Serum Total Bilirubin Concentration Research Articles

Low incidence of spontaneous bacterial peritonitis in asymptomatic cirrhotic outpatients

To compare the incidence of spontaneous bacterial peritonitis in cirrhotic outpatients and inpatients undergoing therapeutic paracentesis From January 1 to May 31, 2004, 1041 patients from 70 different hospitals underwent 2123 therapeutic abdominal paracentesis (AP) performed as a outpatient procedure in 355 and as inpatient procedure in 686 cases respectively. The following parameters were compared prospectively between outpatients and inpatients: spontaneous bacterial peritonitis (SBP) prevalence, age, gender, cause of cirrhosis, symptoms, score and grade according to Child-Pugh classification, cirrhosis complications, antibiotics treatment, serum creatinine, platelet count and ascitic protein concentration. SBP was observed in 91 patients. In the whole population the SBP prevalence was 8.7% (95%CI: 7.2-10.6) it was 11.7% (95%CI: 9.5-14.3) in inpatients and 3.1% (95%CI: 1.7-5.5) in outpatients (P < 0.00001). SBP prevalence was 8.3% (95%CI: 4.3-15.6) in symptomatic outpatients vs 1.2% (95%CI: 0.4-3.4) in asymptomatic outpatients (P < 0.002). Patients undergoing outpatient AP were significantly different from those undergoing inpatient AP; they were older (61.1 ± 11.1 years vs 59.4 ± 11.7 years; P = 0.028), cause of cirrhosis was less often alcohol (83 .7 vs 88.2%; P < 0.001), Child-Pugh score was lower (8.9 vs 10.1; P < 0.001) and more often B than C (63.7% vs 38%; P < 0.001). In addition, in outpatients the platelet count was higher (161 ± 93 Giga/L vs 143 ± 89 Giga/L; P = 0.003), serum total bilirubin concentration was lower (38.2 ± 60.7 μmol/L vs 96.3 ± 143.3 μmol/L; P < 0.0001), and ascitic protein concentration higher (17.9 ± 10.7 g/L vs 14.5 ± 10.9 g/L; P < 0.001) than in inpatients. In asymptomatic cirrhotic outpatients, the incidence of spontaneous bacterial peritonitis is low thus exploratory paracentesis could be avoided in these patients without significant risk.

Prognostic Value of Total Bilirubin in Patients With ST-Segment Elevation Acute Myocardial Infarction Undergoing Primary Coronary Intervention

Previous studies have shown that the serum total bilirubin (TB) concentration was inversely related with stable coronary artery disease, diabetes mellitus, hypertension, and metabolic syndromes. The relation between TB levels and in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI) is not known. Data from 1,624 consecutive patients with STEMI who underwent primary PCI were evaluated. TB was measured after primary PCI, and the study population was divided into tertiles. The high TB group (n=450) was defined as a value in the upper third tertile (>0.9 mg/dl) and the low TB group (n= 1,174) as any value in the lower 2 tertiles (≤0.9 mg/dl). The in-hospital mortality rate was significantly greater in the high TB group than in the low TB group (4% vs 1.5%, p= 0.003). In the multivariate analyses, a significant association was noted between high TB levels and the adjusted risk of in-hospital cardiovascular mortality (odds ratio 3.24, 95% confidence interval 1.27 to 8.27, p= 0.014). In the receiver operating characteristic curve analysis, TB >0.90 mg/dl was identified as an effective cutpoint in patients with STEMI for in-hospital cardiovascular mortality (area under the curve 0.66, 95% confidence interval 0.55 to 0.76, p= 0.001). The mean follow-up period was 26.2 months. No differences wereseen in the long-term mortality rates between the 2 groups. In conclusion, high TBisindependently associated with in-hospital adverse outcomes in patients with STEMIwhoundergo primary PCI. However, no association was found with long-term mortality.

