Pre-Cycloplegic Exam Benefit of Photoscreening and Accommodation-Relaxing Skiascopy.

Background: Seeking a quick way to estimate refractions for challenging pediatric patients, we studied two non-contact methods with particular attention to accuracy and level of stress in uncovering cycloplegic hyperopia. Methods: Newly referred and follow-up pediatric eye patients had timed school bus accommodation-relaxing skiascopy (SBARS) and Plusoptix A12 (Px) photoscreener testing before cyclopentolate 1% confirmatory examinations. The ABCD ellipsoid univariate method based on relative blur and vector components was used to compare dry sphero-cylinder refraction estimates with cycloplegic. Receiver operating characteristic (ROC) curves were used to determine screening value. Results: Three compared refractions were attempted in 191 racially diverse children of whom 100 were age 0.2-3.9 years and 91 were 4 to 14 years. Plusoptix failed to yield a result in 21 and an additional 21 were interpreted as an excess sphere. Median spherical equivalent did not differ between Px and SBARS for 149 with Px readings but in hyperopic patients, Plusoptix uncovered 27% less hyperopia. The ellipsoid for SBARS of 0.8 was better than 2.4 for Plusoptix (Mann-Whitney p<0.001). Plusoptix was fastest (3-15 seconds) followed by SBARS (15-30 seconds) compared to 30-45 minutes for cycloplegic exam. Conclusion: Non-contact quick refractive methods enhanced confirmatory cycloplegic pediatric exam in high-risk pediatric patients.

Risk of Hepatitis B Reactivation in Patients Receiving Ibrutinib: The National Veterans Affairs Cohort.

Background: Ibrutinib has been a first-line treatment for chronic lymphocytic leukemia since 2014. Case reports of hepatitis B virus (HBV) reactivation after ibrutinib initiation have been presented. The association between the risk of HBV reactivation and ibrutinib initiation remains unclear. This nationwide study aimed to estimate the incidence of HBV reactivation after ibrutinib initiation. Method: This study included patients who received ibrutinib between 1 February 2014 and 31 October 2019. Possible reactivations were searched by (1) changes in HBV surface antigen or HBV DNA from no data or negative status to positive after ibrutinib initiation, (2) alanine aminotransferase levels that were at least 3 times the baseline value after ibrutinib initiation, and (3) new antiviral prescriptions against HBV after ibrutinib initiation. Individual chart reviews were conducted to identify HBV reactivation attributed to ibrutinib. The cumulative incidence of HBV reactivation was calculated. Results: A total 4130 patients were eligible during the study period. Of these, patients with negative HBV core antibody (anti-HBcAb; n = 1670) and patients who were taking antivirals against HBV (n = 60) were excluded. There were 2219 patients without anti-HBcAb testing results. Among the remaining 181 patients with positive anti-HBcAb, 7 HBV reactivations were directly attributable to ibrutinib treatment after chart review, for a 3.9% cumulative incidence. Conclusions: Our study revealed a low cumulative incidence of HBV reactivation after ibrutinib initiation among patients with previous anti-HBcAb positivity, indicating a moderate risk of HBV reactivation.

The yield of total body CT in the workup of fever of unknown origin in hospitalized medical patients.

INTRODUCTION: Total body computerized tomography (TBCT) is frequently used as a diagnostic tool for fever of unknown origin (FUO) workup instead of a recommended fluorodeoxyglucose positron emission tomography FDG-PET/CT. We have assessed the TBCT diagnostic yield on a large, unselected cohort of patients with FUO. METHODS: We performed a single-center retrospective cohort study, examining all patients hospitalized in internal medicine between 2012 and 2019 with a documented fever and three negative blood cultures who subsequently had a total-body CT performed. After manually reviewing, we included 408 who met the criteria of FUO. We defined a positive study as a scan that led to the documented final diagnosis. RESULTS: A total of 164 patients (40.2 %) had a positive TBCT result. The majority of positive CT findings were of infectious etiologies (58.5 %), followed by neoplasms (22.8 %) and inflammatory disorders (14.0 %), with the chest (43.9 %) and abdomen (29.8 %) most affected. Using a logistic regression model, a positive scan results were associated with an elevated CRP (p<0.001). Decision tree analysis showed that 55 % of scans of patients with an elevated CRP (>6 mg/dL), low hemoglobin and high leucocyte count (>18000/ml) were positive. Patients without an elevated CRP had a positive scan in only 26 % of tests, and those with also an elevated albumin (>4 gr/dL) and low CRP had positive scan in only 11 % of cases. CONCLUSIONS: TBCT has a clinically significant yield under specific clinical scenarios in medical patients with FUO- reaching 55 % in patients with an elevated CRP and leukocyte count and low hemoglobin. It is reasonable to proceed to TTBCT when FDG-PET/CT is unavailable and in well-defined clinical situations.

