Serum Total Bilirubin Levels Research Articles

Biochemical perturbations associated with Salmonella gallinarum infection in laying hens:Is oxidative stress implicated?

The aim of this study was to investigate some biochemical and tissue changes associated with Salmonella gallinarum infection in laying hens (LHs), and the complicities of oxidative stress (OS). Fifty LHs were assigned to two groups of 25 LHs infected with S. gallinarum (109 cfu*mL-1 of S. gallinarum) and 25 uninfected controls. Biochemical assays and histopathology were carried out following standard procedures. There was a significant loss of body weight, drop in egg production, as well as 28% mortality in the infected group. Serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and superoxide dismutase (SOD) activities, as well as serum total protein, globulin, total cholesterol, total bilirubin, uric acid, creatinine and malondialdehyde (MDA) levels were significantly higher, whereas serum albumin levels were significantly lower in infected LHs. There were inflammatory, degenerative and necrotic changes observed in the affected organs. Considering the significant elevation in MDA levels coupled with elevated SOD activity in the infected LHs, OS may play a significant role in the pathology of fowl typhoid and may suggest a possible treatment of infected layers with antioxidants.

Use of fenofibrate as adjuvant to phototherapy in unconjugated neonatal hyperbilirubinemia: A systematic review and meta-analysis of randomized controlled trials.

Most neonates have neonatal jaundice, with 5-15% requiring phototherapy. Although phototherapy is beneficial, it can potentially extend hospital stays and cause harm. This study's purpose was to analyze the effects of fenofibrate and phototherapy on total serum bilirubin (TSB) levels at 24 and 48 hours (primary outcome) after intervention. Furthermore, the phototherapy duration and adverse events were also of interest (secondary outcome). The study protocol was registered in the PROSPERO database. Articles were searched on EMBASE, PubMed, Cochrane Library, and Google Scholar. Study selection was done following PRISMA and risk of bias studies were conducted. The Review Manager 5.4 was used for the meta-analysis. Nine studies, including 610 newborns, were identified and included in the meta-analysis. This meta-analysis discovered a significant change in TSB levels at 24 hours after intervention (mean difference (MD) -0.96 (95% CI -1.09, -0.83), p < 0.00001) with low heterogeneity and at 48 hours after intervention (MD -1.75 (95% CI -2.26, -1.24), p < 0.00001) with high heterogeneity. Significant shortening of phototherapy duration was observed in the interventional group (MD -15.28 (95% CI -20.65, -9.90), p < 0.00001) with high heterogeneities. One of the nine studies reported a non-significant occurrence of abdominal distension and diarrhea in the fenofibrate group. Fenofibrate might be applied as an adjuvant in unconjugated neonatal hyperbilirubinemia to reduce the average total serum bilirubin and shorten the length of phototherapy.

ROLE OF BIOCHEMICAL MARKERS AMONG COVID-19 PATIENTS AND THEIR ASSOCIATION WITH SEVERITY OF DISEASE

Objectives: The present study was aimed to evaluate the levels of biomarkers (D-dimer, Procalcitonin [PCT], lactate dehydrogenase [LDH], interleukin [IL]-6, and C-reactive protein [CRP]) among coronavirus disease 2019 (COVID-19) patients visiting/admitted in Government Medical College Jammu and analyze their association with the severity of disease. Methods: The study was conducted on 100 COVID-19-positive patients 18–75 years of age of either sex, visiting/admitted in Government Medical College Jammu, for a period of 6 months. The serum glucose levels, creatine phosphokinase, LDH, liver function tests, renal function tests, and various biochemical COVID-19 markers such as CRP, serum ferritin, IL-6, D-dimer, and PCT were analyzed. Results: In the present study, it was observed that when patients were divided according to the severity of disease, there was a significant difference in the mean levels of total bilirubin, serum sodium, serum potassium, D-dimer, SpO2, and duration of symptoms in a mild and severe group of patients, while there was no significant difference in the parameters such as IL-6, ferritin, CRP, PCT, LDH, and other routine biochemistry parameters. When a comparison was done between both the groups according to SpO2, only the mean levels of serum total bilirubin were significant. Conclusion: Thus, it is concluded that serum bilirubin was significantly elevated in mild, moderate, and severe groups of patients. Further research should be conducted to find some biomarkers which are specific to COVID-19 only.