Glycine ameliorates liver injury and vitamin D deficiency induced by bile duct ligation

BackgroundPatients with chronic liver disease had lower serum concentrations 25-hydroxyvitamin D (25OHD). Glycine, a nonessential amino acid, exerts anti-inflammatory, cytoprotective, and immunomodulatory properties. This study aimed to establish a tandem mass spectrometry assay to measure 25OHD in guinea pigs serum and to investigate the effects of glycine against the liver damage induced by bile duct ligation (BDL). MethodsBDL was performed on male guinea pigs. Glycine, alanine, serine or tyrosine was given by intraperitoneal injection. The animals were sacrificed and examined at 7 and 14days after BDL. Serum concentrations of total bilirubin and aminotransferase were measured. Serum concentrations of 25OHD2 and 25OHD3 were measured by API 5000 mass spectrometer. In addition, oxidative stress was assessed by serum ischemia-modified albumin (IMA) and hepatic malondialdehyde (MDA), and apoptosis by hepatic caspase 3 activities. ResultsSerum 25OHD concentrations were decreased around 50% in the BDL group at days 7 and 14 post ligation, compared to sham (mean 65.3ng/ml, p<0.005). Glycine but not other amino acid treatment blunted the reduced serum 25OHD (52.6ng/ml, p<0.05) resulting from BDL. The concentrations of 25OHD were negatively associated with concentrations of IMA (r=−0.305, p<0.05) and caspase 3 (r=−0.562, p<0.0001). At day-14 post ligation, glycine treatment also ameliorated liver damage indicated by serum AST (p<0.005), ALT (p<0.05) and hepatic caspase 3 activities (p<0.05) and oxidative stress. ConclusionOur results indicate that glycine may protect against BDL-induced liver injury through attenuation of oxidative stress, apoptosis and the vitamin D deficiency.

Neonatal Transcutaneous Bilirubin Measurements: An Opportunity to Enhance Laboratory Utilization and Improve Patient Care

By far the most common clinical problem addressed by family practitioners and pediatricians in the first weeks of an infant's life is hyperbilirubinemia. With the exception of the standard metabolic screen, the measurement of a total serum bilirubin (TSB)2 concentration is the most common laboratory test ordered for a newborn infant. That is not surprising because the clinical sign, jaundice, is seen in approximately 80% of infants in a well-baby nursery during the first few days (1). The process of observation, clinical monitoring, and laboratory testing that continues throughout the infant's first week of life has a single objective—to prevent extreme hyperbilirubinemia [a TSB concentration >25–30 mg/dL (>428–513 μmol/L)] and its rare but dreaded consequence, bilirubin encephalopathy. Data from most of the Western world suggest that chronic bilirubin encephalopathy, or kernicterus, is currently occurring at an incidence of approximately 0.5–2 per 100 000 live births (2). Thus, of approximately 4 × 106 infants born annually in the US, perhaps 20–40 will develop kernicterus, a permanently disabling condition characterized by athetoid cerebral palsy, severe sensorineural hearing loss, paralysis of upward gaze, and dental dysplasia. For decades practitioners have relied on the appearance and intensity of jaundice as a means of deciding when to obtain a TSB measurement, but recognizing that estimating TSB by eye is difficult and on occasion grossly misleading (3) has prompted the development of transcutaneous bilirubinometry. The instruments that measure the transcutaneous bilirubin (TcB) concentration operate by transmitting light that penetrates the blanched skin and transilluminates the subcutaneous tissues. The …

The relationship between the severity of hemolysis, clinical manifestations and risk of death in 415 patients with sickle cell anemia in the US and Europe