FDrisk: development of a validated risk assessment tool for Fabry disease utilizing electronic health record data.

Purpose: Fabry disease (FD) is a rare, X-linked, lysosomal storage disease characterized by great variability in clinical presentation and progressive multisystemic organ damage. Lack of awareness of FD and frequent misdiagnoses cause long diagnostic delays. To address the urgent need for earlier diagnosis, we created an online, risk-assessment scoring tool, the FDrisk, for predicting an individual's risk for FD and prompting diagnostic testing and clinical evaluation. Methods: Utilizing electronic health records, data were collected retrospectively from randomly selected, deidentified patients with FD treated at the Emory Lysosomal Storage Disease Center. Deidentified, negative controls were randomly selected from the Fabry Disease Diagnostic Testing and Education project database, a program within the American Association of Kidney Patients Center for Patient Education and Research. Diagnosis of FD was documented by evidence of a pathogenic variant in GLA and/or an abnormal level of leukocyte α-Gal A. Thirty characteristic clinical features of FD were initially identified and subsequently curated into 16 clinical covariates used as predictors for the risk of FD. An overall prediction model and two sex-specific prediction models were built. Two-hundred and sixty samples (130 cases, 130 controls) were used to train the risk prediction models. One-hundred and ninety-seven independent samples (30 cases, 167 controls) were used for testing model performance. Prediction accuracy was evaluated using a threshold of 0.5 to determine a predicted case vs. control. Results: The overall risk prediction model demonstrated 80% sensitivity, 83.8% specificity, and positive predictive value of 47.1%. The male model demonstrated 75% sensitivity, 95.8% specificity, and positive predictive value of 75%. The female model demonstrated 83.3% sensitivity, 81.3% specificity, and positive predictive value of 45.5%. Patients with risk scores at or above 50% are categorized as "at risk" for FD and should be sent for diagnostic testing. Conclusion: We have developed a statistical risk prediction model, the FDrisk, a validated, clinician-friendly, online, risk-assessment scoring tool for predicting an individual's risk for FD and prompting diagnostic testing and clinical evaluation. As an easily accessible, user-friendly scoring tool, we believe implementing the FDrisk will significantly decrease the time to diagnosis and allow earlier initiation of FD-specific therapy.

What can lattice DFT teach us about real-space DFT?

In this paper we establish a connection between density functional theory (DFT) for lattice models and common real-space DFT. We consider the lattice DFT description of a two-level model subject to generic interactions in Mermin's DFT formulation in the grand canonical ensemble at finite temperature. The case of only density-density and Hund's rule interaction studied in earlier work is shown to be equivalent to an exact-exchange description of DFT in the real-space picture. In addition, we also include the so-called pair-hopping interaction which can be treated analytically and, crucially, leads to non-integer occupations of the Kohn-Sham (KS) levels even in the limit of zero temperature. Treating the hydrogen molecule in a minimal basis is shown to be equivalent to our two-level lattice DFT model. By means of the fractional occupations of the KS orbitals (which, in this case, are identical to the many-body ones) we reproduce the results of full configuration interaction, even in the dissociation limit and without breaking the spin symmetry. Beyond the minimal basis, we embed our HOMO-LUMO model into a standard DFT calculation and, again, obtain results in overall good agreement with exact ones without the need of breaking the spin symmetry.

