Transferrin Levels Research Articles

Transferrin and Prealbumin Identify Esophageal Cancer Patients with Malnutrition and Poor Prognosis in Patients with Normal Albuminemia: A Cohort Study

In this study, we aimed to analyze whether serum prealbumin and transferrin have a higher sensitivity than albumin for detecting malnutrition and predicting survival in esophageal cancer patients. A total of 212 patients were prospectively enrolled. Serum albumin, prealbumin, and transferrin were analyzed by enzyme-linked immunosorbent assays. The association of nutritional markers with survival was analyzed. We found that malnutrition was presented in 44.5% of the patients, while 56.6% were unaware of their body weight change. The area under the curve for diagnosing malnutrition was largest for prealbumin, followed by transferrin and albumin, with optimal breakpoints of 21 mg/dL, 206 mg/dL, and 4.3 g/dL, respectively, for diagnosing malnutrition. The diagnostic sensitivity for malnutrition was 34.1-63.4% with a single marker and this increased to 80.5% with all 3 markers. In patients with normal albuminemia (≥ 4.3 g/dL), a low level of prealbumin and/or transferrin predicted malnutrition and poor prognosis. Multivariate Cox regression analysis confirmed that a low level of the nutritional marker was an independent poor prognostic factor. In conclusion, serum prealbumin and transferrin outperformed albumin in identifying esophageal cancer patients with malnutrition and poor prognosis. Checking all three markers will help with the early diagnosis of malnutrition and enable timely intervention.

MO937: Relationship Between Nutritional Status and Zonulin Level in Patients With End-Stage Renal Disease on Dialysis

Abstract BACKGROUND AND AIMS Protein energy wasting (PEW) is currently considered as one of the most important and independent predictors of an unfavourable prognosis in patients receiving haemodialysis treatment. The insufficient intake of nutrients and energy can be related to the ̏leaky gut̎ syndrome. Zonulin secretion has been shown to be dependent and is followed by an increase in gut permeability secondary to the disassembly of the protein ZO-1 from the tight junctional complex. Thus, the serum zonulin level may be considered as a biomarker of impaired intestinal barrier function. Тhe aim of our study was to evaluate the relationship between PEW and intestinal permeability, estimated by the level of serum zonulin, in patients receiving hemodialysis treatment. METHOD This was a case-control study involving 148 participants (123 haemodialysis patients and 25 control subjects). Patients diagnosed with infectious illness, unstable blood pressure, clinically active gastrointestinal disease, past history of abdominal operation and taking antibacterial, nonsteroidal anti-inflammatory and laxatives drugs were excluded. The presence of PEW was carried out by the International Society of Renal Nutrition and Metabolism (ISRNM) diagnostic criteria, which requires that patients meet at least one criterion in three of the four proposed categories: altered biochemical laboratory tests, loss of body mass, loss of muscle mass and decreased protein or energy intake. Bioimpedance measurements were obtained with an InBody720 equipment (Biospace, Korea). Plasma concentration of zonulin was assessed by ELISA using commercially available kit (BlueGene Biotech, Shanghai, China). RESULTS This study included 123 (75 men and 48 women) clinically stable patients undergoing haemodialysis in our centre. The average age was 59 years (49–67 years), and the mean duration of dialysis treatment was 36 (24–53) months. Given the absence of generally accepted reference values for serum zonulin levels, haemodialysis patients parameters were compared with the data of 25 healthy volunteers (13 men and 12 women) with an average age of 49 years (41.5–55). Zonulin level was significantly higher in the haemodialysis patients as compared with the healthy control 236.1 (190.3–310.9) ng/mL versus 190.6 (156.3–231.4) ng/mL, P < 0.01. Of the total population, 27 patients (22%) met the diagnostic criteria of PEW. The subgroup analysis between those with PEW and without PEW showed a statistically significant difference in serum zonulin concentration: 311.1 (282.6–406) versus 223.7 (182.8–271) ng/mL, respectively, P < 0.0001. Among subjects with PEW, there was a significant correlation between zonulin level and serum albumin (r = –0.404; P = 0.018), body mass index (r = –0.281; P = 0.021), body fat mass index (r = –0.55; P = 0.019), skeletal muscle mass index (r = –0.395; P = 0.007), erythrocyte sedimentation rate (r = 0.199; P = 0.04) and C-reactive protein (r = 0.642; P < 0.001). In the meantime, there was no significant interaction between zonulin and age, duration of dialysis treatment, Kt/V, shoulder muscle circumference, triceps skinfold, haemoglobin, total cholesterol, transferrin and lymphocyte levels (all P-values > 0.05). CONCLUSION Our study shows that PEW in haemodialysis patients could be associated with the increased intestinal permeability. Thus, different strategies that attenuate intestinal barrier disruption may be a potential therapeutic tool for the prevention and treatment of PEW. Limitation of the present study was the limited sample of participants, which probably influenced the significance of statistical tests. Further clinical studies are needed in a larger population as well as their prospective follow-up to enhance the understanding of this topic.

