血清铁过载与老年女性骨质疏松性骨折的关系研究

目的:探讨血清铁过载与老年女性骨质疏松性骨折的关系。方法:选取老年女性骨折患者122例(老年骨折组)、中青年女性骨折患者120例(中青年骨折组)及健康老年女性100例(对照组),检测三组患者骨密度与血清铁蛋白(FER),并在三组中进行对比分析。结果:老年骨折组T值处于骨质疏松范围,中青年骨折组与对照组T值正常。老年骨折组T值显著低于中青年骨折组与对照组(P<0.05);中青年骨折组T值显著高于对照组(P<0.05)。老年骨折组FER明显高于正常,中青年骨折组与对照组FER正常。老年骨折组FER显著高于中青年骨折组与对照组(P<0.05),中青年骨折组与对照组FER无统计学差异(P>0.05)。结论:老年骨质疏松性骨折女性骨密度降低,同时体内铁含量增高。高水平的血清铁在老年女性骨质疏松症的发生发展病理生理过程中起了重要作用,血清铁水平的异常增高也是老年女性骨质疏松的重要危险因素。

Anemia after gastrectomy for early gastric cancer:Long-term follow-up observational study

AIM:To identify the incidence and etiology of anemia after gastrectomy in patients with long-term follow-up after gastrectomy for early gastric cancer.METHODS:The medical records of those patients with early gastric adenocarcinoma who underwent curative gastrectomy between January 2006 and October 2007 were reviewed.Patients with anemia in the preoperative workup,cancer recurrence,undergoing systemic chemotherapy,with other medical conditions that can cause anemia,or treated during follow up with red cell transfusions or supplements for anemia were excluded.Anemia was defined by World Health Organization criteria(Hb < 12 g/dL in women and < 13 g/dL in men).Iron deficiency was defined as serum ferritin < 20 g/dL.Vitamin B12 deficiency was defined as serum vitamin B 12 < 200 pg/mL.Iron deficiency anemia was defined as anemia with concomitant iron deficiency.Anemia from vitamin B 12 deficiency was defined as megaloblastic anemia(mean cell volume > 100 fL) with vitamin B 12 deficiency.The profile of anemia over 48 mo of follow-up was analyzed.RESULTS:One hundred sixty-one patients with gastrectomy for early gastric cancer were analyzed.The incidence of anemia was 24.5% at 3 mo after surgery and increased up to 37.1% at 48 mo after surgery.The incidence of iron deficiency anemia increased during the follow up and became the major cause of anemia at 48 mo after surgery.Anemia of chronic disease and megaloblastic anemia were uncommon.The incidence of anemia in female patients was significantly higher than in male patients at 12(40.0% vs 22.0%,P = 0.033),24(45.0% vs 25.0%,P = 0.023),36(55.0% vs 28.0%,P = 0.004),and 48 mo(52.0% vs 31.0%,P = 0.022) after surgery.Patients with total gastrectomy showed significantly higher incidence of anemia than patients with subtotal gastrectomy at 48 mo after surgery(60.7% vs 31.3%,P = 0.008).The incidence of iron deficiency was significantly higher in female patients than in male patients at 6(35.4% vs 13.3%,P = 0.002),12(45.8% vs 16.8%,P < 0.001),18(52.1% vs 22.3%,P < 0.001),24(60.4% vs 20.9%,P < 0.001),36(62.5% vs 29.2%,P < 0.001),and 48 mo(66.7% vs 34.7%,P = 0.001) after surgery.CONCLUSION:Anemia was frequent after gastrectomy for early gastric cancer,with iron deficiency being the major cause.Evaluation for anemia including iron status should be performed after gastrectomy and appropriate iron replacement should be considered.

