In patients with cirrhosis and spontaneous bacterial peritonitis, treatment with intravenous albumin in addition to an antibiotic reduces the incidence of renal impairment and death in comparison with treatment with an antibiotic alone.

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One hundred seventy-nine Holstein male calves [44.7 kg of body weight (BW) and 8.3 d of age] participated in a series of 3 experiments to evaluate the effect of different forage sources on performance, apparent digestibility, and feeding behavior. Animals in each study were randomly assigned to 1 of 3 different dietary treatments: control (CON) calves were fed starter feed without any forage provision (this treatment was repeated in each of the 3 experiments), and the 2 other treatments consisted of the same starter feed plus a forage source: chopped alfalfa (AH) or rye-grass hay (RH) in the first study; chopped oat hay (OH) or chopped barley straw (BS) in the second study; corn silage (CS) or triticale silage (TS) in the third study. All calves were offered 2L of milk replacer (MR) at 12.5% dry matter (DM) twice daily via a bottle until 50 d of age, and 2L of MR at 12.5% DM during the week before weaning (57 d of age). The study finished when calves were 71 d old. Starter feed, MR, and forage intakes were recorded daily and BW weekly. Calves were individually housed and bedded with wood shavings. Compared with CON, animals receiving OH, TS, and BS consumed more starter feed (0.88 vs. 1.14, 1.17, 1.06 kg/d, respectively) and had greater average daily gain (0.72 vs. 0.93, 0.88, 0.88 kg/d, respectively). Animals in treatments RH, BS, CS, and TS consumed less forage (51 g/d) than AH (120 g/d) and OH (101 g/d) calves. Apparent organic matter, DM, and neutral detergent fiber digestibilities did not differ among treatments (81.5, 81.1, and 54.4%, respectively). Apparent crude protein digestibility was greater in RH, CS, and AH treatments than in CON (80.5 vs. 76.4%, respectively). Compared with CON calves, animals in the AH treatment spent less time eating starter feed and lying, animals in AH and RH treatments spent more time ruminating, with odds ratios (OR) of 5.24 and 5.40, respectively. The AH and RH calves devoted less time to performing nonnutritive oral behaviors (OR: 0.38 and 0.34, respectively), and TS calves tended to devote less time to perform nonnutritive oral behaviors (OR: 0.21) 1h after being offered MR and solid feed. In conclusion, free-choice provision of a forage source to young calves improves feed intake and performance without impairing digestibilities of DM, organic matter, crude protein, and neutral detergent fiber, and, depending on forage source, reduces nonnutritive oral behaviors and stimulates rumination.

Recurrent hepatitis C virus (HCV) infection after liver transplantation (LT) is associated with accelerated progression of liver disease, frequently leading to graft loss and early death. Existing treatment options for severe recurrent HCV infection are limited by suboptimal efficacy, poor tolerability, and numerous drug interactions. We provided sofosbuvir (SOF) and ribavirin (RBV) on a compassionate-use basis to patients with severe recurrent hepatitis C, including those with fibrosing cholestatic hepatitis (FCH) and decompensated cirrhosis who had a life expectancy of 1 year or less. All patients were to receive 24-48 weeks of SOF plus RBV. Investigators could add pegylated interferon to the regimen at their discretion. Data from the first 104 patients who completed or prematurely discontinued treatment by January 1, 2014 are presented. Of the 104 patients analyzed, 52 had an early severe recurrence (diagnosed <12 months after LT) and 52 had cirrhosis (diagnosed >12 months after LT). Twelve patients who underwent retransplantation were excluded from our efficacy analysis. Of the 92 patients assessed, 54 (59%) achieved sustained virological response (SVR) at 12 weeks after the end of treatment, with a higher rate (73%; 35 of 48) in patients with early severe recurrence. Of the 103 patients assessed for clinical outcome, 59 (57%) reported clinical improvement at the last study visit, 23 (22%) were unchanged, 3 (3%) had a worsened clinical status, and 13 (13%) died. Overall, 123 serious adverse events (SAEs) occurred in 49 patients (47%). SAEs associated with hepatic decompensation were the most frequent, with 26 SAEs occurring in 19 patients (18%). Conclusion: SOF and RBV provide high rates of SVR in patients with severe recurrent HCV, including patients with early severe recurrence, FCH, and cirrhosis. (HEPATOLOGY 2015;61:1485-1494

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