Biochemical abnormalities among patients referred for celiac disease antibody blood testing in a primary health care setting

To investigate possible biochemical abnormalities associated with celiac disease (CD) antibody positivity in a primary health care setting and thereby identify predictors that could potentially reduce diagnostic delay and underdiagnosis of CD. This observational cohort study included measurements of CD antibodies in the Copenhagen Primary Care Laboratory (CopLab) database from 2000 to 2015; CD antibody positivity was defined as tissue transglutaminase antibody IgA or IgG ≥ 7 kU/L and/or deamidated gliadin peptide antibody IgG ≥ 10 kU/L. Individuals with a prior diagnosis of CD were excluded. We examined differences between individuals with positive and negative CD antibody tests regarding the results of biochemical tests performed six months before and one month after the date of the CD antibody test. We identified 76,265 measurements of CD antibodies during 2000–2015, and 57,061 individuals met the inclusion criteria (706 antibody-positive and 56,355 antibody-negative). We found lower ferritin, hemoglobin, cobalamin and folic acid levels and higher levels of transferrin, ALAT (alanine transaminase), and alkaline phosphate among individuals with a positive CD antibody test. Furthermore, we illustrated more measurements below the sex-specific reference intervals for hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), ferritin, cobalamin and folic acid among individuals with a positive CD antibody test. This study identified several biochemical abnormalities associated with CD antibody positivity among individuals referred to CD antibody testing. The pattern of abnormalities suggested that micronutrient deficiencies were prevalent among CD antibody-positive individuals, confirming malabsorption as a sign of CD. These findings illustrate the possibility of reducing diagnostic delay and underdiagnosis of CD.