EFFECT OF PHOTOTHERAPY ON SERUM CALCIUM AND MAGNESIUM LEVELS IN NEWBORNS WITH HYPERBILIRUBINEMIA ADMITTED TO NEONATAL INTENSIVE CARE AT A TERTIARY CARE TEACHING HOSPITAL IN THE KOLHAN REGION OF JHARKHAND

Objectives: Neonatal jaundice is a medical condition causing yellowish skin discoloration, leading to hospital readmissions in the first 2 weeks of life. It affects 60% of full-term babies and 80% of premature infants. Severe jaundice can cause kernicterus and neurological damage. Treatment options include phototherapy, exchange transfusions, or pharmacological therapy. Phototherapy is the safest and most effective treatment, but it can lead to hypocalcemia and hypomagnesemia due to its effect on the pineal gland. The present study shows the effect of phototherapy on serum calcium and magnesium levels in hyperbilirubinemia. Methods: A prospective observational study was conducted on 221 neonates with hyperbilirubinemia who were treated with phototherapy. We measured bilirubin, calcium, and magnesium levels in their blood samples at admission and 48 h after initiation of phototherapy. The data were analyzed using Epi-Info software. Results: Before phototherapy, the mean serum calcium was 8.79±1.44, but it decreased significantly to 8.13±1.67 (p&lt;0.05). Before phototherapy, the mean serum magnesium level was 3.22±0.72 and reduced considerably to 2.56±0.50 (p&lt;0.05). After phototherapy, total serum bilirubin levels reduced dramatically (from 13.07±3.41 to 8.63±3.10) (p&lt;0.05). Conclusion: The present study shown that phototherapy has a significant effect on the levels of serum calcium, magnesium, and total serum bilirubin by reducing the level.

8626 Associations Between Low Serum Bilirubin Levels and the Progression of Diabetic Kidney Disease in Individuals with Type 2 Diabetes, Including Those in a Normoalbuminuric State

Abstract Disclosure: E. Kim: None. Y. Cho: None. O. Hong: None. K. Jo: None. J. Han: None. S. Moon: None. Objective: This study aimed to investigate the potential correlation between serum bilirubin levels and the progression of diabetic nephropathy, assessing whether low serum bilirubin levels are associated with a decline in renal function, while considering the baseline albumin excretion status. Methods: The longitudinal observation, spanning 11 years, involved 1167 Korean subjects aged 20 years or older, diagnosed with type 2 diabetes mellitus (T2DM), and having a baseline estimated glomerular filtration rate (eGFR) greater than 60 ml/min per 1.73 m2. Albuminuria was assessed by the 24-hour urinary albumin to creatinine excretion rate (ACR) and categorized into normoalbuminuria (ACR &amp;lt;30 mg/g), micro- or macroalbuminuria (ACR &amp;gt;300/g). Cox regression analysis was employed to explore connections between serum bilirubin levels and eGFR decline ≥40%, with adjustments for potential confounding variables. Results: Over a median follow-up of 8.2 years, 128 individuals experienced a decline in eGFR &amp;gt;40%. The hazard ratio (HR) of incident GFR decline was 1.72 (95% CI: 1.04-2.85, P=0.036) in the lowest total bilirubin (TB) tertile compared to the highest TB tertile after multivariable adjustment. When stratified by baseline albuminuria status, low bilirubin levels were significantly associated with eGFR decline, even in the normoalbuminuria group (HR: 2.21, 95% CI: 1.26-3.90, P=0.006), with a gradually increasing risk according to the absence of low TB levels and albuminuria (HR: 2.92, 95% CI: 1.65-5.19, P&amp;lt;0.001), and low TB levels and albuminuria (HR: 3.01, 95% CI: 1.65-5.46, P&amp;lt;0.001). Conclusion: Low serum TB levels are associated with an increased risk of rapid GFR decline in Korean patients with T2DM. Serum bilirubin levels may serve as a prognostic marker for the development and progression of diabetic kidney disease. Presentation: 6/1/2024

Duration of a standard phototherapy course in jaundiced newborns with no neurotoxicity risk.