T2* magnetic resonance imaging of the liver in thalassemic patients in Iran

AIM: To investigate the accuracy of T2*-weighted magnetic resonance imaging (MRI T2*) in the evaluation of iron overload in beta-thalassemia major patients. METHODS: In this cross-sectional study, 210 patients with beta-thalassemia major having regular blood transfusions were consecutively enrolled. Serum ferritin levels were measured, and all patients underwent MRI T2* of the liver. Liver biopsy was performed in 53 patients at an interval of no longer than 3 mo after the MRIT2* in each patient. The amount of iron was assessed in both MRI T2* and liver biopsy specimens of each patient. RESULTS: Patients’ ages ranged from 8 to 54 years with a mean of 24.59 ± 8.5 years. Mean serum ferritin level was 1906 ± 1644 ng/mL. Liver biopsy showed a moderate negative correlation with liver MRI T2* (r = -0.573, P = 0.000) and a low positive correlation with ferritin level (r = 0.350, P = 0.001). Serum ferritin levels showed a moderate negative correlation with liver MRI T2* values (r = -0.586, P = 0.000). CONCLUSION: Our study suggests that MRI T2* is a non-invasive, safe and reliable method for detecting iron load in patients with iron overload.

Diagnostic and therapeutic implications of the association between ferritin level and severity of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease(NAFLD),defined by excessive liver fat deposition related to the metabolic syndrome,is a leading cause of progressive liver disease,for which accurate non-invasive staging systems and effective treatments are still lacking.Evidence has shown that increased ferritin levels are associated with the metabolic insulin resistance syndrome,and higher hepatic iron and fat content.Hyperferritinemia and iron stores have been associated with the severity of liver damage in NAFLD,and iron depletion reduced insulin resistance and liver enzymes.Recently,Kowdley et al demonstrated in a multicenter study in 628 adult patients with NAFLD from the NAFLD-clinical research network database with central re-evaluation of liver histology and iron staining that the increased serum ferritin level is an independent predictor of liver damage in patients with NAFLD,and is useful to identify NAFLD patients at risk of non-alcoholic steatohepatitis and advanced fibrosis.These data indicate that incorporation of serum ferritin level may improve the performance of noninvasive scoring of liver damage in patients with NAFLD,and that iron depletion still represents an attractive therapeutic target to prevent the progression of liver damage in these patients.

Is iron overload in alcohol-related cirrhosis mediated by hepcidin?

In this case report we describe the relationship between ferritin levels and hepcidin in a patient with alcohol-related spur cell anemia who underwent liver transplantation.We demonstrate a reciprocal relation-ship between serum or urinary hepcidin and serum ferritin,which indicates that inadequate hepcidin production by the diseased liver is associated with elevated serum ferritin.The ferritin level falls with increasing hepcidin production after transplantation.Neither inflammatory indices(IL6)nor erythropoietin appear to be related to hepcidin expression in this case.We suggest that inappropriately low hepcidin production by the cirrhotic liver may contribute substantially to elevated tissue iron stores in cirrhosis and speculate that hepcidin replacement in these patients may be of therapeutic benefi t in the future.

Acute liver failure caused by drug-induced hypersensitivity syndrome associated with hyperferritinemia

Drug-induced hypersensitivity syndrome(DIHS) is a severe reaction usually characterized by fever,rash,and multiorgan failure,occurring 2-6 wk after drug introduction.It is an immune-mediated reaction involving macrophage and T-lymphocyte activation and cytokine release.A 54-year-old woman was diagnosed with rheumatic arthritis and initiated salazosulfapyridine by mouth.About 10 d later,she had a high fever,skin rash and liver dysfunction.She was admitted to hospital and diagnosed with a drug eruption.She was treated with oral prednisolone 30 mg/d;however,she developed high fever again and her blood tests showed acute liver failure and cytopenia associated with hyperferritinemia.She was diagnosed with acute liver failure and hemophagocytosis caused by DIHS.She was transferred to the Department of Medicine and Bioregulatory Science,Kyushu University,where she was treated with arterial steroid injection therapy.Following this treatment,her liver function improved and serum ferritin immediately decreased.We hypothesized that an immune-mediated reaction in DIHS may have generated over-activation of macrophages and T-lymphocytes,followed by a cytokine storm that affected various organs.The measurement of serum ferritin might be a useful marker of the severity of DIHS.