PECULIARITIES OF OXIDATIVE STRESS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITH IRON DEFICIENCY ANEMIA

The article presents changes in hemogram and oxidative stress in patients with acute myocardial infarction (AMI) on the background of iron deficiency anemia (IDA). Iron deficiency anemia is an additional factor that contributes to the deepening of myocardial ischemia and deepens the processes of peroxidation and damage to cardiomyocytes, which is an important factor in the unfavorable course, both acute period and recovery processes in myocardial necrosis. In order to study the indicators of the general analysis of blood and functional state of the antioxidant system in patients with acute myocardial infarction with IDA, 36 patients with AMI with IDA were examined, including 39% men and 61% women. The first group consisted of 10 patients with AMI without IDA, the second 26 patients with AMI and IDA of varying severity, the control group consisted of 30 healthy individuals. Hemogram parameters, glutathione system function, oxyproline, arginase and magnesium levels in the blood were determined. It has been established that women with mild and moderate anemia predominate among patients with acute myocardial infarction with concomitant iron deficiency anemia. Among men, half of the patients have severe anemia. In addition to a decrease in Hb levels, patients with ACS with IDA have the following laboratory signs of anemia: a tendency to increase the average concentration of hemoglobin in one erythrocyte, low serum iron levels and an increase in serum transferrin levels. In the presence of IDA in patients with ACS there are changes in the antioxidant system. Anemic syndrome in such patients is accompanied by increased concentrations of glutathione transferase and peroxidase, as well as decreased concentrations of oxyproline.
 Anemia can trigger oxidative stress, and an increase in OS may be associated with changes in cardiac function. Possible cardiovascular effects in patients with comorbid conditions should also be considered.
 Iron deficiency is the most prevalent micronutrient disorder globally. When severe, iron deficiency leads to anemia, which can be deleterious to cardiac function. Given the central role of iron and oxygen in cardiac biology, multiple pathways are expected to be altered in iron-deficiency anemia, and identifying these requires an unbiased approach.
 Oxidative stress is an imbalance between free radicals and antioxidant molecules that can play an important role in the pathogenesis of iron-deficiency anemia (IDA).
 Maintenance of the iron homeostasis is essential for metabolic and physiological processes. Iron plays a critical role in erythropoiesis, is incorporated into erythroblasts and reticulocytes, and has a crucial role in oxygen transport and oxygen storage. Moreover, iron is essential for cardiac and skeletal muscle metabolism, the synthesis and degradation of proteins, lipids, ribonucleic acids, and mitochondrial function.
 Research has now focused on non-traditional cardiovascular risk factors and the roles of iron and iron deficiency (ID) in patients with cardiovascular disease.
 The Iron required for immune response, hormonal balance, and plays an important role in regulating oxidative stress and aerobic metabolism. The myocardial tissue has a mainly aerobic cellular metabolism, which depends of mitochondria's Krebs cycle enzymes that need iron as an essential cofactor. In this regard, there is some evidence that myocardial iron deficiency is highly prevalent in HF and may play a role in the progression of the disease.

The potential use of urinary transferrin, urinary adiponectin, urinary Retinol Binding Protein, and serum zinc alpha 2 glycoprotein levels as novel biomarkers for early diagnosis of diabetic nephropathy: A case-control study

Background and aimsThe level of albuminuria is used to evaluate diabetic nephropathy (DN). However, to detect or predict the early stages of DN, better biomarkers are needed. MethodsThis study is a case-control observational study. 80 Egyptians participated in the study: 60 patients with type 2 diabetes mellitus (T2DM) were divided into three groups (20 patients each), and 20 healthy subjects with matched age and gender were used as controls. Demographic and laboratory data were analyzed. An enzyme-linked immunosorbent assay was used to determine the levels of four biomarkers of DN; urinary adiponectin (ADP), urinary transferrin, serum Zinc Alpha 2 Glycoprotein (ZAG), and urinary Retinol Binding Protein (RBP). ResultsThe levels of DN biomarkers urinary ADP, transferrin, RBP, and serum, ZAG were significantly higher in patients with T2DM than in controls. The ROC curve of the validity of the simultaneous use of all four biomarkers in predicting albuminuria indicates a sensitivity of 90% and a specificity of 90%. The Area Under the Curve (AUC) was 0.948, the 95% confidence interval was 0.998–0.897, and the p-value was 0.001. ConclusionsIn patients with T2DM, urine adiponectin, transferrin, RBP, and serum ZAG concentration may be useful biomarkers in the early diagnosis of DN. A further longitudinal prospective study is required to explore the potential utility of these biomarkers.

Impacts of dietary supplementation with nano-iron and methionine on growth, blood chemistry, liver biomarkers, and tissue histology of heat-stressed broiler chickens