Microfluidic in-line dynamic light scattering with a commercial fibre optic system.

We report the coupling of dynamic light scattering (DLS) in microfluidics, using a contact-free fibre-optic system, enabling the under-flow characterisation of a range of solutions, dispersions, and structured fluids. The system is evaluated and validated with model systems, specifically micellar and (dilute) polymer solutions, and colloidal dispersions of different radii (∼1-100 nm). A systematic method of flow-DLS analysis is examined as a function of flow velocity (0-16 cm s-1), and considerations of the relative contribution of 'transit' and 'Brownian' terms enable the identification of regions where (i) a quiescent approximation suffices, (ii) the flow-DLS framework holds, as well as (iii) where deviations are found, until eventually (iv) the convection dominates. We investigate practically relevant, robust setups, namely that of a capillary connected to microdevice, as well as direct measurement on a glass microdevice, examining the role of capillary dimensions and challenges of optical alignment. We conclude with a demonstration of a continuous flow measurement of a binary surfactant/salt solution, whose micellar dimensions vary with composition, characterised with hundreds of data points (every ∼5 s) and adequate statistics, within a few minutes.

User experience of a hepatitis c population management dashboard in the Department of Veterans Affairs.

BACKGROUND: The Veterans Health Administration (VA) is the largest integrated healthcare organization in the US and cares for the largest cohort of individuals with hepatitis C (HCV). A national HCV population management dashboard enabled rapid identification and treatment uptake with direct acting antiviral agents across VA hospitals. We describe the HCV dashboard (HCVDB) and evaluate its use and user experience. METHODS: A user-centered design approach created the HCVDB to include reports based on the HCV care continuum: 1) 1945-1965 birth cohort high-risk screening, 2) linkage to care and treatment of chronic HCV, 3) treatment monitoring, 4) post-treatment to confirm cure (i.e., sustained virologic response), and 5) special populations of unstably housed Veterans. We evaluated frequency of usage and user experience with the System Usability Score (SUS) and Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) instruments. RESULTS: Between November 2016 and July 2021, 1302 unique users accessed the HCVDB a total of 163,836 times. The linkage report was used most frequently (71%), followed by screening (13%), sustained virologic response (11%), on-treatment (4%), and special populations (<1%). Based on user feedback (n = 105), the mean SUS score was 73±16, indicating a good user experience. Overall acceptability was high with the following UTAUT2 rated from highest to least: Price Value, Performance Expectancy, Social Influence, and Facilitating Conditions. CONCLUSIONS: The HCVDB had rapid and widespread uptake, met provider needs, and scored highly on user experience measures. Collaboration between clinicians, clinical informatics, and population health experts was essential for dashboard design and sustained use. Population health management tools have the potential for large-scale impacts on care timeliness and efficiency.

Microglia as a cellular target of diclofenac therapy in Alzheimer's disease.

Alzheimer's disease (AD) is an untreatable cause of dementia, and new therapeutic approaches are urgently needed. AD pathology is defined by extracellular amyloid plaques and intracellular neurofibrillary tangles. Research of the past decades has suggested that neuroinflammation plays a critical role in the pathophysiology of AD. This has led to the idea that anti-inflammatory treatments might be beneficial. Early studies investigated non-steroidal anti-inflammatory drugs (NSAIDS) such as indomethacin, celecoxib, ibuprofen, and naproxen, which had no benefit. More recently, protective effects of diclofenac and NSAIDs in the fenamate group have been reported. Diclofenac decreased the frequency of AD significantly compared to other NSAIDs in a large retrospective cohort study. Diclofenac and fenamates share similar chemical structures, and evidence from cell and mouse models suggests that they inhibit the release of pro-inflammatory mediators from microglia with leads to the reduction of AD pathology. Here, we review the potential role of diclofenac and NSAIDs in the fenamate group for targeting AD pathology with a focus on its potential effects on microglia.

Potential benefits of a blend of essential oils on metabolism, digestibility, organ development and gene expression of dairy calves.