In this study, we aimed to determine an ordinary/empiric/standard phototherapy treatment protocol for duration without controlling total serum bilirubin (TSB) levels after initiating phototherapy in early-term and full-term jaundiced newborns who had no hyperbilirubinemia neurotoxicity risk factors. We compared two groups, each receiving either 24 h (Group I) or 18 h (Group II) of continuous phototherapy in terms of demographic characteristics and efficacy (rate of decrease in TSB levels with phototherapy). No control TSB measurements were performed in the study groups until the end of phototherapy for the predetermined durations. Declines in TSB after phototherapy were significantly greater in Group I than in Group II, both in terms of mg/dl (11.81 ± 2.93 mg/dl vs. 10.75 ± 2.48 mg/dl, P = .0008) and percentage (56.71 ± 9.06% vs. 52.86 ± 8.37%, P = .0002). However, the rate of TSB reduction after phototherapy in mg/dl/h (0.59 ± 0.13 mg/dl/h vs. 0.49 ± 0.12 mg/dl/h, P = <.0001) and percentage per hour (2.93 ± 0.37% vs. 2.36 ± 0.46%, P = <.0001) were significantly higher in Group II than in Group I. This indicates an inverse time-response relationship between the duration of phototherapy and the response rate in the study groups. Although the 24-h phototherapy course showed greater efficacy concerning the primary bilirubin outcome measures (decline in TSB in mg/dl and %), the 18-h course of phototherapy treatment provided better hourly outcomes and reached its saturation point around the 18th hour. Therefore, an 18-h phototherapy without TSB monitoring until the end of the phototherapy should be considered for jaundiced newborns lacking neurotoxicity risk factors.

Association of PM2.5 exposure in early pregnancy and maternal liver function: A retrospective cohort study in Shenzhen, China

ObjectiveStudies have shown that fine particulate matter (PM2.5) has adverse effects on the liver function, but epidemiological evidence is limited, especially regarding pregnant women. This study aims to investigate the association between PM2.5 exposure in early pregnancy and maternal liver function during pregnancy. MethodsThis retrospective cohort study included 13,342 pregnant participants. PM2.5 and Ozone (O3) exposure level, mean temperature, and relative humidity for each participant were assessed according to their residential address. The levels of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (TBIL) were measured during the second and third trimesters. Data on PM2.5 and O3 exposure level were sourced from Tracking Air Pollution in China (TAP), while the mean temperature and relative humidity were obtained from the ERA5 dataset. The Generalized Additive Model (GAM) was used to analyze the associations between PM2.5 exposure and maternal liver function during pregnancy, adjusting for potential confounding factors. ResultsAccording to the results, each 10 μg/m3 increase in PM2.5 was associated with an increase of 3.57% (95% CI: 0.29%, 6.96%) in ALT and 4.25% (95% CI: 2.33%, 6.21%) in TBIL during the second trimester and 4.51% (95% CI: 2.59%, 6.47%) in TBIL during the third trimester, respectively. After adjusting for O3, these associations remained significant, and the effect of PM2.5 on ALT during the second trimester was further strengthened. No significant association observed between PM2.5 and AST. ConclusionsPM2.5 exposure in early pregnancy is associated with increasement of maternal ALT and TBIL, suggesting that PM2.5 exposure may have an adverse effect on maternal liver function. Although this finding indicates an association between PM2.5 exposure and maternal liver function, more research is needed to confirm our findings and explore the underlying biological mechanisms.

Iron overload and liver function in patients with beta thalassemia major: A cross sectional study.

In thalassemia major, repeated blood transfusions result in iron overload causing organ damage. The objective of this study was assessment of liver enzymes in patients with Thalassemia major and to observe their association with ferritin. A cross-sectional study was performed, at Islamabad Medical and Dental College and its affiliated Akbar Niazi Teaching Hospital from November 2021 till August 2022. Serum ferritin, AST, ALT, and total bilirubin levels were determined, in 135 patients of beta thalassemia major receiving transfusions. Data analysis was performed using SPSS Version 20. For categorical variables, calculation of frequencies and percentages was performed. Mean (± standard deviation) was determined for quantitative variables. ANOVA with post hoc Tukey's test was used for determining association between liver enzymes and serum ferritin. A p-value of <0.05 was considered significant. The correlation between ferritin and LFTs was determined by Pearson's correlation coefficient. Patients had an age range of 7-30 years, and males constituted 51% of sample. Mean level of ferritin was 6062.61 + 3641.79 ng/ml, with an insignificant difference between the genders (p =0.366). The levels of AST, ALT and bilirubin were perceived to show a significant increase in patients with ferritin levels >5000ng/ml, when compared with patients having ferritin levels < 2,500 ng/ml. A significant positive correlation of increasing serum ferritin levels was observed with ALT (r= 0.682), to a lesser extent with AST (r = 0.532), and only a weak correlation with serum bilirubin (r = 0.350). Liver damage was caused by increased iron deposition. LFTs should be performed regularly to detect and reduce liver damage by increasing chelation therapy, thereby reducing morbidity and mortality due to thalassemia.