A 28-day study was done to explore the impact of nano-iron alone or combined with methionine on growth, blood chemistry, liver biomarkers, and tissue histology of heat-stressed chicken. One-day-old Ross 308 chicks were randomly allocated to three groups. Each group was divided into three replicates (13 chicks/replicate). The first group was the control one that was fed a basal diet without supplementation (T0). The second group was fed a basal diet with nano-iron 4 mg kg−1 diet (T1). The third group was fed a basal diet with nano-iron 4 mg kg−1 diet plus methionine 4 g kg−1 diet (T2). The results showed that the birds in the control group had significantly (p < 0.05) higher final weights. Also, a partial relief of heat stress adverse effects was observed on growth by T1 compared to T2. The T2 showed a significantly increased (p < 0.05) free iron (Fe) level and transferrin saturation index. Likewise, T2 significantly (p < 0.05) reduced total iron-binding capacity (TIBC) and transferrin level in comparison with T0 and T1. Also, hepatic impairment and inflammatory response were observed in the T2 group when compared to T0 and T1, besides a bad lipid profile. Further, T2 showed raised levels of Fe and ferritin in their hepatic tissues compared to those T1 and T0. A significant increment of thiobarbituric acid reactive and decrement of reduced glutathione levels in the hepatic tissues of T2 and T1 versus T0 levels were recorded. It is concluded that nano-iron at the level of 4 mg kg−1 in this study is highly absorbed, leading to harmful effects. Further investigations are needed to detect the proper supplemental level.

Stacking Machine Learning Algorithms for Biomarker-Based Preoperative Diagnosis of a Pelvic Mass.

Simple SummaryIt is critical for women who are diagnosed with a pelvic mass, or an ovarian cyst to be accurately assessed for their risk of having an ovarian malignancy. Accurate risk stratification for these women will allow for appropriate triage and referral to centers best equipped to treat women diagnosed with ovarian cancer. In this study, machine learning (ML) algorithms were used to determine the optimal combination of biomarkers for prediction of malignancy in women presenting with a pelvic mass. Nine unique ML algorithms were employed to evaluate age, menopausal status, race, and levels of 67 biomarkers from serum, urine, and plasma samples prospectively collected in a cohort 140 women with a variety of pelvic mass diagnoses benign and malignant. A complex statistical algorithm using serum levels of CA125, HE4 and transferrin provided greater than 93% sensitivity and specificity for the preoperative prediction of malignancy in women presenting with a pelvic mass.Objective: To identify the most predictive parameters of ovarian malignancy and develop a machine learning (ML) based algorithm to preoperatively distinguish between a benign and malignant pelvic mass. Methods: Retrospective study of 70 predictive parameters collected from 140 women with a pelvic mass. The women were split into a 3:1 “training” to “testing” dataset. Feature selection was performed using Gini impurity through an embedded random forest model and principal component analysis. Nine unique ML classifiers were assessed across a variety of model-specific hyperparameters using 25 bootstrap resamples of the training data. Model predictions were then combined into an ensemble stack by LASSO regression. The final ensemble stack and individual classifiers were then applied to the testing dataset to assess model performance. Results: Feature selection identified HE4, CA125, and transferrin as three predictive parameters of malignancy. Assessment of the ensemble stack on the testing dataset outperformed all individual ML classifiers in predicting malignancy. The ensemble stack demonstrated an accuracy of 97.1%, a receiver operating characteristic (ROC) area under the curve (AUC) of 0.951, and a sensitivity of 93.3% with a specificity of 100%. Conclusions: Combining the measurement of three distinct biomarkers with the stacking of multiple ML classifiers into an ensemble can provide valuable preoperative diagnostic predictions for patients with a pelvic mass.

Evaluation of Serum Iron and Ferritin Levels as Inflammatory Markers in Calves with Bovine Respiratory Disease Complex