The objective of this study was to evaluate blood cells and metabolites, insulin-like growth factor-1 (IGF-1), digestibility, internal organs weight and histology, gene expression, and spleen cell proliferation of pre-weaned bull calves supplemented with a blend of essential oils in milk replacer (MR). Sixteen newborn Holstein × Gyr crossbred dairy bull calves, with body weight at birth of 33.3 ± 3.7 kg, were housed in individual sand bedded pens, blocked by genetic composition, and randomly assigned to 1 of 2 treatments in a randomized complete block design: Control (CON, n = 8) and blend of essential oils supplementation (BEO, n = 8, 1 g/day/calf, Apex Calf, Adisseo, China). The commercial blend was composed by plant extracts derived from anise, cinnamon, garlic, rosemary, and thyme. Animals were fed 5 L of MR/day reconstituted at 15% (dry matter basis), divided into two equal meals. Water and starter were provided ad libitum. ß-hydroxybutyrate, urea, and glucose were evaluated weekly, IGF-1 was evaluated biweekly, and total blood cell count was performed every four weeks until the end of the trial at eight weeks of age. Feed samples were collected three times a week and polled for weekly analysis. Apparent total nutrient digestibility was determined from d 56 to 60 of age. On d 60 ± 1, animals were euthanized for organ weight, histology, spleen cell proliferation, and intestinal gene expression analysis. Data were analyzed independently using linear mixed models using the REML method in the nlme package in R for continuous outcomes. A non-parametric test was used for ordered categorical outcomes using the Artools package in R. There were no differences between groups for blood evaluations, digestibility, gene expression, and a spleen cell proliferation assay. However, BEO calves presented a heavier pancreas, heavier intestines, bigger ileum villi, and higher cecum butyrate levels (P < 0.05), demonstrating that the EO supplementation helped intestinal development and symbiotic bacteria. It was also observed in CON animals' heavier respiratory tract and a higher eosinophil count (P < 0.05). Therefore, the organs where eosinophils are more active had a better response for BEO animals. No differences were found in the intestinal gene expression in the immune context. These results demonstrate that supplementing essential oils in MR could contribute to gut development and immune function. However, more research is needed to understand its impact on body development and define the best dosage and route of administration.

Phytogenics and encapsulated sodium butyrate can replace antibiotics as growth promoters for lightly weaned piglets.

The objective of this study was to evaluate the effect of essential oils plus dry herbs (PHYTO) and encapsulated sodium butyrate (BUT) supplementation compared with enramycin (ENR), as a growth promoter, on the performance, diarrhoea control and intestinal microbiota in lightly weaned piglets. Two hundred weaned piglets, 20 days old, 4.69 ± 0.56 kg, were submitted during the nursery phase (20 to 69 days of age) to four treatments: control (CTR)-without any additive supplementation; ENR (with 8 ppm of enramycin throughout), BUT (with 2000 ppm between 20 to 34 d, 1500 ppm between 34 to 48 d and 1000 ppm between 48 to 69 d), and PHYTO (150 ppm between 20 to 48 d). At 62 days old, forty piglets (10 replicates per treatment) were slaughtered to perform bacterial identification through 16S rRNA (V3-V4) sequencing of the caecal content. During the second phase of the trial (34 to 48 days), the BUT group showed higher DWG (P = 0.023) and BW (P = 0.039) than the CTR group, and all groups that received additives had better FCR than the CTR group (P = 0.001). In the last phase of the trial (48 to 69 days), the ENR group presented a better FCR (P = 0.054) than the CRT and other groups. In the total period (20 to 69 days), ENR and BUT showed better FCR (P = 0.006) than CRT. Diarrhoea incident data showed differences (P<0.05), favouring the BUT treatment compared to the CTR. Only the Megasphaeraceae and Streptococcaceae families showed differences (p<0.05) in relative abundance between CTR and PHYTO and between CTR and BUT, respectively. Differential abundances of the Megasphaera and Streptococcus genera were observed between CTR and PHYTO and CTR and BUT. Phytogenics and encapsulated sodium butyrate are able and effective for modulating the specific caecal microbiota, improving performance and controlling diarrhoea occurrence.

