Novel Encapsulated Calcium Butyrate Supplement Enhances On-Farm Dairy Calf Growth Performance and Body Conformation in a Pasture-Based Dairy Production System.

The effect of supplementing neonatal heifer calves with varying levels of ECAB on pre-weaning growth performance was investigated. Post-weaning growth was also measured, to determine any carry-over effect of pre-weaning supplementation of ECAB. Forty-eight heifer calves (7 ± 0.4 days old, average liveweight of 39.3 ± 5.3 kg) were utilized in a complete randomised experimental design, comprising 16 calves per pen, randomly allocated to one of the following three treatments: (1) Basal commercial calf starter mix without ECAB (Control); (2) control plus 4 kg/ton of ECAB (Low); and (3) control plus 6 kg/ton of ECAB (High). Calves were group-fed ad libitum for 77 days (11 weeks, pre-weaning period) with free choice access to water and 5.5 L of milk per head per day through an automated feeder. Calves were weighed weekly during the pre-weaning period, after which all calves were then weaned onto the same ryegrass pasture as one group. At approximately 9 months of age, calves were weighed to estimate post-weaning body weight gain. During the pre-weaning period, average daily dry matter feed intake was similar for 4 kg/ton and 6 kg/ton calves (649 g versus 688 g, respectively) and both were greater than that of the control calves (382 g). Average daily gain (ADG) was significantly higher for 4 kg/ton calves compared to 6 kg/ton calves or control calves (0.83 ± 0.03 kg, 0.74 ± 0.03 kg and 0.71 ± 0.03 kg, respectively; p = 0.0001). Similarly, 4 kg/ton calves had significantly increased chest girth (95.9 ± 0.7 cm), withers height (88.9 ± 0.5 cm), body length (82.9 ± 0.6 cm), and body condition score (1.99 ± 0.12) compared to 6 kg/ton calves (93.4 ± 0.7 cm, 87.4 ± 0.7, 81.5 ± 0.6 cm, and 1.67 ± 0.10, respectively) or control calves (92.9 ± 0.7 cm, 88.2 ± 0.5 cm, 80.1 ± 0.6 cm, and 1.30 ± 0.08, respectively). There was significant treatment × week interaction for all pre-weaning growth parameters. Breed differences were detected but there was no treatment × breed interaction. Post-weaning, 4 kg/t calves and 6 kg/t calves had significantly higher ADG compared to control calves (0.80 ± 0.03 kg, 0.85 ± 0.03 kg versus 0.70 ± 0.03 kg, respectively; p = 0.0047). It is concluded that under the conditions of this study, supplementing heifer calves with ECAB during pre-weaning period resulted in improved growth performance and there appears to be a post-weaning carry-over effect.

Palliative long-term abdominal drains versus repeated drainage in individuals with untreatable ascites due to advanced cirrhosis: study protocol for a feasibility randomised controlled trial.

BACKGROUND: UK deaths due to chronic liver diseases such as cirrhosis have quadrupled over the last 40 years, making this condition now the third most common cause of premature death. Most patients with advanced cirrhosis (end-stage liver disease [ESLD]) develop ascites. This is often managed with diuretics, but if refractory, then the fluid is drained from the peritoneal cavity every 10-14 days by large volume paracentesis (LVP), a procedure requiring hospital admissions. As the life expectancy of patients with ESLD and refractory ascites (if ineligible for liver transplantation) is on average ≤ 6 months, frequent hospital visits are inappropriate from a palliative perspective. One alternative is long-term abdominal drains (LTADs), used successfully in patients whose ascites is due to malignancy. Although inserted in hospital, these drains allow ascites management outside of a hospital setting. LTADs have not been formally evaluated in patients with refractory ascites due to ESLD. METHODS/DESIGN: Due to uncertainty about appropriate outcome measures and whether patients with ESLD would wish or be able to participate in a study, a feasibility randomised controlled trial (RCT) was designed. Patients were consulted on trial design. We plan to recruit 48 patients with refractory ascites and randomise them (1:1) to either (1) LTAD or (2) current standard of care (LVP) for 12 weeks. Outcomes of interest include acceptability of the LTAD to patients, carers and healthcare professionals as well as recruitment and retention rates. The Integrated Palliative care Outcome Scale, the Short Form Liver Disease Quality of Life questionnaire, the EuroQol 5 dimensions instrument and carer-reported (Zarit Burden Interview) outcomes will also be assessed. Preliminary data on cost-effectiveness will be collected, and patients and healthcare professionals will be interviewed about their experience of the trial with a view to identifying barriers to recruitment. DISCUSSION: LTADs could potentially improve end-of-life care in patients with refractory ascites due to ESLD by improving symptom control, reducing hospital visits and enabling some self-management. Our trial is designed to see if such patients can be recruited, as well as to inform the design of a subsequent definitive trial. TRIAL REGISTRATION: ISRCTN, ISRCTN30697116 . Registered on 7 October 2015.

Developing a community HCV service: project ITTREAT (integrated community-based test - stage - TREAT) service for people who inject drugs.