The intensity of hemolytic anemia has been proposed as an independent risk factor for the development of certain clinical complications of sickle cell disease, such as pulmonary hypertension, hypoxemia and cutaneous leg ulceration. A composite variable derived from several individual markers of hemolysis could facilitate studies of the underlying mechanisms of hemolysis. In this study, we assessed the association of hemolysis with outcomes in sickle cell anemia. A hemolytic component was calculated by principal component analysis from reticulocyte count, serum lactate dehydrogenase, aspartate aminotransferase and total bilirubin concentrations in 415 hemoglobin SS patients. Association of this component with direct markers of hemolysis and clinical outcomes was assessed. As primary validation, both plasma red blood cell microparticles and cell-free hemoglobin concentration were higher in the highest hemolytic component quartile compared to the lowest quartile (P≤0.0001 for both analyses). The hemolytic component was lower with hydroxyurea therapy, higher hemoglobin F, and alpha-thalassemia (P≤0.0005); it was higher with higher systemic pulse pressure, lower oxygen saturation, and greater values for tricuspid regurgitation velocity, left ventricular diastolic dimension and left ventricular mass (all P<0.0001). Two-year follow-up analysis showed that a high hemolytic component was associated with an increased risk of death (hazard ratio, HR 3.44; 95% confidence interval, CI: 1.2-9.5; P=0.02). The hemolytic component reflects direct markers of intravascular hemolysis in patients with sickle cell disease and allows for adjusted analysis of associations between hemolytic severity and clinical outcomes. These results confirm associations between hemolytic rate and pulse pressure, oxygen saturation, increases in Doppler-estimated pulmonary systolic pressures and mortality (Clinicaltrials.gov identifier: NCT00492531).

Effect of Calitropis Procera Aqueous Root Extract Against CCL&lt;sub&gt;4&lt;/sub&gt; Induced Liver Toxicity in Rabbits

The hepatocurative effect of aqueous root extract of Calitropis Procera on CCl4 induced hepatotoxicity in rabbits was studied in groups of rabbit and the levels of liver enzymes; aspartate amino transferase (AST), alanine amino transferase (ALT) and alkaline phosphatase (ALP). Serum concentrations of total bilirubin and direct bilirubin were found to be significantly (p&lt;0.05) higher in group induced with hepatotoxicity, with significantly (p&lt;0.05) lower total protein and urea compared to the control group. These findings confirmed induction of hepatotoxicity. Three different dosages were orally administred (1.0g/kg, 2.5g/kg and 3.6 g/kg) twice daily for 9 days. The C. Procera root extract was found to significantly (p&lt;0.05) reduce the serum levels of AST, ALT, and ALP, serum concentration of total bilirubin in rats with hepatotoxicity compared to the the control group and significantly (p&lt;0.05) incerased the serum concentration of total protein and urea. These indicates the possible hepatocurative effects of aqueous root extract of C. Procera on CCl4 induced liver toxicity.

Analytical evaluation of two enzymatic methods for the measurement of total bile acid in intrahepatic cholestasis of pregnancy

The aim of this study was to estimate bilirubin interference and accuracy of six routine methods for measuring creatinine compared with isotope dilution–liquid chromatography mass spectrometry (ID–LC/MS).A total of 40 clinical serum samples from 31 patients with serum total bilirubin concentration > 68.4 μmol/L were collected. Serum creatinine was measured using two enzymatic reagents and four Jaffe reagents as well as ID–LC/MS. Correlations between bilirubin concentration and percent difference in creatinine compared with ID–LC/MS were analyzed to investigate bilirubin interference. Bias estimations between the six reagents and ID–LC/MS were performed. Recovery tests using National Institute of Standards and Technology (NIST) Standard Reference Material (SRM) 967a were also performed.Both the enzymatic methods showed no bilirubin interference. However, three of the four Jaffe methods demonstrated significant bilirubin concentration-dependent interference in samples with creatinine levels < 53 μmol/L, and two of them showed significant bilirubin interference in samples with creatinine levels ranging from 53.0 to 97.2 μmol/L. Comparison of these methods with ID–LC/MS using patients' samples with elevated bilirubin revealed that the tested methods failed to achieve the bias goal at especially low levels of creatinine. In addition, recovery test using NIST SRM 967a showed that bias in one Jaffe method and two enzymatic methods did not achieve the bias goal at either low or high level of creatinine, indicating they had calibration bias. One enzymatic method failed to achieve all the bias goals in both comparison experiment and recovery test.It is important to understand that both bilirubin interference and calibration traceability to ID–LC/MS should be considered to improve the accuracy of creatinine measurement.

