The present study has four limitations. First, we could not exclude subjects who reported a history of known liver disease, including viral, genetic, autoimmune, and drug-induced liver disease. Since the high levels of bili- rubin and GGT may be clinically related to very serious liver diseases, we also tested for the HRs of another four study groups according to the reference ranges of totalbilirubin and GGT for incident metabolic syndrome. The GGT-higher than reference group and both-higher than reference group showed an increased unadjusted HR for incident metabolic syndrome compared with the totalbilirubin-higher than reference group. The result for study groups according to the reference ranges were almost in line with the result for study groups according to the median values. Second, we analyzed the data of subjects who visited the health promotion center as part of the mandatory annual health check-up for employ- ees of various companies, and this group might not be representative of the general population. Third, because of funds shortage, we did not measure the parameters of oxidative stress, mediators of inflammation, and sex hormones in our study subjects. Fourth, male subjects in the GGT-high group and both-high group showed an increased adjusted HR for incident metabolic syndrome after adjusting for covariates compared with the totalbilirubin-high group; however, the risk in the both-low group did not differ from that of the totalbilirubin-high group. We cannot explain this sex difference, although the sex difference in the correlation coefficient between GGT and bilirubin levels may have resulted in the discrepancy.
METHODS: The plasma totalbilirubin concentration (B T ), unbound bil- irubin concentration, and albumin concentration values for healthy newborns with jaundice ( ⱕ 100 hours of age, ⱖ 35 weeks of gestation, and ⱖ 2.5 kg at birth) were obtained from medical records. ⌬ B T (in milligrams per deciliter per hour) was calculated as the slope of B T versus age (in hours). Binding avidity was quantiﬁed as the product of the albumin concentration and its bilirubin binding constant (K). Linear correlation was used to test the hypothesis that ⌬ B T would increase signiﬁcantly with K·albumin concentration.
diastolic dysfunction grading in HFpEF. We postulated those results might be related to the antioxidant effects of bilirubin. As we all know, HF may cause hepatic congestion and reduced forward flow, which would lead to elevated TB levels, but we found that it was negatively correlated with the severity of our patients’ LV diastolic dysfunction. This finding implied that some potential benefits might out- weigh the underlying severity of HF causing the TB level increasing. The mechanisms linking low bilirubin and risk or worse outcomes for cardiovascular disease are not fully understood. A number of mechanisms has been proposed for the antioxidant effects of bilirubin, including suppres- sion of low-density lipoprotein oxidation , monocyte migration , vascular smooth muscle cell proliferation  and endothelial dysfunction . Early animal experi- ments indicated that bilirubin served as a physiological antioxidant in ischemia–reperfusion  and served a protective function against injury-mediated prolifera- tion of intimal cells . It was reported that moderate hyperbilirubinemia reduced blood pressure in angiotensin II-dependent hypertension through decreasing oxidative stress and increasing nitric oxide levels . Our study was only a clinical observation, further experiments are needed to explore the underlying mechanisms.
health survey was reported in our previous articles [22–29]. In simple terms, the questionnaires were distributed to the participants who reported to be healthy ostensibly. After an overnight fast (time ≥ 8 h), blood samples were obtained to measure levels of blood parameters immediately. In order to control confounding factors, the following situations were excluded: participants who had histories of blood, liver, kidney, stomach, thyroid inflammation, infection, can- cer, and autoimmune diseases; subjects taking any medica- tion which might affect TB and TG; subjects with TB of 40 μmol/L or higher, alanine aminotransferase (ALT) of 100 U/L or higher; excessive drinking; pregnancy. To avoid the increase of TB caused by hemolysis, samples after cen- trifugation were visually tested for hemolysis. For the pur- pose of this particular study, the data was collected from September 2010 to September 2015. A total of 80,298 par- ticipants (48,971 males and 31,327 females) met the re- quirements and had sufficient data for our analysis.