Single dose of intra-muscular platelet rich plasma reverses the increase in plasma iron levels in exercise-induced muscle damage:A pilot study

Background:Platelet rich plasma(PRP) therapy is widely used in enhancing the recovery of skeletal muscle from injury.However,the impact of intramuscular delivery of PRP on hematologic and biochemical responses has not been fully elucidated in exercise-induced muscle damage.The purpose of this investigation the effects of intramuscular delivery of PRP on hematologic and biochemical responses and recovery strategy muscle damage induced by high intensity muscle exercise(exercise-induced muscle damage,EIMD).Methods:Moderately active male volunteers participated in this study and were assigned to a control group(control,n = 6) and PRP administration group(PRP,n = 6).The subjects performed exercise with a load of 80% one repetition maximum(1RM) maximal voluntary contraction of the elbow flexors until point of exhaustion of the non-dominant arm was reached.The arms were treated with saline or autologous PRP post-24 h EIMD.Venous blood samples were obtained in the morning to establish a baseline value and 1–4 days post-exercise and were analyzed for serum ferritin,iron,iron binding capacity(IBC),creatinine kinase(CK),lactate dehydrogenase(LDH),aspartate aminotransferase(AST),and alanine aminotransferase(ALT).Results:The baseline levels of plasma iron,ferritin,IBC,CK,LDH,AST,and ALT were similar in both the control and PRP groups.However,24-h following exercise a significant increase in these parameters was observed in both groups between 1 and 4 days during the recovery period.Interestingly,PRP administration decreased plasma iron levels compared to the control on the second day post-exercise.Plasma IBC increased in PRP group from Days 2 to 4 post-exercise compared to the control group whilst PRP administration had no effect on plasma ferritin,CK,AST,ALT,or LDH.Conclusion:Acute exhaustive exercise increased muscle damage markers,including plasma iron,IBC,and ferritin levels,indicating muscle damage induced by exercise.PRP administration improves inflammation by reversing the increase in the iron levels post-exercise without displaying any myotoxicity and may have a role to play in the recovery of exercise-induced muscle damage.

Iron homeostasis and H63D mutations in alcoholics with and without liver disease

MM： To evaluate the prevalence of HFE gene mutation and indices of disturbed iron homeostasis in alcoholics with and without liver disease. METHODS： One hundred and fifty-three heavy drinkers （defined as alcohol consumption 〉 80 g/d for at least 5 years） were included in the study. These comprised 78 patients with liver disease [liver disease alcoholics （LDA）] in whom the presence of liver disease was confirmed by liver biopsy or clinical evidence of hepatic decompensation, and 75 subjects with no evidence of liver disease, determined by normal liver tests on two occasions [non-liver disease alcoholics （NLDA）], were consecutively enrolled. Serum markers of iron status and HFE C282Y and H63D mutations were determined. HFE genotyping was compared with data obtained in healthy blood donors from the same geographical area. RESULTS： Gender ratio was similar in both study groups. LDA patients were older than NLDA patients （52 ± 10 years vs 48 ± 11 years, P = 0.03）. One third and one fifth of the study population had serum transferrin saturation （TS） greater than 45% and 60% respectively. Serum iron levels were similar in both groups. However, LDA patients had higher TS （51 ± 27 vs 36 ± 13, P 〈 0.001） and ferritin levels （559 ± 607 ng/mL vs 159 ± 122 ng/mL, P 〈 0.001）, and lower total iron binding capacity （TIBC） （241 ± 88 μg/dL vs 279 ± 40 μg/dL, P = 0.001）. The odds ratio for having liver disease with TS greater than 45% was 2.20 （95% confidence interval （CI）： 1.37-3.54）. There was no difference in C282Y allelic frequency between the two groups. However, H63D was more frequent in LDA patients （0.25 vs 0.16, P = 0.03）. LDA patients had a greater probability of carrying at least one HFE mutation than NLDA patients （49.5% vs 31.6%, P = 0.02）. The odds ratio for LDA in patients with H63D mutation was 1.57 （95% CI： 1.02-2.40）. CONCLUSION： The present study confirms the presence of iron overload in alcoholics, which was more severe in the subset of subjects with liver disease, in parallel with an increased frequency of H63D HFE mutation.