Effects of Multibracket Orthodontic Treatment versus Clear Aligners on Periodontal Health: An Integrative Review.

Objective: This integrative review aimed to identify studies comparing the periodontal health in patients wearing multibracket orthodontic appliances and clear aligners. Materials and methods: An integrative literature search was performed through different databases, PubMed/Medline, PMC, and the Cochrane Library. This work was submitted to a search strategy following the PICO method and included the focus question: "Could the chosen orthodontic appliance change significantly the oral hygiene of the patient, impairing the periodontal health?" This work included analytical and controlled studies on humans published between 2005 and 2020, in the English language, establishing a comparison of the periodontal status in patients undergoing orthodontic multibracket and clear aligners therapies. The main periodontal indexes assessed were plaque index (PI), pocket depth (PD), gingival index (GI), and bleeding on probing (BoP). Results: The electronic research displayed 386 articles on PMC, 106 on PubMed, and 40 on the Cochrane Library. After removal, just 25 articles were selected for full-text screening, but just eight studies were eligible for this integrative review. It was enumerated that 204 patients were treated with aligners and 294 with multibracket orthodontic appliances, mainly elastomeric ligated brackets. Only the plaque index displayed a significant difference between the two groups and general data obtained showed a better control for periodontal health in the clear aligners. Limitations such as age, malocclusion severity, therapeutic choice, and different time measure was observed. In addition, the oral hygiene instruction and follow-up by a professional were different, and the role of malocclusion was not present in the studies. Conclusions: Within the limitations of this study, better results for periodontal health were found in the clear aligners. Therefore, more studies are necessary to affirm that aligners are synonymous with better gingival conditions in comparison with multibracket appliances. Other variables such as oral hygiene instructions, motivation, and supportive treatment tend to be more prevalent than the type of appliance itself in the periodontal evaluation.

Hemoadsorption in the critically ill-Final results of the International CytoSorb Registry.

The aim of the current paper is to summarize the results of the International CytoSorb Registry. Data were collected on patients of the intensive care unit. The primary endpoint was actual in-hospital mortality compared to the mortality predicted by APACHE II score. The main secondary endpoints were SOFA scores, inflammatory biomarkers and overall evaluation of the general condition. 1434 patients were enrolled. Indications for hemoadsorption were sepsis/septic shock (N = 936); cardiac surgery perioperatively (N = 172); cardiac surgery postoperatively (N = 67) and "other" reasons (N = 259). APACHE-II-predicted mortality was 62.0±24.8%, whereas observed hospital mortality was 50.1%. Overall SOFA scores did not change but cardiovascular and pulmonary SOFA scores decreased by 0.4 [-0.5;-0.3] and -0.2 [-0.3;-0.2] points, respectively. Serum procalcitonin and C-reactive protein levels showed significant reduction: -15.4 [-19.6;-11.17] ng/mL; -17,52 [-70;44] mg/L, respectively. In the septic cohort PCT and IL-6 also showed significant reduction: -18.2 [-23.6;-12.8] ng/mL; -2.6 [-3.0;-2.2] pg/mL, respectively. Evaluation of the overall effect: minimal improvement (22%), much improvement (22%) and very much improvement (10%), no change observed (30%) and deterioration (4%). There was no significant difference in the primary outcome of mortality, but there were improvements in cardiovascular and pulmonary SOFA scores and a reduction in PCT, CRP and IL-6 levels. Trial registration: ClinicalTrials.gov Identifier: NCT02312024 (retrospectively registered).

Impact of proton pump inhibitors on sustained virologic response in veterans treated with sofosbuvir/velpatasvir for chronic hepatitis C virus: A retrospective cohort study.