Abstract Iron and ferritin have been used in human medicine for years to reveal the presence of inflammation. However, studies evaluating these parameters, especially in respiratory system diseases, are quite rare in veterinary medicine. We aimed to test the usability of serum Fe and Fe-related parameters [total iron-binding capacity (TIBC), unsaturated iron-binding capacity (UIBC) and transferrin saturation (TS) levels] as inflammatory and diagnostic biomarkers in calves with bovine respiratory disease complex (BRDC). To mark inflammation, some selected acute-phase proteins including serum ferritin and transferrin levels were measured because of their close relationship with iron metabolism. The material of this study consisted of 15 calves, aged 1-3 months with BRDC (Group I) and 10 healthy calves aged 1-3 months (Group II) based on the presence of respiratory clinical findings. Serum Fe, TIBC and TS levels were low and ferritin levels were high in Group I (P ≤ 0.001). The BRDC group was separated into two subgroups based on PCR results, namely Virus+ (n=9) and Virus- (n=6). The calves in the Virus+ group had significantly lower levels of Fe (P=0.001) and significantly higher values of ferritin (P=0.002), compared to the healthy group. On the basis of inter-group comparison and ROC analysis, we concluded that Fe (primarily), ferritin, TIBC and TS levels can be used as inflammatory biomarkers and possible diagnostic markers in the BRDC as useful, practical, inexpensive substitutes. As a suggestion, these parameters which are believed to play a role in the pathogenesis of the disease, can be used as potential prognostic biomarkers in studies involving treatment.

IRE-dependent Regulation of Intestinal Dmt1 Prevails During Chronic Dietary Iron Deficiency but is Dispensable in Conditions of Acute Erythropoietic Stress.

IRE-dependent Regulation of Intestinal Dmt1 Prevails During Chronic Dietary Iron Deficiency but is Dispensable in Conditions of Acute Erythropoietic Stress.

RELATIONSHIP OF CHANGES IN HEMATOLOGICAL AND BIOCHEMICAL INDICATORS OF PERIPHERAL BLOOD WITH THE TRANSFERRIN CONCENTRATION AND CD71+ LYMPHOCYTE COUNT

Transferrin is an essential component of cell growth and metabolic processes that require iron. An increase in the expression of transferrin receptors on lymphocytes ensures their differentiation, maturation and activation of proliferation. It was of interest to study the relationship between the level of transferrin in the peripheral blood and the level of lymphocytes with the receptor to it.&#x0D; Purpose. To determine the nature of changes in hematological and biochemical parameters of peripheral blood based on the concentration of transferrin and the count of lymphocytes expressing the transferrin receptor CD71+.&#x0D; Materials and methods. a survey of 100 people aged 20 to 40 years living in the city of Arkhangelsk was carried out. Leukograms were carried out using a XS-1000i hematology analyzer (Sysmex). Enzyme immunoassay was used to measure cytokine concentrations. CD71 lymphocyte counts were carried out by flow cytometry (Epixs XL). A biochemical analyzer (STAT FAX 3300) was used to measure biochemical blood parameters. Analyses of the number of lymphocytes expressing the transferrin receptor and the concentration of transferrin in the blood serum were performed. The number of CD71+ lymphocytes within the physiological norm (less than 0.3 × 109 cells/L) and those with increased CD71+ levels (more than 0.5 × 109 cells/L) was identified. Within each group, subgroups with a normal and high transferrin content were identified.&#x0D; Results. It was found that an increase in the concentration of transferrin in the blood is associated with a decrease in the circulation of lymphocytes with the CD71+ receptor and a decrease in the coefficient of transferrin saturation with iron. This situation may be associated with an increased risk of secondary immunodeficiency. Against the background of increased concentrations of transferrin and an increase in the circulation of CD71+ lymphocytes, the concentration of lactate increases, which reflects an increase in the processes of tissue hypoxia.&#x0D; Conclusion. High concentrations of transferrin in the peripheral blood against the background of a decrease in the saturation of transferrin with iron and an increase in tissue hypoxia increase the risk of developing chronic inflammatory processes and may be associated with the formation of secondary immunodeficiency.