Clinical variations of serum levels of ferritin,folic acid and vitamin B_(12) in acute leukemia patients

Acute leukemia is one of the most common hematologic malignancies and its exact mechanism of development is unknown yet. In clinical, acute leukemia alw g12 acid are important components of blood cells ays In accompany with abnormal iron balance. Ferritin, folic acid and vitamin this study, we measured variations of serum levels of ferritin （SF）, folic and vitamin B^2 in the acute leukemia patients under different disease stages including first diagnosed stage complete remission （CR） stage and not remission （NR） or relapse stage. It demonstrated that serum SF levels in patients at the first diagnosed stage and NR or relapse stage were significantly higher than the CR stage in acute m leukemia （AML） patients and acute lymphoblastic leukemia （ALL） patients （P〈0.05）. The serum folic acid yelocy levels tic in patients at the first diagnosed stage and NR or relapse stage were significantly lower than the CR stage in AML patients and ALL patients （P〈0.001）. Whereas, serum vitamin B12 levels in AML patients were significantly higher at the first diagnosed stage and NR or relapse stage than the CR stage （P〈0.001）. And it was significantly higher in ALE patients at the NR or relapse stage than at the first diagnosed stage and CR stage （P〈0.05）. There are obvious variations of serum levels of SF, folic acid and vitamin and vitamin B12 and decreased levels B12 offo in acute leukemia patients under different stages. Increased serum levels of SF lic acid may correlate to the active degree of acute leukemia as well as tumor load

Binding interactions of pefloxacin mesylate with bovine lactoferrin and human serum albumin

The binding of pefloxacin mesylate （PFLX） to bovine lactoferrin （BLf） and human serum albumin （HSA） in dilute aqueous solution was studied using fluorescence spectra and absorbance spectra. The binding constant K and the binding sites n were obtained by fluorescence quenching method. The binding distance r and energy-transfer efficiency E between pefloxacin mesylate and bovine lactoferrin as well as human serum albumin were also obtained according to the mechanism of Forster-type dipole-dipole nonradiative energy-transfer. The effects of pefloxacin mesylate on the conformations of bovine lactoferrin and human serum albumin were also analyzed using synchronous fluorescence spectroscopy.

Association of Thalassemia and Trait, Sickle Cell and Trait and Haemoglobin C with Iron-Deficiency Anemia in Colombians of African Descent

The conditions of poverty and violence in Colombia have increased the displacement of people of African descent. The research group concerned with the health of these communities has performed research to find the association of alterations in the hemoglobin molecule with the presence of iron deficiency anemia. This research was performed with the support of the epidemiological public health laboratory. The objective of the study is the association of sickle cell disease and sickle cell trait, and the presence of hemoglobin C and its trait, with iron deficiency anemia in Afro-Colombians between 18 and 50 years of age, by investigation of hemograms, peripheral blood study, serum ferritin, soluble receptor for transferrin （sTfR） and index of sTfR, and hemoglobin electrophoresis. This research is a descriptive, quantitative, transverse, structured, non-experimental and correlational study, with a total of 56 samples （10 men, 46 women）. The results showed that ferritin in men had normal values, compared to 32% （15/46） of women who had low levels of ferritin. Men＇s sTfR levels were normal, while in women 2% （1/46） had iron deficiency in stage I, 41% （19/46） iron deficiency in stage If, and 9% （4/46） possibly without anemia iron deficiency. In hemoglobin electrophoresis, 84% （46/56） of the population presents hemoglobin A, 4% （2/56） increased hemoglobin A2 and fetal hemoglobin related to a possible thalassemia trait, 11% （6/56） had hemoglobin AS related to sickle cell trait, and 2% （1/56） show hemoglobin AC, related to hemoglobin AC trait. This project supports investigative and social projects, and also contributes to the improvement of the quality of life and dissemination of good health practices in these communities.