Background and aims Majority of the individuals with hepatitis C virus (HCV) infection in England are people who inject drugs, a vulnerable and disenfranchised cohort with poor engagement with secondary care. Our aim is to describe our experiences in setting up a successful nurse led HCV service at a substance misuse service (SMS). METHODS: We justify the need for a community HCV service and review the different community based models. Our experiences in engaging with stakeholders, obtaining funding, service set up, challenges faced and key recommendations are discussed. Finally, a summary of interim clinical outcomes is presented. RESULTS: A successful community based "one-stop" nurse led HCV service was set up in Dec 2013 at a large SMS. It provides all aspects of care (blood borne virus screening, non-invasive assessment of hepatic fibrosis, Hepatology input, HCV treatment, peer mentor, social and psychiatrist support, and opiod substitution) at one site. Interim clinical data indicate high service uptake with HCV treatment outcomes comparable to secondary care. CONCLUSIONS: The advent of direct acting antivirals provides a unique opportunity for HCV elimination in England by 2030. Our "one-stop" integrated and multidisciplinary community HCV model suggests that HCV care can be successfully delivered outside of a hospital setting and warrants national adoption.

Drug-induced liver injury.

Drug-induced liver injury (DILI) remains the most common cause of acute liver failure (ALF) in the western world. Excluding paracetamol overdose, nearly all DILI encountered in the clinical setting is idiosyncratic in nature because affected individuals represent only a small proportion of those treated with such drugs. In many cases, the mechanism for idiosyncrasy is immune-mediation and is often identified by genetic risk determined by human leukocyte antigen variants. In the absence of diagnostic tests and/or biomarkers, the diagnosis of DILI requires a high index of suspicion after diligently excluding other causes of abnormal liver tests. Antibiotics are the class of drugs most frequently associated with idiosyncratic DILI, although recent studies indicate that herbal and dietary supplements are an increasingly recognised cause. It is imperative that upon development of DILI the culprit drug be discontinued, especially in the presence of elevated transaminases (aspartate aminotransferase/alanine aminotransferase ratio ≥5 times the upper limit of normal) and/or jaundice. Risk factors for the development ALF include hepatocellular DILI and female gender, the treatment being supportive with some benefit of N-acetylcysteine in the early stages. In view of the poor transplant-free survival in idiosyncratic DILI, early consideration for liver transplant is mandatory.

Hepatotoxicity from anabolic androgenic steroids marketed as dietary supplements: contribution from ATP8B1/ABCB11 mutations?

BACKGROUND: Though possession of androgenic anabolic steroids (AAS) is illegal, non-prescription use of AAS persists. METHODS: We describe two Caucasian males (aged 25 and 45 years) with cholestatic hepatitis following ingestion of the dietary supplement Mass-Drol ('Celtic Dragon') containing the AAS 2α-17α-dimethyl-etiocholan-3-one,17ß-ol. RESULTS: Despite substantial hyperbilirubinaemia peak gamma-glutamyl transferase (GGT) remained normal. Besides 'bland' intralobular cholestasis, liver biopsy in both found deficiency of canalicular expression of ectoenzymes as seen in ATP8B1 disease. In the older patient, bile salt export pump marking (encoded by ABCB11) was focally diminished. We hypothesized that AAS had either induced inhibition of normal ATP8B1/ABCB11 expression or triggered initial episodes of benign recurrent intrahepatic cholestasis (BRIC) type 1/or 2. On sequencing, ATP8B1 was normal in both patients although the younger was heterozygous for the c.2093G>A mutation in ABCB11, a polymorphism previously encountered in drug-induced liver injury. CONCLUSION: AAS marketed as dietary supplements continue to cause hepatotoxicity in the UK; underlying mechanisms may include unmasking of genetic cholestatic syndromes.

Hepatotoxicity associated with dietary supplements containing anabolic steroids.

BACKGROUND & AIMS: The aim of this article was to re-emphasize the hepatotoxicity associated with the use of anabolic androgenic steroids and to highlight the marketing and sale of anabolic androgenic steroids as dietary supplements. METHODS: This was a case series of 2 patients who developed a cholestatic liver panel after consumption of anabolic androgenic steroids. A detailed Pubmed/Medline search was performed to research this topic. RESULTS: We present 2 young men who developed significant cholestatic liver injury after consumption of anabolic androgenic steroids. This was associated with considerable morbidity, although both patients recovered without the need for a liver transplant. Both of these anabolic androgenic steroids were being marketed as dietary supplements. CONCLUSIONS: Despite being classified as class III controlled substances, anabolic androgenic steroids are still a cause for serious hepatotoxicity in the United States. Some of these anabolic androgenic steroids are being marketed as dietary supplements. Although the Food and Drug Administration is making concerted efforts to regulate this, increased vigilance also is required from the medical profession.

Complementary and alternative medicine in hepatology: review of the evidence of efficacy.

There is an increase in the use of complementary and alternative medicine (CAM), especially herbal therapy, among patients with liver disease. The most commonly used herbal agent is silymarin. In animal models, many of the commonly used agents have shown anti-inflammatory and antifibrotic effects. Although many human studies have shown improvements in subjective symptoms (well being) and liver biochemistry, there are no convincing data to suggest a definite histologic and/or virologic improvement with most of these agents. Poorly designed studies, heterogeneous patient populations, lack of standardized preparations, and poorly defined nonobjective end points may partly explain the conflicting reports in the literature. Hepatotoxicity and drug interactions are common with many herbal medications, and therefore physicians need to be cognizant of known or occult use of CAM by their patients. Only well-designed, randomized, controlled trials will be able to ascertain whether CAM has any role in the management of patients with acute or chronic liver diseases. Until such time, the use of CAM cannot be recommended as a therapy for patients with liver disease.