STUDY OBJECTIVE: The objective of this study was to determine the clinical relationship between proton pump inhibitor (PPI) use and sustained virologic response (SVR) in patients treated with sofosbuvir/velpatasvir (SOF/VEL) for chronic hepatitis C virus (HCV) infection. DESIGN: This was a multicenter retrospective cohort study. SETTING: Data was collected on patients from 128 Veterans Affairs Medical Centers throughout the United States. PATIENTS: This study included veterans aged 18-89 years with viremic HCV who received a full course of SOF/VEL treatment from June 2016 - July 2017. INTERVENTION: Sustained viral response was compared in patients taking SOF/VEL with or without concurrent PPI prescriptions. MEASUREMENTS AND MAIN RESULTS: Analysis of the primary outcome was completed utilizing logistic regression. The relationship between SVR and PPI use was adjusted for African-American race, presence of cirrhosis, prior treatment, BMI greater than 30 kg/m2, and HCV genotype. The final analysis included 4,008 veterans, 830 with concomitant PPI use and 3,178 without PPI use. After adjustment for other variables in the logistic model, there was no statistically significant association between PPI use and lower SVR (odds ratio 0.67; 95%CI: 0.42, 1.06; p = 0.087). CONCLUSION: Concomitant PPI treatment adjusted for other variables did not significantly impact success or failure of SOF/VEL treatment of chronic HCV. Despite the lack of significant association identified in this study, in efforts to provide the best care possible, it remains prudent to proceed with caution in patients desiring to use PPI therapy while receiving SOF/VEL, and ensure prescribing instructions are closely followed in regard to concomitant PPI use, especially in patients with other risk factors for decreased SVR.

The COVID-19 Pandemic Highlights Opportunities to Improve Hepatocellular Carcinoma Screening and Diagnosis in a National Health System.

INTRODUCTION: We evaluated the coronavirus disease 2019 (COVID-19) pandemic's impact on hepatocellular carcinoma (HCC) screening and diagnosis among patients with cirrhosis in the Veterans Health Administration. METHODS: Rates and predictors of screening and diagnosis were reviewed September 1, 2019-February 29, 2020 ("pre-COVID-19," N = 94,612) and April 1, 2020-September 30, 2020 ("post-COVID-19," N = 88,073). RESULTS: Screening and diagnosis rates declined by 44% and 13%, respectively, after the COVID-19 pandemic. Screening declined irrespective of liver disease severity, but diagnosis declined only in Model for End Stage Liver Disease-Sodium score <20 or Fibrosis-4 score <3.25. Fibrosis-4 score ≥3.25 and HCC risk ≥1.5%/year strongly predicted HCC diagnosis but only moderately predicted receipt of screening. DISCUSSION: Screening and diagnosis rates declined after the COVID-19 pandemic. Prioritizing screening for patients at greatest risk for HCC may reduce delays in diagnosis.

Provider Attitudes Toward Risk-Based Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis in the United States.

BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) surveillance rates are suboptimal in clinical practice. We aimed to elicit providers' opinions on the following aspects of HCC surveillance: preferred strategies, barriers and facilitators, and the impact of a patient's HCC risk on the choice of surveillance modality. METHODS: We conducted a web-based survey among gastroenterology and hepatology providers (40% faculty physicians, 21% advanced practice providers, 39% fellow-trainees) from 26 US medical centers in 17 states. RESULTS: Of 654 eligible providers, 305 (47%) completed the survey. Nearly all (98.4%) of the providers endorsed semi-annual HCC surveillance in patients with cirrhosis, with 84.2% recommending ultrasound ± alpha fetoprotein (AFP) and 15.4% recommending computed tomography (CT) or magnetic resonance imaging (MRI). Barriers to surveillance included limited HCC treatment options, screening test effectiveness to reduce mortality, access to transportation, and high out-of-pocket costs. Facilitators of surveillance included professional society guidelines. Most providers (72.1%) would perform surveillance even if HCC risk was low (≤0.5% per year), while 98.7% would perform surveillance if HCC risk was ≥1% per year. As a patient's HCC risk increased from 1% to 3% to 5% per year, providers reported they would be less likely to order ultrasound ± AFP (83.6% to 68.9% to 57.4%; P < .001) and more likely to order CT or MRI ± AFP (3.9% to 26.2% to 36.1%; P < .001). CONCLUSIONS: Providers recommend HCC surveillance even when HCC risk is much lower than the threshold suggested by professional societies. Many appear receptive to risk-based HCC surveillance strategies that depend on patients' estimated HCC risk, instead of our current "one-size-fits all" strategy.