Efficacy of nutritional support protocol for patients with pressure ulcer: comparison of before and after the protocol

ObjectivesBecause most patients who develop pressure ulcer (PU) are malnourished, additional nutritional support is important for PU improvement. The aim of this study was to investigate the potential benefit of a simple nutritional support protocol in PU improvement. MethodsThis study was a comparative before-and-after study, prospectively performed from May to December 2020. Participants were inpatients of Seoul National University Hospital (SNUH), South Korea. Among the patients who developed PU from May to December 2020, those on enteral nutrition were included in the protocol group. Application of the nutritional support protocol was established in May 2020 in SNUH. Serum levels of prealbumin, transferrin, cholesterol, and zinc were measured initially and 2 and 4 wk after protocol application to evaluate clinical course. A tailored regimen that adjusted the amount of protein and trace elements was provided according to consultation with the nutritional support team. Size and Pressure Ulcer Scale for Healing was evaluated every 2 wk by the same nurse in charge of PU. To validate the efficacy of the protocol, patients who developed PU from May to December 2018, were hospitalized for >2 wk, and who received enteral nutrition were selected as a control group. ResultsSixty-one patients were included in the protocol group and 100 were in the control group. The protocol group had a higher proportion of PU improvement (85.2 versus 50%; P < 0.001), daily protein intake (1.6 ± 3.2 versus 0.9 ± 0.4; P = 0.048), Braden scale (12.9 ± 1.8 versus 12.3 ± 1.8; P = 0.025), and baseline albumin level (3.1 ± 0.5 versus 2.8 ± 0.4; P = 0.001) when compared with the control group. Multivariate analysis showed that implementation of the nutritional support protocol was the most effective factor in improving PU (odds ratio, 0.18; 95% confidence interval, 0.089–0.366; P < 0.001). ConclusionsA simple nutritional support protocol was easy to develop and its application contributed significantly to the recovery of PU.

SARS-CoV-2 Infects Red Blood Cell Progenitors and Dysregulates Hemoglobin and Iron Metabolism

BackgroundSARS-CoV-2 infection causes acute respiratory distress, which may progress to multiorgan failure and death. Severe COVID-19 disease is accompanied by reduced erythrocyte turnover, low hemoglobin levels along with increased total bilirubin and ferritin serum concentrations. Moreover, expansion of erythroid progenitors in peripheral blood together with hypoxia, anemia, and coagulopathies highly correlates with severity and mortality. We demonstrate that SARS-CoV-2 directly infects erythroid precursor cells, impairs hemoglobin homeostasis and aggravates COVID-19 disease.MethodsErythroid precursor cells derived from peripheral CD34+ blood stem cells of healthy donors were infected in vitro with SARS-CoV-2 alpha variant and differentiated into red blood cells (RBCs). Hemoglobin and iron metabolism in hospitalized COVID-19 patients and controls were analyzed in plasma-depleted whole blood samples. Raman trapping spectroscopy rapidly identified diseased cells.ResultsRBC precursors express ACE2 receptor and CD147 at day 5 of differentiation, which makes them susceptible to SARS-CoV-2 infection. qPCR analysis of differentiated RBCs revealed increased HAMP mRNA expression levels, encoding for hepcidin, which inhibits iron uptake. COVID-19 patients showed impaired hemoglobin biosynthesis, enhanced formation of zinc-protoporphyrine IX, heme-CO2, and CO-hemoglobin as well as degradation of Fe-heme. Moreover, significant iron dysmetablolism with high serum ferritin and low serum iron and transferrin levels occurred, explaining disturbances of oxygen-binding capacity in severely ill COVID-19 patients.ConclusionsOur data identify RBC precursors as a direct target of SARS-CoV-2 and suggest that SARS-CoV-2 induced dysregulation in hemoglobin- and iron-metabolism contributes to the severe systemic course of COVID-19. This opens the door for new diagnostic and therapeutic strategies.Graphical

The Effects of Intravenous Iron Infusion on Preoperative Hemoglobin Concentration in Iron Deficiency Anemia: Retrospective Observational Study.