Erythrocyte-bound immunoglobulin isotypes in dogs with immune-mediated hemolytic anemia: 54 cases (2001–2010)

To identify erythrocyte-bound immunoglobulin (Ig) isotypes in dogs with primary immune-mediated hemolytic anemia (IMHA). Retrospective case series. Animals-54 dogs with IMHA. Medical records of dogs with IMHA diagnosed between January 2001 and April 2010 were examined. Immunoglobulin isotype (tested via direct immunofluorescence by flow cytometry to identify erythrocyte-bound Ig), Hct, serum bilirubin concentration, presence of autoagglutination, degree of spherocytosis, duration of hospitalization, and 90-day outcome were recorded. The Hct on admission was significantly lower in dogs with IgG and IgM isotypes bound to erythrocytes, compared with dogs with a single Ig isotype, and the degree of spherocytosis was greater in dogs with IgG and IgM bound to erythrocytes, compared with dogs that only had IgM. Dogs with only IgM were not more likely to have autoagglutination, compared with dogs that only had IgG on the erythrocyte surface. Although Ig isotype was not associated with survival time, initial serum total bilirubin concentration was higher in nonsurvivors. Results suggested that dogs with IMHA with ≥ 2 Ig isotypes bound to erythrocytes, particularly IgG and IgM, are likely to have a more severe degree of anemia, spherocytosis, and autoagglutination.

Frequency, Risk Factors and Prognosis of Postoperative Hyperbilirubinemia after Heart Valve Surgery

Objectives: Despite recent advances in cardiovascular surgery, hyperbilirubinemia after heart valve surgery occurs often and the mechanism is not well clarified. We evaluated the incidence and nature of postoperative hyperbilirubinemia in heart valve surgery patients to analyze its risk factors and to identify its clinical significance for associated morbidity and mortality. Methods: We investigated 334 consecutive patients who underwent heart valve surgery. Postoperative hyperbilirubinemia was defined as total serum bilirubin concentration greater than 3 mg/dl at any postoperative measurement point. Results: Postoperative hyperbilirubinemia developed in 63 patients (19.0%) and was associated with greater in-hospital mortality (15.9 vs. 1.5%, p < 0.01). Univariate analysis revealed congestive heart failure history, cardiogenic shock, infective endocarditis, preoperative liver dysfunction, longer cardiopulmonary bypass time and transfusion as significantly related to postoperative hyperbilirubinemia. In multivariate analysis, preoperative liver dysfunction [odds ratio (OR) 6.5, p < 0.05] and longer cardiopulmonary bypass time (OR 1.007, p < 0.01) were independent predictors. In postoperative hyperbilirubinemia patients, preoperative New York Heart Association status and history of heart failure were associated with outcome. Conclusions: Postoperative hyperbilirubinemia remains common in patients undergoing heart valve surgery and is associated with a high rate of in-hospital mortality. For patients with heart failure or liver dysfunction, meticulous operative management is required to reduce cardiopulmonary bypass time and transfusion.