Association of elevated baseline bilirubin caused by preadmission statin use with cardiovascular prognosis in patients undergoing elective percutaneous coronary intervention

Bilirubin is widely recognized to possess antioxidant and anti-inflammatory characteristics. However, the relationship between bilirubin and coronary artery disease (CAD) remains controversial, particularly in individuals receiving Percutaneous Coronary Intervention (PCI). Given that statins may enhance the production of heme oxygenase-1 (HO-1) and bilirubin, we investigated the long-term cardiovascular prognostic role of bilirubin levels elevated by statin use in patients undergoing PCI. Data of 6945 subjects undergoing PCI were enrolled in this study. We divided the patients into two groups based on serum total bilirubin (TB) levels detected prior to PCI. The high TB group consisted of patients with serum TB values > 8.4 μmmol/L, while the low TB group consisted of patients with serum TB values ≤ 8.4 μmmol/L. The median follow-up time was 836 days. Cox proportional hazards models were performed to evaluate the hazard ratios (HRs) and 95% confidence interval (CI) for the incidence of major adverse cardiovascular event (MACE) associated with bilirubin levels. The association between TB levels and risk of MACE was significant [adjusted HR = 0.557, 95% CI (0.59–0.96), p = 0.020). Linear analysis was performed to determine the association between preadmission usage of statin and bilirubin level. The preadmission usage of statin independently linearly increases TB [adjusted-β = 0.371, 95% CI (0.134–0.608), p = 0.002] and direct bilirubin (DB) [adjusted-β = 0.411, 95% CI (0.300–0.522), p < 0.001). Mediation analysis demonstrated a direct protective role of preadmission statins treatment (β = − 0.024, p < 0.01), TB (β = − 0.003, p < 0.05) and DB (β = − 0.009, p < 0.05). Furthermore, it was found that TB (4.0%) and DB (12.0%) mediated the relationship between preadmission statins therapy and MACE. Bilirubin has a protective effect against MACE. In patients with normal bilirubin level undergoing elective PCI, preadmission statin use elevated bilirubin levels, which were independently associated with a lower incidence of MACE over the long-term follow-up period.

Development and validation of a prediction model for rebound hyperbilirubinemia: a Chinese neonatal cohort study.

Rebound hyperbilirubinemia (HBB) is still present in as high as 10% of newborn babies. However, the applicability of established prediction models for rebound HBB to Chinese newborns is unclear. This study aimed to establish a model to predict HBB rebound after phototherapy among Chinese neonates. A retrospective cohort study was conducted on 1,035 HBB infants receiving phototherapy. Rebound HBB was defined as total serum bilirubin (TSB) returning to or above the American Academy of Pediatrics (AAP) phototherapy threshold within 72 hours after the end of phototherapy. The predictive effects of previously published two- and three-variable scores were verified. Neonates were randomly assigned in a 6:4 ratio to the training (n=621) group and the testing (n=414) group. All variables in the training set were used to select predictors by least absolute shrinkage and selection operator (LASSO) regression analysis. The internal validation of the prediction model was performed using the testing set. The model's predictive performance was evaluated by area under the curve (AUC), accuracy, sensitivity, and specificity, each with 95% confidence intervals (CIs). Receiver operating characteristic (ROC) and calibration curves were constructed to evaluate the discrimination ability and fitting effect of the prediction model, respectively. Rebound HBB was observed in 210 patients (20.3%). The AUC for the two- and three-variable scores were 0.498 (95% CI: 0.455-0.540) and 0.498 (95% CI: 0.457-0.540), respectively. Predictive factors for the risk of rebound HBB included formula feeding (>3 times/day), standard phototherapy irradiation time, TSB levels and age at termination of phototherapy, neonatal weight, and differences between TSB levels at the phototherapy termination and phototherapy threshold. The prediction model's AUC was 0.935 (95% CI: 0.911-0.958), the sensitivity was 0.880 (95% CI: 0.809-0.950), the specificity was 0.831 (95% CI: 0.790-0.871), and the accuracy was 0.841 (95% CI: 0.805-0.876). The established model performed well in predicting rebound risk among Chinese infants with HBB, which may be beneficial in treating and managing HBB in infants.