BackgroundAn iron infusion pathway using Ferrinject (ferric carboxymaltose) was implemented at Southend University Hospital for preoperative surgical patients with iron deficiency anemia undergoing major surgery. This was based on a treatment algorithm proposed by Munting and colleagues according to the international consensus statement on perioperative management of anemia and the UK National Institute for Health and Care Excellence (NICE) guidelines. These guidelines state that intravenous iron is indicated when oral iron is poorly tolerated or ineffective, there is insufficient time to surgery, or due to a functional iron deficiency.ObjectiveThe objective of this study was to evaluate the change in adult hemoglobin (Hb) concentration (g/L) after Ferrinject infusion at the time of surgery.MethodsData were retrospectively collected on all surgical patients that received an iron infusion preoperatively for iron deficiency anemia from July 2019 to April 2020. Nonsurgical, obstetric, and pediatric patients, and those without a postinfusion Hb level measurement were excluded. Data collected included the Hb, ferritin, and transferrin levels pre and postinfusion; correct dose of intravenous iron received; and any adverse reactions noted.ResultsThirty-two surgical patients with iron deficiency anemia received intravenous iron between July 2019 and April 2020 prior to surgery. The average pre and post iron infusion Hb concentration across the cohort was 97 g/L and 114 g/L, respectively (18% increase; P=.001). Two (6%) patients had a posttransfusion Hb level ≥130 g/L prior to surgery after infusion. Nine patients had both a pre and postinfusion ferritin level recorded, which showed an increase from 12 ng/mL preinfusion to 94 ng/mL postinfusion (P=.02). Twenty-three (72%) patients did not receive the full dose of intravenous iron based on their Hb level and weight. Twenty-four (75%) patients received an iron infusion >2 weeks prior to surgery and the other 8 (25%) patients received the infusion <2 weeks before their surgery. There was an average increase in Hb of 22% (21 g/L, 95% CI 13-28) and 5% (5 g/L, 95% CI 1-10), respectively, across the two groups (P=.03). There were no documented adverse reactions to intravenous iron.ConclusionsIntravenous iron is an effective intervention to improve the Hb concentration in patients with iron deficiency anemia despite the majority of patients not receiving the full dose based on their baseline Hb level and weight. Increasing the interval time between infusion and surgery was associated with a greater increase in Hb, with only a minimal increase observed if given less than 2 weeks prior to surgery.

Efficacy of early enteral nutrition versus total parenteral nutrition for patients with gastric cancer complicated with diabetes mellitus: A systematic review and meta-analysis.

This study aimed to synthesise available data and evaluate the clinical evidence regarding the effect of early enteral nutrition versus total parenteral nutrition on nutritional status and blood glucose in patients with gastric cancer complicated with diabetes mellitus after gastrectomy. This systematic review and meta-analysis was designed, conducted and reported following the PRISMA guideline. We performed searches in PubMed, Embase, Medline, Web of Science, Cochrane Library, Chinese Biomedicine Literature Database, Chinese Scientific Journal Database, Chinese National Knowledge Infrastructure and Wanfang Database. The study designs were randomised controlled trials, quasi-randomised controlled trials, and controlled clinical trials. The trials compared early enteral nutrition (experimental group) with total parenteral nutrition (control group) in patients with gastric cancer complicated with diabetes mellitus after gastrectomy. The risk of bias was assessed using the Cochrane risk of bias tool. A total of 19 trials (1255 patients) were included. Meta-analysis showed a significantly shorter length of hospital stay (days; mean difference-5.07, 95% confidence interval [CI] [-6.28, -3.86], p < 0.00001) and a lower post-operative complications rate (%; odds ratio0.29, 95% CI [0.16, 0.50], p < 0.0001) in the early enteral nutrition group than in the total parenteral nutrition group. Compared with the total parenteral nutrition group, the early enteral nutrition group had lower blood glucose fluctuation values (mmol/L; mean difference-2.03, 95% CI [-2.44, -1.61], p < 0.00001), lower levels of glycosylated haemoglobin (%; mean difference -0.62, 95% CI [-1.22, -0.03], p=0.04), higher levels of prealbumin (g/L; p=0.002), transferrin (g/L; p=0.002), total protein (g/L; p=0.001) and haemoglobin (g/L; p=0.005). Early enteral nutrition may maintain stable blood glucose levels and improve nutritional status, leading to better therapeutic effectiveness in gastric cancer complicated with diabetes mellitus patients.

