Longitudinal outcomes of obeticholic acid therapy in ursodiol-nonresponsive primary biliary cholangitis: Stratifying the impact of add-on fibrates in real-world practice.

BACKGROUND: Suboptimal response to ursodeoxycholic acid occurs in 40% of primary biliary cholangitis (PBC) patients, affecting survival. Achieving a deep response (normalisation of alkaline phosphatase [ALP] and bilirubin ≤0.6 upper limit of normal) improves survival. Yet, the long-term effectiveness of second-line treatments remains uncertain. AIMS: To evaluate the long-term effectiveness of obeticholic acid (OCA) ± fibrates. Focusing on biochemical response (ALP ≤1.67 times the upper limit of normal, with a decrease of at least 15% from baseline and normal bilirubin levels), normalisation of ALP, deep response and biochemical remission (deep response plus aminotransferase normalisation). METHODS: We conducted a longitudinal, observational, multicentre study involving ursodeoxyccholic acid non-responsive PBC patients (Paris-II criteria) from Spain and Portugal who received OCA ± fibrates. RESULTS: Of 255 patients, median follow-up was 35.1 months (IQR: 20.2-53). The biochemical response in the whole cohort was 47.2%, 61.4% and 68.6% at 12, 24 and 36 months. GLOBE-PBC and 5-year UK-PBC scores improved (p < 0.001). Triple therapy (ursodeoxycholic acid plus OCA plus fibrates) had significantly higher response rates than dual therapy (p = 0.001), including ALP normalisation, deep response and biochemical remission (p < 0.001). In multivariate analysis, triple therapy remained independently associated with biochemical response (p = 0.024), alkaline phosphatase normalisation, deep response and biochemical remission (p < 0.001). Adverse effects occurred in 41.2% of cases, leading to 18.8% discontinuing OCA. Out of 55 patients with cirrhosis, 12 developed decompensation. All with baseline portal hypertension. CONCLUSION: Triple therapy was superior in achieving therapeutic goals in UDCA-nonresponsive PBC. Decompensation was linked to pre-existing portal hypertension.

Evaluation of sludge from paper recycling as bedding material for broilers.

Several materials have been used as bedding substrates in broiler production. In this work, the sludge from paper recycling was tested for its potential use as litter material and was compared with wood shavings. Moisture content, apparent density, and water-holding capacity were measured and characterized in both materials. Later, 192 male broiler chickens were distributed among 16 experimental pens, 8 of which contained wood shavings as bedding material and 8 of which contained the sludge. Growth rate, consumption, tonic immobility, gait score, breast lesions, foot pad dermatitis, hock burn, tibial dyschondroplasia, and metatarsal thickness were determined in the birds. Although the moisture content of the sludge was high, it decreased strongly after 7 d of drying, reaching lower values than those of wood shavings. In general, few differences were found between the materials in terms of bird performance and welfare and only the incidence of hock burn was higher in the sludge than in the wood shavings. Although further research is needed, sludge from paper recycling is a possible alternative to traditional bedding materials because it achieves most of the requirements for broiler bedding materials and does not show negative effects on the birds.

Development of a pododermatitis score in breeding does using clustering methods.

Pododermatitis in rabbit production is an important welfare problem and there is less information on this type of lesion in rabbits than in many other species. The aim of this work was to develop a scoring system to assess the presence and severity of pododermatitis through observation of 1367 photos of rabbit feet by two observers. Different groups of lesions were established according to color, size, presence of chaps, presence of ulcers, shape, appearance and presence of blood in each observed foot. A two-step cluster methodology was used to gather the results in homogenous and objective units. The inter-rater agreement was moderate, and after the cluster analysis four main clusters were obtained. These clusters were later comprehensively described in terms of pododermatitis severity. Finally, attending to cluster description, a five-level score was defined and this scale resulted in a practical and objective way to assess pododermatitis in rabbit does. Cluster analysis provided a detailed characterization of this type of lesions and helped to obtain uniform scores.