Serum Total Bilirubin Concentration Is Inversely Correlated with Framingham Risk Score in Koreans

Compelling evidence suggests that bilirubin, via its antioxidant potential, has anti-atherogenic properties, and that serum bilirubin concentrations within the reference range for the general population may provide some protection against coronary artery disease (CAD). This study examined the association between serum total bilirubin concentration and Framingham risk score (FRS) in the Korean population. This cross-sectional study was performed on 19,792 Koreans. In addition to FRS, data on body mass index, fasting blood glucose, liver enzymes, lipid profile, uric acid, gamma glutamyltransferase, high-sensitive C-reactive protein and total bilirubin were used. Negative correlations were established between log-transformed total bilirubin concentration and FRS (females; r = -0.067, p <0.001, males; r = -0.128, p <0.001). Analyses relating total bilirubin to FRS ≥10% utilized multiple confounder adjusted logistic regression. Unadjusted odd ratios for FRS ≥10% were 0.325 (95% CI: 0.160-0.659, p = 0.002) and 0.342 (95% CI: 0.281-0.417, p <0.001) for log-transformed total bilirubin in females and males, respectively. These inverse relationships remained significant after adjustments for multiple confounders in both genders. Increased total bilirubin concentrations are associated with the decrease in FRS. Serum total bilirubin may be helpful to decrease the future risk of CAD.

Effects of long-term oral administration of aqueous extracts of Irvingia gabonensis bark on blood glucose and liver profile of normal rabbits

Irvingia gabonensis, which is consumed widely in Nigeria, has been shown to possess hypoglycaemic/anti-diabetic properties. In this study, the long term effects of aqueous extracts of I. gabonensis bark, orally administered daily, on body weight, blood glucose and liver function of normal rabbits were monitored at pre-determined intervals for 24 weeks. Body weight and fasting blood sugar were significantly (p<0.05) reduced in the medicinal plant treated rabbits. Indices of hepato-cellular injury, alanine transaminase and aspartate transaminase were initially slightly elevated, while markers of cholestasis, alkaline phosphatase and γ-glutamyl transferase were initially significantly (p<0.05) increased. These parameters returned to the levels of control midway into the monitoring period and tissue enzymes were not depleted, suggesting that the initial toxic response was not sustained. Administration of I. gabonensis bark had no effect on serum total proteins, albumin and globulins, as well as serum total and direct bilirubin concentrations. The sustained anti-obesity and hypoglycaemic effects, as well as the relative low liver toxicity ofI. gabonensis bark extracts makes it an important candidate for the treatment of diabetes. Key words: Irvingia gabonensis, hypoglycaemic/anti-diabetic, liver function, medicinal plants, toxicity; anti-obesity.

Limitations and Opportunities of Transcutaneous Bilirubin Measurements

Although transcutaneous bilirubinometers have existed for over 30 years, the clinical utility of the technique is limited to a screening method for hyperbilirubinemia, rather than a replacement for invasive blood sampling. In this study, we investigate the reason for this limited clinical value and address possibilities for improvement. To obtain better insight into the physiology of bilirubin measurements, we evaluated a transcutaneous bilirubinometer that determines not only the cutaneous bilirubin concentration (TcB) but also the blood volume fraction (BVF) in the investigated skin volume. For 49 neonates (gestational age 30 ± 3.1 weeks, postnatal age 6 [4-10] days) at our NICU, we performed 124 TcB and 55 BVF measurements. The TcB correlated well with the total serum bilirubin concentration (TSB) (r = 0.88) with an uncertainty of 55 µmol/L. The BVF in the measured skin volume ranged between 0.1% and 0.75%. The performance of our bilirubinometer is comparable to existing transcutaneous devices. The limited clinical value of current bilirubinometers can be explained by the low BVF in the skin volume that is probed by these devices. Because the TcB depends for over 99% on the contribution of extravascular bilirubin, it is a physiologically different parameter from the TSB. Hence, the standard method of evaluation that compares the TcB to the TSB is insufficient to fully investigate the clinical value of transcutaneous bilirubinometers, ie, their predictive value for kernicterus. We suggest that the clinical value may be improved considerably by changing either the method of evaluation or the technological design of transcutaneous bilirubinometers.