Association of total bilirubin and prognosis in disorders of consciousness

Accurate prediction of the recovery of Disorders of Consciousness (DoC) is of paramount significance for clinicians and families. Serum total bilirubin (TBIL) formed by activation of heme oxygenase 2, is associated with incidence and prognosis of cardiovascular and cerebrovascular diseases. However, studies that based TBIL and DoC are limited. The study attempted to examine the association between serum TBIL levels and prognosis in patients with DoC. One hundred and sixty-eight patients with DoC in the Second hospital of Shandong University from June 2021 to June 2023 were recruited. The clinical characteristics and venous blood samples were collected within 24 h after admission. The diagnosis of DoC was determined by two skilled investigators employing various behavioral evaluations along the coma recovery scale-revised (CRS-R) and the investigators conducted follow-up assessments of diagnosis at 1, 3, and 6 months after admission. For statistical analysis, we categorized patients with an improvement in clinical diagnosis from study entry as having a “good outcome”. In total, 139 individuals enrolled in the study. The median TBIL level was 8.2 μmol/L. Good recovery of DoC at 1, 3, and 6 months occurred in 25 (18.0%), 41 (29.5%), and 56 (40.3%) patients, respectively. After full adjustment, a significant association was found between TBIL levels and the prognosis of DoC at 1, 3, and 6 months. When TBIL levels were analyzed as categorical variables, an increasing trend in the tertiles of TBIL levels demonstrated a significant positive association with the recovery of DoC at 1, 3, and 6 months. Stratified analysis revealed that the association between serum TBIL levels and the recovery of DoC remained consistent across different sub-populations. A high serum TBIL level is associated with an improved likelihood of recovery of DoC. Additional research is required to elucidate the underlying pathophysiological causal association between TBIL levels and DoC.

Effect of probiotic administration to breastfeeding mothers with very low birthweight neonates on some neonatal and maternal outcomes: study protocol for a randomised, double-blind, placebo-controlled trial

IntroductionPremature birth and very low birth weight (VLBW) are leading causes of neonatal mortality. Almost all premature infants experience hyperbilirubinaemia. Administering probiotics to breastfeeding mothers may positively affect infant outcomes....

Bilirubinemia and retinopathy of prematurity in infants ≤ 29 weeks' gestational age.

Bilirubin is a known antioxidant. We hypothesized that the degree of bilirubinemia is inversely associated with oxidative stress-mediated retinopathy of prematurity (ROP). A prospective study was performed to determine if bilirubinemia is associated with ROP in infants ≤ 29 wks' gestational age and birth weights ≤ 1000 g. Total serum bilirubin (TSB) levels were measured at least twice daily during the first week and at least daily during the second week to determine peak and mean TSB levels. The outcomes were the incidence and severity of ROP. Of 193 infants studied, 110 developed ROP: 53 had mild (stage 1 in zone 2 or 3); 31 had moderate (stage 2 in zone 2 or 3); and 26 had severe ROP ( ≥ stage 3 in any zone or any stage in zone 1). Mean TSB levels were associated with the severity (adjusted odds ratio [AOR] 0.68, 95% confidence interval [CI]:0.47-0.98, p = 0.04), but not with the incidence of ROP (AOR 0.81, 95% CI:0.52-1.27, p = 0.3). Peak TSB levels were also associated with the severity (AOR 0.71, 95% CI:0.52-0.96, p = 0.02), but not with the incidence of ROP (AOR 0.71, 95% CI:0.48-1.01, p = 0.07). Bilirubinemia may be protective against severity of ROP. Retinopathy of prematurity (ROP) is a disease mediated by oxidative stress. Increasing antioxidant status may decrease the incidence and severity of ROP. Bilirubin is a known antioxidant; however, findings from observational studies evaluating the role of bilirubinemia against the incidence and/or severity of ROP in premature infants are conflicting. Our findings from this prospective study suggests that bilirubinemia may be protective against the severity of ROP.