at measuring bilirubin levels ⬍ 12 mg/dL. However, with careful review of the data, we found that the lower accuracy at STB ⱖ 12 mg/dL is not clinically important. For example, of the 127 jaundiced infants studied, only 1 (0.8%) infant had a TcB value that would have potentially directed us to a different treatment strategy and, therefore, would have led to a real potential for increased morbidity (ie, not per- forming an exchange blood transfusion otherwise indicated by STB values). This infant had poor cor-
In chronic liver disease patients total T4 showed significant negative correlation with totalbilirubin, direct bilirubin, prothrombin time and Child- Pugh score (p value of < 0.01). There was significant positive correlation between serum albumin levels and total T4 (p value of < 0.01). This was in contrast to the situation in acute liver disease group where there was significant positive correlation between total T4 levels and totalbilirubin and direct bilirubin and significant negative correlation with serum albumin levels. There was no significant correlation between total T4 and other liver variables despite high coefficient of correlation value. This was due to the small number of subjects in the acute liver disease study group (10). It can be concluded that in chronic liver disease total T4 decreases as the severity of the disease worsens but in acute liver diseases total T4 increases as the disease severity worsens. This may be due to the fact that in acute liver disease group it acts as a marker of inflammation while in chronic liver disease group it is decreased probably due to direct suppression of the thyroid function in chronic liver disease group or abnormalities in pituitary thyroid axis.
DISCUSSION: In our study, we were found a positive relation in admitted patients, between serum totalBilirubin concentration and serum HDL, while there were no relation between serum HDL concentration and serum Bilirubin level in OPD patients, who had normal Bilirubin concentration. It means when increased the level of serum totalBilirubin in admitted patients at the same decreased the risk of CVD and CAD in these patients, while OPD patients with normal Bilirubin concentration had higher risk of CVD/CAD. Coronary artery diseases develops through narrowing of the coronary arteries which leads to death of portion of the heart muscle because of lacking of blood flow that supply oxygen and nutrition, and leads to heart attack. 18 . Lipid profile plays the essential role of lipid deposition in artery wall and CAD development, by accumulating the LDL inside layers of artery wall, except HDL which has beneficial effects for a number of reasons by decreasing lipid oxidation after depositing in blood vessels, leading to retarding CAD development 19, 20 .
The same result was observed by Akboga et al. (2015) who conducted a study evaluating anti-inflammatory properties of bilirubin. In a retrospective cross- sectional study, they included 1501 patients who underwent coronary angiogra- phy. They divided them into three groups based on Gensini scores: No CAD (control group, n = 380), mild CAD (n = 497) and severe CAD (n = 624), with the objective of establishing anti-inflammatory effects of bilirubin in addition to its anti-oxidant effects. A significant inverse correlation between totalbilirubin and C-reactive protein (r = −0.112, p < 0.001), neutrophil to lymphocyte ratio (r = −0.070, p = 0.026) and red cell distribution width (r = −0.074, p = 0.027) was observed. These findings helped establish anti-inflammatory properties of bili- rubin in addition to their anti-oxidant effects. They also reconfirmed the inverse association of bilirubin with CAD severity (spearman’s rank correlation coeffi- cient (r) = −0.173, p < 0.001) .
Serum creatinine levels of malaria untreated, ACT treated and A. annua treated groups showed no significant difference when compared with the control. The increased totalbilirubin in group 4 may indicate an impairment of the liver functions. This suggests that the extract may have the ability of increasing the breakdown of the Red blood cells infested by the plasmodium parasites. Bilirubin is produced when the old red blood cells are broken down by the liver. It’s normally low in the blood, so its elevation may indicate certain diseases like impairment of the liver functions, blocked bile ducts, etc. it is responsible for the colour of stool and urine. The totalbilirubin of both group 2 and 3 showed no significant difference when compared with the control. But ordinarily, bilirubin level rises in malaria untreated patients. A significant increase in the conjugated bilirubin levels was recorded in both group 3 and 4 while that of group 2 was significantly lower when compared with the control, which implies that both A. annua extract and ACT could impair bilirubin excretion. No significant change was recorded in the unconjugated bilirubin level of both group 2, 3 and 4 compared with the control. Conjugated bilirubin is virtually absent from the serum of healthy individual because of the rapid secretion of bile which aids its excretion. The breakdown of heme from haemoglobin produces unconjugated bilirubin which is transported to the liver where it is conjugated with UDP glucuronyltransferase making it water soluble and to be easily excreted.
