned (1:1:1) to receive either once-daily oral voxelotor 1500 mg, voxelotor 900 mg, or placebo for 72 weeks. Randomisation was done centrally by use of an interactive web response system, stratified by baseline hydroxyurea use (yes vs no), age group (adolescents [12 to <18 years] vs adults [18 to 65 years]), and geographic region (North America vs Europe vs other). The primary endpoint (already reported) was the proportion of patients who achieved a haemoglobin response at week 24. In this final analysis, we report prespecified long-term efficacy assessments by intention to treat, including changes in haemoglobin concentrations from baseline to week 72, changes in the concentration of haemolysis markers (absolute and percentage reticulocytes, indirect bilirubin concentrations, and lactate dehydrogenase concentrations) from baseline to week 72, the annualised incidence of vaso-occlusive crises, and patient functioning, as assessed with the Clinical Global Impression of Change (CGI-C) scale. Safety was assessed in patients who received at least one dose of treatment (modified intention-to-treat population). This trial is registered with ClinicalTrials.gov, NCT03036813. Between Dec 5, 2016, and May 3, 2018, 449 patients were screened, of whom 274 were randomly assigned to the voxelotor 1500 mg group (n=90), the voxelotor 900 mg group (n=92), or the placebo group (n=92). At week 72, the adjusted mean change in haemoglobin concentration from baseline was 1·0 g/dL (95% CI 0·7 to -1·3) in the voxelotor 1500 mg group, 0·5 g/dL (0·3 to -0·8) in the voxelotor 900 mg group, and 0·0 g/dL (-0·3 to 0·3) in the placebo group, with a significant difference observed between the voxelotor 1500 mg group and the placebo group (p<0·0001), and between the voxelotor 900 mg group and the placebo group (p=0·014). Significant improvements in markers of haemolysis, as assessed by the difference in adjusted mean percentage change from baseline at week 72 versus placebo, were observed in the voxelotor 1500 mg group in indirect bilirubin concentrations (-26·6% [95% CI -40·2 to -12·9]) and percentage of reticulocytes (-18·6% [-33·9 to -3·3]). The proportion of patients in the voxelotor 1500 mg group who were rated as "moderately improved" or "very much improved" at week 72 with the CGI-C was significantly greater than in the placebo group (39 [74%] of 53 vs 24 [47%] of 51; p=0·0057). Serious adverse events unrelated to sickle cell disease were reported in 25 (28%) of 88 patients in the voxelotor 1500 mg group, 20 (22%) of 92 patients in the voxelotor 900 mg group, and 23 (25%) of 91 patients in the placebo group. Grade 3 or 4 adverse events were infrequent (ie, occurred in <10% of patients); anaemia occurred in five or more patients (two [2%] patients in the voxelotor 1500 mg group, seven [8%] patients in the voxelotor 900 mg group, and three [3%] patients in the placebo group). Of all 274 patients, six (2%) deaths occurred during the study (two deaths in each treatment group), all of which were judged as unrelated to treatment. Voxelotor 1500 mg resulted in rapid and durable improvements in haemoglobin concentrations maintained over 72 weeks and has potential to address the substantial morbidity associated with haemolytic anaemia in sickle cell disease. Global Blood Therapeutics.

Analysis of early death factors and prognosis of acute promyelocytic leukemia

目的总结初诊急性早幼粒细胞白血病（APL）早期死亡患者的临床特征，分析早期死亡的危险因素和直接死亡原因，同时对患者进行生存分析。方法回顾性分析2011年1月至2017年12月苏州大学附属第一医院、苏州大学附属第一医院广慈分院、苏州弘慈血液病医院收治的368例初诊APL患者的临床特征，分析早期死亡的独立危险因素，比较出血性早期死亡与非出血性早期死亡患者的临床特征，并对所有APL患者进行生存分析。结果368例初诊APL患者中早期死亡31例，早期病死率为8.4%，从诊断至死亡的中位时间为7（0~29）d。比较早期死亡患者与非早期死亡患者的临床特征，应用Logistic回归模型进行多因素分析显示，年龄≥50岁和初诊时WBC≥10×109/L为初诊APL患者发生早期死亡的独立危险因素（P值均<0.01）。31例早期死亡患者中有27例（87.1%）的直接死亡原因为出血，出血是<50岁患者的唯一死亡原因，≥50岁患者的主要死亡原因。比较出血性早期死亡患者与非出血性早期死亡患者的临床特征，提示出血性早期死亡患者的中位年龄和间接胆红素水平较非出血性早期死亡患者低（P<0.05）。所有患者中位随访时间为41.0（0.3~101.4）个月。2年总生存（OS）率为（93.5±1.3）%，5年OS率为（91.0±1.5）%。2年无病生存（DFS）率为（98.8±0.6）%，5年DFS率为（97.1±0.9）%。≥50岁与<50岁患者的2年OS率分别为79.3%和94.2%（P=0.000）；2年DFS率分别为92.3%和98.1%（P=0.023）。高危患者与非高危患者的2年OS率分别为77.3%和96.7%（P=0.000）；2年DFS率分别为94.0%和98.4%（P=0.139）。结论年龄≥50岁和WBC≥10×109/L是APL患者早期死亡的独立危险因素；高危和低危APL的早期病死率有差异而DFS率差异无统计学意义。

Abnormal Serum Bilirubin/Albumin Concentrations in Dementia Patients With Aβ Deposition and the Benefit of Intravenous Albumin Infusion for Alzheimer's Disease Treatment.