Percutaneous endobiliary radiofrequency ablation and stent placement for unresectable malignant biliary obstruction: a propensity score matching retrospective study

BackgroundWhether endobiliary radiofrequency ablation (EB-RFA) changes the standard role of stent placement in treating unresectable malignant biliary obstruction (MBO) remains unclear. The aim of this study is to compare percutaneous EB-RFA and metal stent placement (RFA-Stent) with metal stent placement alone (Stent) in treating unresectable MBO using a propensity score matching (PSM) analysis.MethodsFrom June 2013 to June 2018, clinical data from 163 patients with malignant biliary obstruction who underwent percutaneous RFA-Stent or stenting alone were retrospectively analyzed using a nearest-neighbor algorithm to one-to-one PSM analysis to compare primary and secondary stent patency (PSP, SSP), overall survival (OS) and complications between the two groups.ResultsBefore matching, for whole patients, RFA-Stent resulted in longer median PSP (8.0 vs. 5.1 months, P = 0.003), SSP (9.8 vs. 5.1 months, P < 0.001) and OS (7.0 vs. 4.5 months, P = 0.034) than the Stent group. After matching (54 pairs), RFA-Stent also resulted in better median PSP (8.5 vs. 5.1 months, P < 0.001), SSP (11.0 vs. 6.0 months, P < 0.001), and OS (8.0 vs. 4.0 months, P = 0.007) than Stent. RFA-Stent was comparable with Stent for complication rates. In Cox analysis, RFA-Stent modality and serum total bilirubin level were independent prognostic factors for PSP. RFA-Stent modality, performance status score and combination therapy after stent were independent prognostic factors for OS.ConclusionPercutaneous RFA-Stent was superior to Stent in terms of PSP, SSP, and OS in selected patients with unresectable MBO.

Association between serum total bilirubin with Parkinson's disease among American adults (NHANES 1999 to 2018)

BackgroundCurrently, the existing evidence on the correlation between serum total bilirubin (STB) and Parkinson's disease (PD) is insufficient. The objective of this study was to clarify the relationship between STB levels and PD within the US (United States) population. MethodsA cross-sectional analysis was conducted using data from 25,637 participants in the National Health and Nutrition Examination Survey (NHANES) 1999–2018. Weighted logistic regression, smooth curve fitting, subgroup analysis, and sensitivity analyses were employed to validate the research objectives. ResultsAmong all eligible subjects, the mean age was 57.11 ± 11.78 years. The prevalence of PD was 1.18 % overall, with 47.86 % in males. After adjusting for multiple variables, the odds ratio [OR] (95 % confidence interval [CI]) for PD associated with STB levels in T2 and T3 were 0.59 (95 % CI = 0.40–0.85, p = 0.006) and 0.67 (95 % CI = 0.45–0.99, p = 0.045), respectively, when compared to STB levels in T1. The analysis using restricted cubic splines (RCS) indicated an L-shaped relationship between STB levels and the prevalence of PD (p for nonlinearity = 0.004), with the lowest risk observed at 10.84 μmol/L. Comparable patterns of association were noted in subgroup analyses. Furthermore, consistent findings were derived from additional sensitivity analyses. ConclusionsOur study findings indicated that the level of STB is significantly negatively correlated with the prevalence of PD. Therefore, more prospective studies need to be designed to prove the causal relationship between them.

Application of radioactive iodine-125 microparticles in hepatocellular carcinoma with portal vein embolus.