These biomarkers have been effectively and extensively used to assess the impacts of a large number of environmental contaminants  on fishes generally, and also in the clariids [11, 12, 13, 14, 15, 16]. Very few reports are available on the effects of oilfield wastewaterson fishes which include impacts on the mycology , bacterial flora , haematology , organ indices  and enzymes  of C. gariepinus. However, there is scarcely any literature on the effects of oilfield wastewaters on the metabolites in C. gariepinus. This paper is a report on the impact of oilfield water on the metabolites (total protein, albumin, creatinine, total urea and totalbilirubin) in the plasma, gill, liver, kidney and muscle tissues of C. gariepinus under laboratory conditions which has not hitherto been reported neither in the fields nor open water bodies.
For the totalbilirubin to have reached 31.7 mg/dL with an unbound bilirubin of 7.7 g/dL an extremely large bilirubin load must have been present. The large bilirubin load does not appear because of greatly increased hemolysis, since the carboxyhemo- globin level was normal and the hematocrit 34%. This supports the hypothesis that poor hepatic con- jugation and excretion of bilirubin may sometimes play an important role in kernicterus associated with G6PD deficiency, although the infant did not have Gilbert’s disease.
general population, mainly characterized by intermittent unconjugated hyperbilirubinemia in the absence of hepatocellular disease or hemolysis, which can become clinically appar- ent during fasting, physical exercise, stress, or menstruation [1, 2]. CNS forms are classified into two types based on serum totalbilirubin concentrations (STBC): the severe type (CNS-I) is defined by high levels of STBC (342-684 μmol/L), while the milder type, namely CNS-II, is defined by lower level of STBC ranging from 103 to 342 μmol/L .
The serum globulin concentrations in the exposed fish groups increased by 104.2% at the end of 35 days, 114.3% after 65 days period and 118.5% in 95 days period. The toxicity of heavy metals could cause an increase in the serum globulin level of fish. Exposure to heavy metals had a detrimental effect on the immunological response in fish (Gopal et al., 1997). The increases in serum globulin levels of 35-, 65- and 95-day groups in proportion to control group have shown similarities with findings of Gopal et al. (1997) The serum totalbilirubin values increased by 78% during 35-day period and 72.1% during 65-day period; however, there was a 72.1% decrease in the totalbilirubin concentration of the serum in the exposed group during 95-day period. The direct bilirubin levels in the serum of the fish exposed to copper sulfate elevated 123.8% in 35 days, 160% after 65 days period and 185% at the end of 95 days. Significant increases of the serum globulin, totalbilirubin (except the decrease in totalbilirubin of the 95-day exposure group) and direct bilirubin concentrations in the exposed fish groups may be the result of the effects of copper sulfate. Direct bilirubin is an amount of the soluble bilirubin in water. On the contrary, totalbilirubin comes to the muscle and the liver by binding to the albumin and globulin in the serum through filtration by the kidney. In addition, bilirubin is a predominant bile pigment found in the circulation in the Nile tilapia derived from disruption of hemoglobin (Folmar, 1993). Serum bilirubin levels of fish could change with hepatocellular disease (Chen et al., 2004) and the effect of mycotoxin (Van Vuren et al., 1994).
Abstract: Ischemic type biliary lesion (ITBL) is frequently occurred after orthotopic liver transplantation and severely affects patients’ survival rate. The pathogenesis of ITBL is still unclear yet, but has been suggested to be related with multiple factors including ischemia time of donor liver, reperfusion damage and immune factors. Complete ischemia model of intrahepatic biliary tract was established in rabbit by combined blockage of common biliary tract and common hepatic artery. In transplantation group, mononuclear cells separated from bone marrow as infused via hepatic artery. Liver functions in two groups were compared. Both mRNA and protein expressions were determined by real-time PCR and Western blotting, respectively. After autograft transplantation of bone marrow derived mononuclear cells, liver function indexes including AST, ALT, ALP, totalbilirubin and direct bilirubin were all decreased compared to control group (P<0.05). Both mRNA and protein expression levels of Bcl-2 and VEGF were increased while expression of Fas was decreased (P<0.05). Autograft transplantation of bone marrow derived mononuclear cells could prevent the occurrence of ITBL, via facilitating angiogenesis, improving apoptosis/anti- apoptosis balance and improving hepatic and biliary functions.