Noninvasive Measurements of Bilirubin

* Abbreviations: TcB — : transcutaneous bilirubin TSB — : total serum bilirubin The relationship between the total serum bilirubin (TSB) concentration and the intensity of neonatal jaundice was documented almost 100 years ago,1 and although practitioners have long used this clinical sign to help them decide whether to measure the TSB, the difficulty of accurately estimating the TSB by eye2–6 has led to the development of transcutaneous bilirubinometry. When light is transmitted to the skin, the yellowness of the reflected light can be measured to provide an objective measurement of skin color7 and, taking into account the contributions of hemoglobin, melanin, and dermal thickness, current transcutaneous bilirubinometers provide a readout that estimates the TSB.8–11 Because measuring the yellowness of the skin is not equivalent to measuring the TSB,12–15 experts recommend that transcutaneous bilirubin (TcB) measurements should be used as a screening tool and not as a substitute for the TSB.13–17 In this edition of the journal, Bosschaart et al18 describe a new method of measuring bilirubin noninvasively that raises the possibility of improving the technique to the point where transcutaneous bilirubin (TcB) measurements … Address correspondence to M. Jeffrey Maisels, MB, BCh, DSc, Beaumont Children's Hospital and Department of Pediatrics, Oakland University William Beaumont School of Medicine, 3601 W. 13 Mile Rd, Royal Oak, MI 48073. E-mail: jmaisels{at}beaumont.edu

Role of Plasmapheresis as Liver Support for Early Graft Dysfunction Following Adult Living Donor Liver Transplantation

BackgroundSevere early graft dysfunction has been occasionally encountered following adult living donor liver transplantation (LDLT). We have assessed the effectiveness of plasmapheresis (PP) as liver support for LDLT recipients with severe early graft dysfunction. MethodsOf the 789 adult LDLTs performed between January 2007 and December 2009, 50 patients (6.3%) underwent PP as a supportive measure during the first month. ResultsThe mean time from LDLT to start of plasmapheresis was 11.2 ± 6.8 days (range 2–28). The 50 patients underwent 517 sessions of PP, or a mean of 10.3 ± 6.8 sessions per patient, over a mean 21.6 ± 9.4 days. Thirty-four patients (68%) required concurrent hemodiafiltration. Mean serum total bilirubin concentration before PP was 16.2 ± 6.7 mg/dL, peaking at 20.3 ± 7.9 mg/dL during PP, and decreasing to 13.4 ± 5.4 mg/dL 1 week after completion of PP (P < .001 compared with before PP). Except for prothrombin time, no other biochemical parameter was significantly altered by PP. There were no serious complications related to PP. Of the 50 patients, 17 (34%) died soon or a few months after PP. The 6-month graft survival rate after completion of PP was 66%; the overall 1-year patient survival rate was 64.0%. ConclusionPP appeared to have beneficial effects for LDLT recipients with severe early graft dysfunction, namely total bilirubin concentrations greater than 10 mg/dL.

Mortality risk after liver transplantation in hepatocellular carcinoma recipients: A nonlinear predictive model

The balanced application of a model for the estimate of outcomes of liver transplantation, in concert with assessment of disease severity, would not only improve transplant outcomes and maximize patient benefit from transplantation, but also facilitate informed decision making by patients and their relatives when considering transplantation. So far, however, linear discriminating methods have failed to attain sufficient power to predict post-transplant prognosis. Therefore, our aim was to develop a cancer-specific prognostic model by a nonlinear methodology based on pretransplant characteristics. With data collected retrospectively from 290 liver transplant recipients with HCC from February 1999 to August 2009, a multilayer perceptron (MLP) neural network was constructed to predict mortality risk after transplantation. Its predictive performances at posttransplant 1-, 2-, and 5-year intervals were evaluated using a receiver operating characteristic curve. By the forward stepwise selection in MLP network, donor age, donor body mass index, recipient hemoglobin, serum concentrations of total bilirubin, alkaline phosphatase, creatinine, aspartate aminotransferase, international normalized ratio of prothrombin time, and Na(+); alpha fetoprotein categorization, total diameter, number of tumor lesions, presence of imaging macrovascular invasion, and lobe distribution of the tumor were identified to be the optimal input features. The MLP, employing 24 inputs and 7 hidden neurons, yielded c-statistics of 0.909 (P < .001) in the 1-year, 0.888 (P < .001), in the 2-year, and 0.845 (P < .001) in the 5-year prediction. Post-transplant prognosis is a multidimensional, nonlinear problem, and the specific MLP can achieve high accuracy in the prediction of posttransplant mortality risk for HCC recipients. The pattern recognition methodologies like MLP hold promise for solving outcome prediction after liver transplantation.