BackgroundOur previous study in animal models revealed that bilirubin could induce Aβ formation and deposition. Bilirubin may be important in neurodegenerative dementia with Aβ deposition. Hence, lowering the concentration of the free bilirubin capable of crossing the blood brain–barrier may benefit the treatment of Alzheimer’s disease (AD).ObjectivesThe objectives of this study were to examine the change in the serum bilirubin and albumin concentrations of dementia patients with Aβ deposition, and to determine the effects of intravenous administration of albumin in the treatment of AD.MethodsBilirubin and albumin concentrations in dementia patients with Aβ deposition were examined. Cell viability and apoptosis were determined in dopaminergic neuron-like cells MN9D treated with bilirubin in the presence of diverse concentrations of serum. Human albumin at a dose of 10 g every 2 weeks for 24 weeks was administered intravenously to AD patients to examine the effect of albumin on AD symptoms.ResultsSignificantly higher indirect bilirubin (IBIL) concentrations, lower albumin concentrations, and higher ratio of IBIL to albumin (IBIL/ALB) were observed in dementia patients with Aβ deposition, including AD, dementia with Lewy bodies, and general paresis of insane. In vitro assays showed that bilirubin-induced injury in cultured dopaminergic neuron-like cells negatively depends on the concentration of serum in the culture medium. General linear model with repeated measures analysis indicated a main effect of group on the change in albumin concentrations and Alzheimer’s Disease Cooperative Study Activities of Daily Living Inventory scale (ADCS-ADL) scores, and the main effect of time and group, and group-by-time interaction on the change of Clinical Dementia Rating Scale–Sum of Boxes (CDR-SB) scores. Analysis of the combined data of the entire 28 weeks of assessment period using the area under curve convincingly showed significantly improvements in the change of albumin concentrations, ADCS-ADL scores, and CDR-SB scores.ConclusionIBIL and the IBIL/ALB ratio are significantly higher in dementia patients with Aβ deposition, and intravenous administration of albumin is beneficial to AD treatment.Trial RegistrationThe intervention study was registered at http://www.chictr.org.cn (ChiCTR-IOR-17011539). Date of registration: June 1, 2017.

Association between serum bilirubin and migraine in children and adolescents

BackgroundMigraine in children and adolescents is very common and can be associated with equivalents, psychiatric disorders, or abnormal electroencephalogram findings. Neurogenic inflammation is involved in migraine pathogenesis where pro-inflammatory cytokines play a significant role. Recent studies have demonstrated that serum bilirubin can be considered as an antioxidant and cytoprotective agent and that its concentration may be influenced in migraine by neurogenic inflammation. Various studies have observed reduced serum bilirubin in migrainous adults, and few studies investigated the association between serum bilirubin and migraine in children and adolescents.ObjectivesTo study the association between serum bilirubin and migraine in children and adolescents.Patients and methodSerum samples were collected from 40 migrainous children and adolescents and from 40 controls. Total, direct, and indirect bilirubin concentrations were measured. Headache features, migraine equivalents, psychiatric comorbidity, and electroencephalogram findings were documented in migraineurs.ResultsSerum total, direct, and indirect bilirubin concentrations were significantly lower in migraineurs than controls. This was statistically significant associated with abnormal electroencephalogram findings during headache-free periods and not statistically significant associated with any headache feature, abnormal electroencephalogram findings during headache attacks, or psychiatric comorbidity.ConclusionSerum bilirubin concentration is lower in migrainous children and adolescents compared to control, with no association with specific migraine type or features, and thus may be considered a useful marker for neurogenic inflammation in migraine.

Interleukin-4 Administration or Zinc Supplementation Is Effective in Preventing Zinc Deficiency-Induced Hemolytic Anemia and Splenomegaly.

Nutritional zinc deficiency aggravates inflammation, subsequently causing anemia and splenomegaly in rats; however, the mechanism underlying such splenomegaly remains poorly understood. Therefore, in this study, we aimed to elucidate the mechanisms underlying the splenomegaly and anemia occurring in zinc-deficient rats and investigate whether these effects of zinc deficiency could be reversed by interleukin (IL)-4 administration or zinc supplementation. Five-week-old male Sprague-Dawley rats were fed a standard diet; fed a zinc-deficient diet (n = 7 each) and injected with saline or IL-4; or fed a zinc-deficient diet for 6weeks followed by a standard diet for 4weeks thereafter. White blood cells, segmented neutrophils, platelets, CD4+ T cells, CD11b/c+ granulocytes, CINC/GRO+ cells, and myeloperoxidase-positive cells in the blood and spleen of the zinc-deficient rats were significantly higher than those in all the other groups. Conversely, red blood cells, hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, lymphocytes, and CD8+ T cells in the blood of the zinc-deficient rats were significantly lower than those in the other groups. Furthermore, serum aspartate aminotransferase, lactate dehydrogenase, indirect bilirubin concentrations, and erythrocyte osmotic fragility in the zinc-deficient rats were significantly higher than those in the other groups. Moreover, zinc deficiency significantly decreased the GATA1 protein levels in the spleen. Collectively, these results indicate that zinc deficiency aggravates the inflammatory response and causes hemolytic anemia and splenomegaly. Importantly, IL-4 administration and zinc supplementation can reverse the zinc deficiency-induced hemolytic anemia and splenomegaly.