All animals were killed on 14 days under light ether anesthesia. Blood samples were collected separately into sterilized dry centrifuge tubes and allowed to coagulate for 30 minute at 37º C. The clear serum was separated at 2500 rpm for 10 minute and biochemical investigations were carried out to assess liver function viz. SGOT, SGPT, Alkaline phosphate, totalbilirubin, direct bilirubin and total proteins.
Poor plasma bilirubin binding increases the risk of bilirubin neurotoxicity in newborns with hyperbilirubinemia. New laboratory tests may soon make it possible to obtain a complete bilirubin binding panel when evaluating these babies. The 3 measured components of the panel are the plasma totalbilirubin concentration (B Total ), which is currently used to guide clinical care; the bilirubin binding capacity (BBC); and the concentration of non–albumin bound or free bilirubin (B Free ). The fourth component is the bilirubin-albumin equilibrium dissociation constant, K D , which is calculated from B Total , BBC, and B Free . The bilirubin binding panel is comparable to the panel of components used in the Henderson-Hasselbalch approach to acid- base assessment. Bilirubin binding population parameters (not prospective studies to determine whether the new bilirubin binding panel components are better predictors of bilirubin neurotoxicity than B Total ) are needed to expedite the clinical use of bilirubin binding. At any B Total , the B Free and the relative risk of bilirubin neurotoxicity increase as the K D /BBC ratio increases (ie, bilirubin binding worsens). Comparing the K D /BBC ratio of newborns with B Total of concern with that typical for the population helps determine whether the risk of bilirubin neurotoxicity varies significantly from the inherent risk at that B Total . Furthermore, the bilirubin binding panel individualizes care because it helps to determine how aggressive intervention should be at any B Total , irrespective of whether it is above or below established B Total guidelines. The bilirubin binding panel may reduce anxiety, costs, unnecessary treatment, and the likelihood of undetected bilirubin neurotoxicity.
RESULTS. Forty-four infants with proximate totalbilirubin concentration, unbound bilirubin concentration, and automated auditory brainstem response measurements were identified, and 4 (9%) had bilateral refer automated auditory brainstem re- sponse results. The mean totalbilirubin concentration of 21.4 mg/dL (SD: 4.0 mg/dL; range: 14.4 –29.5 mg/dL) for the 40 infants with bilateral pass automated auditory brainstem response results was not significantly different from that of 23.0 mg/dL (range: 14.9 –33.1 mg/dL) for the 4 infants with bilateral refer automated auditory brainstem response results. However, the mean unbound bilirubin concentration of 1.32 g/dL (range: 0.22–2.99 g/dL) for the 40 infants with bilateral pass results was significantly lower than the mean of 2.62 g/dL (range: 0.88 – 4.41 g/dL) for the 4 infants with bilateral refer results. Logistic regression showed that increasing un-
Grewia tenax (Goddaim) fruits at 2%, 10% of basic diet ethanolic extract were administered in drinking water (500 mg/Kg/day), via intraperitoneal route (50 mg /kg/day), and via intramuscular route (10/mg/kg/day) for varying periods were fed to 7-day old Bovans-type chicks. After feeding period of 4 weeks and recovering period of 3 weeks, 4 chicks were slaughtered at weeks 2, 4 and 7. Blood samples were collected for hematological and serum analysis. Chicks were examined for gross lesions and specimens of liver, kidneys, heart, spleen and intestines were processed for histopathology. Mean body weights, weight gains, feed conversion ratios were drastically affected throughout the 7-weeks study period in chicks receiving Grewia ethanolic extract via oral, intraperitoneal, and intramuscular routes comparing those fed on 2% Grewia with those fed on 10% Grewia, which exhibited an intense yellow discoloration at the combs and shanks. Enterohepatonephropathy is a characteristic feature of plant toxicities in chicks particularly induced by feeding at 10% of the basic diet or administering ethanolic extract by the oral route (500mg/kg/day), i.p route (50mg/kg/day), and i.m. route (10mg/kg/day). Lesions were correlated with changes in serum aspartate aminotransferase activity and concentrations of total protein, albumin, globulin, totalbilirubin, cholesterol, uric acid, and calcium as well as with alterations in hemoglobin, packed cell volume, red blood cells, mean corpuscular volume and mean corpuscular hemoglobin concentration values.