A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases

Iron deficiency （ID）, with or without anemia, is often caused by digestive diseases and should always be investigated, except in very specific situations, as its causes could be serious diseases, such as cancer. Diagnosis of ID is not always easy. Low serum levels of ferritin or transferrin saturation, imply a situation of absolute or functional ID. It is sometimes difficult to differentiate ID anemia from anemia of chronic diseases, which can coexist. In this case, other parameters, such as soluble transferrin receptor activity can be very useful. After an initial evaluation by clinical history, urine analysis, and serological tests for celiac disease, gastroscopy and colonoscopy are the key diagnostic tools for investigating the origin of ID, and will detect the most important and prevalent diseases. If both tests are normal and anemia is not severe, treatment with oral iron can be indicated, along with stopping any treatment with non-steroidal anti-inflammatory drugs. In the absence of response to oral iron, or if the anemia is severe or clinical suspicion of important disease persists, we must insist on diagnostic evaluation. Repeat endoscopic studies should be considered in many cases and if both still show normal results, investigating the small bowel must be considered. The main techniques in this case are capsule endoscopy, followed by

Iron and Zinc Serum Levels in Young Adult Cameroonians after Supplementation in Poor Vitamin A and Controlled Diets

Iron, zinc and vitamin A deficiencies co-exist in Cameroon in all age groups. However, natural sources of vitamin A are available and could be used to meet the need of the whole population in association with iron and zinc supplementation. This study aims at assessing the serum levels of zinc and iron after 11 days of supplementation. The study enrolled 26 men 08-33 years）, distributed into five groups. From the first day, they were supplemented with 20 mg of zinc and iron, taken each alone, both either together or at two different times. The five last days, participants were put on free vitamin A diets. Serums were obtained at day l, day 5 and day 11 for Zn and Fe levels determination by atomic absorption spectrophotometry. The highest serum iron and zinc concentrations were observed in groups either supplemented with zinc or with iron given alone. In those two groups, serum Zn concentrations increased from 0.69 μg/mL ±0.02μg/mL to 0.95 μg/mL ± 0.13 μg/mL （group 2）, from 0.48 μg/mL ± 0.06 μg/mL to 0.97 μg/mL ± 0.11 μg/mL （group 3）; and serum Fe concentrations from 1.49 μg/mL ± 0.54 μg/mL to 3.49 μg/mL ± 1.01 μg/mL （group 2）; and from 1.42 μg/mL ± 0.45 μg/mL to 3.41 μg/mL ± 0.81 μg/mL （group 3）, respectively. Supplementation with Fe or Zn alone increased both Fe and Zn serum levels of participants. Serum levels of iron and zinc when given together or at different time were not significantly different. Further studies on a larger population are necessary to confirm that supplementation with zinc or with iron alone could raise both zinc and iron levels in serum simultaneously.

Novel nanocomposites based on a strawberry-like gold-coated magnetite （Fe@Au） for protein separation in multiple myeloma serum samples

A new process to produce magnetite partially coated with strawberry-like gold nanoparticles in aqueous media is reported. The fast response to magnetic fields and optical properties of gold nanoparticle-based colloidal systems are the two main advantages of this new Fe@Au nanomaterial. These advantages allow for the use of this new colloidal nanomaterial for various purposes in proteomics and biomedicine, as proteins can bind to the surface, and the surface can also be funcfionalized. As proof-of-concept, the new Fe@Au nanoparticles have been assessed in biomarker discovery as a tool for pre-concentration and separation of proteins from complex proteomes. To this end, sera from healthy people were compared with sera from patients diagnosed with multiple myeloma. The application of this new Fe@Au nanomaterial combined with mass spectrometry has allowed for the identification of 53 proteins, and it has also shown that the heat shock protein HSP75 and the plasma protease C1 inhibitor are potential biomarkers for diagnostics and control of multilvle mveloma vro^ression.