Radioactive iodine-125 (125I) microparticle therapy is a new type of internal radiation therapy that has shown unique advantages in the treatment of malignant tumors, especially hepatocellular carcinoma. Patients with hepatocellular carcinoma frequently experience portal vein embolism, which exacerbates the difficulty and complexity of treatment. 125I particles, used in local radiotherapy, can directly act on tumor tissue and reduce damage to surrounding healthy tissue. Through retrospective analysis, this study discussed the efficacy and safety of radioactive 125I particles in portal vein embolization patients with hepatocellular carcinoma in order to provide more powerful evidence supporting clinical treatment. To investigate the effect of transcatheter arterial chemoembolization combined with portal vein 125I particle implantation in the treatment of primary liver cancer patients with portal vein tumor thrombus and its influence on liver function. The clinical data of 96 patients with primary liver cancer combined with portal vein tumor thrombus admitted to our hospital between January 2020 and December 2023 were retrospectively analyzed. Fifty-two patients received treatment with transcatheter arterial chemoembolization and implantation of 125I particles in the portal vein (combination group), while 44 patients received treatment with transcatheter arterial chemoembolization alone (control group). The therapeutic effects on tumor lesions, primary liver cancer, and portal vein tumor embolisms were compared between the two groups. Changes in relevant laboratory indexes before and after treatment were evaluated. The t test was used to compare the measurement data between the two groups, and the χ 2 test was used to compare the counting data between groups. The tumor lesion response rate in the combination group (59.62% vs 38.64%) and the response rate of patients with primary liver cancer complicated with portal vein tumor thrombus (80.77% vs 59.09%) were significantly greater than those in the control group (χ 2 = 4.196, 5.421; P = 0.041, 0.020). At 8 wk after surgery, the serum alpha-fetoprotein, portal vein main diameter, and platelet of the combined group were significantly lower than those of the control group, and the serum alanine aminotransferase, aspartate aminotransferase, and total bilirubin were significantly greater than those of the control group (t = 3.891, 3.291, 2.330, 3.729, 3.582, 4.126; P < 0.05). The serum aspartate aminotransferase, alanine aminotransferase, and total bilirubin levels of the two groups were significantly greater than those of the same group 8 wk after surgery (P < 0.05), and the peripheral blood platelet, alpha-fetoprotein, and main portal vein diameter were significantly less than those of the same group before surgery (P < 0.05). In patients with primary liver cancer and a thrombus in the portal vein, transcatheter arterial chemoembolization plus portal vein 125I implantation is more effective than transcatheter arterial chemoembolization alone. However, during treatment it is crucial to pay attention to liver function injury caused by transcatheter arterial chemoembolization.

Analysis of UGT1A1 genotype-phenotype correlation in Chinese patients with gilbert and crigler-Najjar II syndrome

The spectrum of UDP-glucuronosyltransferase (UGT1A1) variants, which are associated with Gilbert syndrome (GS) and Crigler-Najjar syndrome (CNS-II), has been reported in Chinese and western countries. However, the genotype-phenotype correlation of the individual UGT1A1 variants in GS and CNS-II remains to be clarified. To explore the UGT1A1 variant pattern and genotype-phenotype correlations, we enrolled 310 Chinese patients, including 232 patients with GS and 78 with CNS-II. Peripheral blood samples were collected for screening variants in the gene UGT1A1 by a polymerase chain reaction and Sanger sequencing. The correlation between different UGT1A1 variants and clinical phenotypes was analyzed. A total of 21 UGT1A1 variants were identified, including nine novel variants, and constituted 42 UGT1A1 genotypes in the GS and CNS-II patients. The most common UGT1A1 variants were A (TA)7TAA, p.G71R, p.Y486D, p.P364L, and p.P229Q, which were different from western countries. The p.Y486D variant had higher minor allele frequency in CNS-II than in GS whereas the A (TA)7TAA variant had higher minor allele frequency in GS than in CNS-II. The serum total bilirubin and triglyceride had significant differences among 14 recurrent genotypes of UGT1A1, in which the serum total bilirubin in patients with compound p.Y486D (homozygous)/p.G71R variant was significantly higher compared with homozygous A (TA)7TAA, homozygous p.G71R, compound heterozygous A (TA)7TAA/p.G71R and A (TA)7TAA/p.P364L, and combined heterozygous A (TA)7TAA/p.G71R/p.P229Q, while the serum triglyceride in patients with combined A (TA)7TAA (homozygous)/p.P229Q variant was significantly higher compared with compound heterozygous A (TA)7TAA/p.G71R, single heterozygous A (TA)7TAA, single heterozygous p.G71R, and homozygous A (TA)7TAA. The spectrum of UGT1A1 genotypes in Chinese patients was distinct from western countries. There were differential levels of serum total bilirubin and triglyceride in patients with recurrent genotypes of UGT1A1.