Hemoadsorption in 'Liver Indication'-Analysis of 109 Patients' Data from the CytoSorb International Registry.

BACKGROUND: Our aim is to report the results of the 'liver indication' subset of patients in the CytoSorb International Registry. METHODS: Structured data were recorded. Treatment characteristics and changes from T1 (start of hemoadsorption) to T2 (termination) were evaluated with a special focus on bilirubin, C-reactive protein, procalcitonin, interleukin-6, platelet levels, SOFA scores, mortality, and subjective assessment by the attending physicians. RESULTS: Until January 2021, from the total 1434 patients, 109 (age: 49.2 ± 17.1 years, 57.8% males) received treatment for hyperbilirubinemia. APACHE II-predicted mortality was 49.6 ± 26.8%. In the study, 91% of patients were alive at the termination of hemoadsorption and improvement was observed by the physicians in 75 cases. Overall, 65 (59.6%) patients died in the hospital, and 60 (55.0%) died in the ICU. Patients received a median of two treatments for a median of 43 h (interquartile range: 24-72 h) in total. Serum bilirubin levels reduced significantly to -4.6 (95% CI: -6.329 to -2.8) mg/dL. Thrombocytopenia was reported in four patients as an adverse event. CONCLUSIONS: We report the largest case series on hemoadsorption for 'liver indication' from the CytoSorb International Registry. The finding of significant bilirubin removal observed in our study could have substantial impact in designing and executing further studies on the effects of hemoadsorption in liver dysfunction, which are certainly warranted.

Mycotoxin deactivator improves performance, antioxidant status, and reduces oxidative stress in nursery pigs fed diets containing mycotoxins.

Ingestion of mycotoxins can result in many problems, including decreased growth rates and immune suppression. The present study aimed to evaluate the impact of the supplementation of a mycotoxin deactivator composed by adsorbent clay minerals; inactivated fermentation extracts of Saccharomyces cerevisiae; and blend of antioxidants, organic acids, and botanicals in diets containing added mycotoxins for nursery pigs on their performance and antioxidant status. Ninety pigs weaned with 24 d of age (7.12 ± 0.68 kg of BW) were used. Pigs were housed in pens of three animals each according to body weight, litter origin, and sex. The dietary treatments consisted of feeding the pigs with a standard control diet as negative control (NC; mycotoxin levels at accepted regulatory Brazilian Ministry of Agriculture standards; deoxynivalenol (DON): <100 µg/kg; zearalenone (ZEA): <20 µg/kg; fumonisins (FB): <1 mg/kg); the standard diet added with mycotoxins to reach a low contamination level is considered as positive low (PCL-; DON: 900 µg/kg; ZEA: 100 µg/kg; FB: 5,000 µg/kg) without deactivator; a positive low added the deactivator at an inclusion rate of 1 kg/ton (PCL+); the standard diet added with mycotoxins to reach a high contamination level is considered as positive high (PCH-; DON: 4,500 µg/kg; ZEA: 500 µg/kg; FB: 18,000 µg/kg) without the deactivator; and a positive high added the deactivator at an inclusion rate of 5 kg/ton (PCH+). Pigs were individually weighed at the beginning and at the end of each phase and feed intake recorded based on daily pen intake during the experiment. On days 7, 19, 34, and 43 post-weaning, blood samples were drawn for antioxidant analyses. Antioxidant enzymes (glutathione peroxidase [GPx] and total superoxide dismutase [TSOD]), vitamins [Vit A, E, and C], and malondialdehyde [MDA]) were evaluated in erythrocyte and plasma samples. Pigs challenged with mycotoxins presented lower performance traits, decrease in the efficiency of central antioxidant systems (↓GPx, ↓TSOD, ↓Vit A, ↓Vit E, and ↓Vit C), and a higher oxidative damage to lipids (↑MDA) when compared with the control and deactivator-associated treatments. Our findings showed that the use of a mycotoxin deactivator can mitigate the negative impacts on performance and oxidative stress when animals are subjected to diets contaminated by different levels of mycotoxins.