Effects of minimal-flow sevoflurane anesthesia combined with Amsorb Plus calcium lime on hepatic and renal functions

Objective To investigate the effects of minimal-flow sevoflurane anesthesia combined with a new CO2 adsorbent Amsorb Plus calcium lime on the hepatic and renal functions in patients.Methods Seventytow ASA Ⅰ or Ⅱ patients,aged 20-60 yr,scheduled for gastrointestinal surgery under general anesthesia,were randomized into 2 groups (n =36 each):middle-flow anesthesia group (group G1 ) and minimal-flow anesthesia group (group G2 ).Amsorb Plus calcium lime was added into the CO2 absorption canister and the core temperature of the calcium lime was continuously monitored and recorded.The patients were tracheal intubated after anesthesia induction and mechanically ventilated.The initial sevoflurane concentration was set at 4％ and the fresh gas flow of oxygen was set at 4 L/min.After the end-tidal concentration of sevoflurane reached 2.6％,the fresh gas flow of oxygen was adjusted to 2 L/min in group G1 or 0.5 L/min in group G2.The end-tidal concentration of sevoflurane was maintained at 2.4％-2.8％ during operation.Venous blood samples were taken 24 h before and 24 h after operation for determination of the serum concentrations of total bilirubin (TBIL),direct bilirubin (DBIL),blood urea nitrogen (BUN) and creatinire (Cr) and activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST).Urine samples were obtained at 24 h before and after operation to detect the concentration of glucose and protein.The urine glucose and protein positive patients were recorded.Results There was no significant difference in the core temperature of calcium lime at different time points between the two groups ( P ＞ 0.05 ).Compared with that at 24 h before operation,AST activity,TBIL and DBIL concentrations were significantly increased,BUN concentration was significantly decreased,but no significant change was found in the Cr concentration and the number of urine glucose and protein positive patients at 24 h after operation in group G1,and DBIL concentration was significantly increased,while BUN concentration was significantly decreased at 24 h after operation in group G2 ( P ＜ 0.05 ).There was no significant difference in the parameters of hepatic and renal functions between the two groups ( P ＞ 0.05).Conclusion The combination of minimal-flow sevoflurane anesthesia and Amsorb Plus calcium lime exerts no effect on the hepatic and renal functions,the effect is similar to that of middle-flow anesthesia,and it can be safely used in patients. Key words: Anesthetics,inhalation; Anesthesia,inhalation; Liver function tests; Kidney function tests

Biochemical and Haematological Studies on the Ethanol Leaf Extract of Spondias mombin Linn

Spondias mombin Linn (Anacardiaceae) is an edible plant that is ethnopharmacologically used for induction of labour, expulsion of afterbirth, and stabilization of women after childbirth. The effects of ethanol extract of the leaf of S. mombin on hepatic, renal and haematologic function indices of albino rabbits were studied using standard methods. Acute toxicity studies of the extract showed the lethal dose (LD 50 ) to be indeterminate, while the effective (abortifacient) dose (ED 50 ) was 753.96 ±0.10 mg/kg body weight. Intraperitoneal administration of 750 mg/kg body weight of the extract significantly (p<0.05) reduced serum alanine aminotransferase and aspartate aminotransferase activities, as well as the serum concentrations of total bilirubin, urea and creatinine, but increased the serum concentrations of total protein, albumin and haemoglobin, as well as the values of white blood cell count, platelet count, and the calculated red cell indices. The results of the study showed that the extract does not have detrimental toxicological effects on the studied organs/tissue function indices. However, it’s observed effect on platelet count calls for further studies.