Raziskovanje toksičnosti, ki jo povzroča trikloroocetna kislina na hepato-renalni sistem, in posredovanje prehrane, bogate z deviškim kokosovim oljem

Virgin coconut oil (VCO) is known for many beneficial health effects associated with its phenolic acids and flavonoid contents. We investigated the mechanisms underlying the antioxidative, anti-inflammatory, and anti-apoptotic mechanisms of Virgin Coconut oil-rich diet in treating trichloroacetic acid (TCA)-induced hepatic and renal damage in rats. Rats received TCA (250 mg/Kg b.wt, p.o) for ten days, followed by 5%, 10% or 15% VCO per gram feed for twenty-one days. Serum liver enzymes, urea, creatinine, tissue oxidative stress parameters, and inflammatory and apoptotic markers were then evaluated along with histological examination. TCA raised serum transaminases (ALT, AST), alkaline phosphatase (ALP), total bilirubin, urea and creatinine levels, which were abrogated by a VCO-rich diet dose-dependently. The activity of superoxide dismutase, catalase, glutathione peroxidase and nuclear factor erythroid 2-related factor 2 in the liver and kidney were enhanced, while malondialdehyde, tumour necrosis factor-α, interleukin-1β, nuclear factor-kB level hitherto increased by TCA were quashed by the VCO- rich diet (p&lt;0.05). Similarly, the augmented level of Caspase-3 in the organs exposed to TCA was downregulated in favour of significantly increased BCl-2. Further, histomorphometry data validated the biochemical findings observed for the anti-inflammatory and anti-apoptotic potentials of VCO. Hepatocyte ballooning, pleomorphism and vascular congestion in the liver, loss of tubular architecture, tubular congestion and leukocyte infiltration in the kidney, all occasioned by TCA-intoxication, were evidently mitigated. Virgin coconut oil-rich diet could ameliorate liver and renal injury associated with trichloroacetic acid exposure via antioxidative, anti-inflammatory and anti-apoptotic mechanisms.

Pseudomonas UTI Masquerading as Neonatal Jaundice: A Case Report

The pathological jaundice in neonates develops due to hematological, infectious, surgical causes. We present an interesting case of persistent neonatal hyperbilirubinemia, who was diagnosed to have urinary tract infection (UTI) and effectively managed. Unexplained persistent neonatal jaundice, poor response to phototherapy, and higher rebound total serum bilirubin levels should be evaluated for UTI.

High-normal serum bilirubin is a useful indicator to assess the risk of diabetic retinopathy in type 2 diabetes: A real-world study

BackgroundTo investigate the association of serum bilirubin within normal range, especially unconjugated bilirubin (UCB), with diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). MethodsIn this cross-sectional, real-world study, 7617 T2DM patients were stratified into quartiles based on serum UCB levels. DR was determined by digital fundus photography and further classified into non-proliferative diabetic retinopathy (NPDR) and PDR. The associations of serum bilirubin levels and UCB quartiles with DR were investigated by logistic regression analysis. ResultsAfter controlling for age, sex, and diabetes duration, the DR prevalence was significantly decreased across the serum UCB quartiles (40.4 %, 33.4 %, 29.7 %, 26.6 % for each quartile, respectively, p < 0.001 for trend). The subjects with DR had lower serum total bilirubin (TB) and UCB, rather than conjugated bilirubin (CB), compared with those without DR (p = 0.003 for TB, p < 0.001 for UCB, and p = 0.528 for CB, respectively), while all three types of serum bilirubin in the subjects with PDR were obviously lower than those with NPDR (p = 0.006 for TB, and p < 0.001 for UCB and CB, respectively). After adjustment for confounding factors, logistic regression demonstrated negative associations of serum TB and UCB levels, rather than CB, with the presence of DR (OR: 0.844, 95%CI: 0.774–0.920, p < 0.001 for TB; OR: 0.828, 95%CI: 0.763–0.899, p < 0.001 for UCB; and OR: 0.984, 95%CI: 0.900–1.074, p = 0.713 for CB, respectively). Additionally, a fully-adjusted analysis revealed a negative correlation between UCB quartiles and DR (p < 0.001). ConclusionHigh-normal serum TB and UCB were closely associated with the decreased odds of DR, while all types of serum bilirubin were negatively correlated with the severity of DR in T2DM patients. Serum bilirubin may be used as a potential indicator to assess the risk and severity of DR in T2DM.