Ins and Outs of Transcutaneous Bilirubin Monitoring

The American Academy of Pediatrics recommends transcutaneous bilirubinometry in the management of hyperbilirubinemia in newborns (JW Pediatr Adolesc Med Aug 9 2004). This method measures bilirubin levels in the skin without painful blood sampling, but does it reliably estimate the total serum bilirubin (TSB) concentration, the gold standard for clinical decision making? Researchers in the Netherlands tested a new bilirubinometer that measures the skin's absorption coefficient across a range of wavelengths and determines the contributions …

Decreased serum bilirubin is associated with arterial stiffness in men

Background and aimsThe brachial-ankle pulse wave velocity (baPWV) is a marker for early atherosclerotic changes. Serum total bilirubin (TB) is an effective antioxidant and has been associated with carotid intima-media thickness, cardiovascular disease, stroke and peripheral arterial disease, all of which may be caused by arteriosclerosis. This study aimed to investigate the association of TB with arterial stiffness. Methods and resultsIn this cross-sectional study, we investigated the relationship between TB and baPWV in 2207 participants (1331 men, 876 women) in a general health examination. Different metabolic parameters were compared across TB quartiles. Age-adjusted mean values of baPWV gradually decreased with TB quartiles in men (Q1 = 1348, Q2 = 1266, Q3 = 1215, and Q4 = 1154 cm/s). However, the age-adjusted means of baPWV had no significance in women according to TB quartiles. Univariate analysis showed that age, smoking status, BMI, SBP, DBP, AST, ALT, GGT, TB, TG, and HDL-C were significantly associated with baPWV in men, whereas only age, BMI, SBP, DBP, TG and FPG were significantly associated with baPWV in women. In addition, BMI, SBP, TB, age, TG, and AST were significant factors in the multivariate model with baPWV in men; only BMI and FPG were significant factors with baPWV in women. ConclusionThe findings show that serum total bilirubin concentration is negatively correlated to arterial stiffness in Chinese men. Early detection of abnormal bilirubin levels could potentially serve as an early biomarker for arterial stiffness.

Novel scoring system as a useful model to predict the outcome of patients with acute liver failure: Application to indication criteria for liver transplantation

In Japan, the indication for liver transplantation in patients with acute liver failure (ALF) is currently determined according to the guideline published in 1996. However, its predictive accuracy has fallen in recent patients. Thus, we attempted to establish a new guideline. The subjects were 1096 ALF patients enrolled in a nationwide survey. All patients showed a prothrombin time <40% of the standardized value and grade II or more severe hepatic encephalopathy. A multiple logistic regression analysis and receiver operating characteristic analysis were performed in 698 patients seen between 1998 and 2003 to identify significant parameters determining the outcome of patients. The extracted parameters were graded as numerical scores. An established scoring system was validated in patients seen between 2004 and 2008. Six parameters were identified and graded as 0, 1 and/or 2; the interval between disease onset and development of hepatic encephalopathy, prothrombin time, serum total bilirubin concentration, the ratio of direct to total bilirubin concentration, peripheral platelet count and the presence of liver atrophy. When the prognosis of the patients with total score of 5 or more was judged as "death", the predictive accuracy was 0.80 with sensitivity, specificity, positive predictive value and negative predictive value greater than 0.70. The values were similarly high in patients for validation. Novel scoring system for predicting the outcome of ALF patients may be useful to determine the indication of liver transplantation, since the system showed high predictive accuracy even after validation.