Effect of Early Enteral Nutrition Support Combined with Chemotherapy on Related Complications and Immune Function of Patients after Radical Gastrectomy.

Objective The purpose was to analyze the effect of early enteral nutrition (EEN) support combined with chemotherapy on related complications and immune function in patients after radical gastrectomy. Methods 80 patients with gastric cancer treated in our hospital from March 2019 to March 2020 were selected as the research objects and divided into the experimental group and control group according to the random number table, with 40 cases in each group. The control group received chemotherapy only after surgery, while the experimental group received EEN on this basis. The total protein (TP), transferrin (TF), albumin (ALB), immune cells, and other indexes were measured in the two groups before and after treatment to analyze the effect of different treatment methods on the complications and immune function of patients after radical gastrectomy. Results There were no significant differences in gender ratio, average age, average BMI, pathological types, disease staging, and residence between the two groups (P > 0.05). The exhaust recovery time, total gastric tube drainage, fluid intake time, and hospitalization time in the experimental group were significantly lower than those in the control group (P < 0.05). There were no significant differences in the TP, TF, and ALB levels between the two groups before treatment (P > 0.05), and the TP, TF, and ALB levels in the experimental group were significantly higher than those in the control group after treatment (P < 0.05). The CD4+/CD8+, CD3+, and CD4+ levels in the experimental group after treatment were significantly higher than those in the control group (P < 0.001). After treatment, the growth hormone levels in both groups significantly increased (P < 0.001), and the growth hormone level in the experimental group was significantly higher than that in the control group (P < 0.001). There was no significant difference in the KPS scores between the two groups before treatment (P > 0.05), and the KPS score in the experimental group was significantly higher than that in the control group after treatment (P < 0.001). The incidence of postoperative complications in the experimental group was significantly lower than that in the control group (P < 0.05). Conclusion EEN combined with chemotherapy is a reliable method to improve the immune function of patients after radical gastrectomy for gastric cancer, which plays an important role in improving the physical state of patients and reducing the incidence of complications. Therefore, its further research will help to establish a better treatment plan for such patients.

Threshold of Serum Ferritin to Discriminate against Those at Greater Risk of Platelet Increase during Treatment with Hypoxia-Inducible Factor Prolyl Hydroxylase Domain Inhibitor

Introduction: Hypoxia-inducible factor prolyl hydroxylase domain inhibitors (HIF-PHI) are a new treatment for renal anemia. HIF-PHI is believed to increase iron usage to improve availability of iron for erythropoiesis. Therefore, there is concern that HIF-PHI might be prone to iron deficiency and that thrombosis might be induced by increased platelet and transferrin levels due to this iron deficiency. Methods: Relationship of iron-related factors with platelet count (PLT) and total iron-binding capacity (TIBC; which reflects the transferrin level) were examined in 29 patients who were treated with darbepoetin alfa (DA) and then switched to roxadustat (Rox). To determine how changes in PLT and TIBC related to changes in iron-related factors, univariable and multivariable linear regression models were applied. To examine what iron-related factors on Day 0 influenced change in PLT, we used receiver operating characteristic (ROC) curves and logistic regression analysis for a rate of change in PLT ≤0% as the endpoint. Logistic regression analysis was performed with the reference group having serum ferritin (s-ft) or Transferrin saturation below the corresponding cutoff value (low vs. high). Results: Multivariable analysis showed significant positive correlations between the rate of change in PLT and the change in s-ft and red blood cells (RBC) count {β-coefficients; 0.40 [95% confidence interval (CI): 0.17–0.62], p = 0.001} (β-coefficients; 30.45 [95% CI: 10.90–50.00], p = 0.004). The rate of change in TIBC was significantly positively correlated with only the change in RBC count. The ROC showed a significant cutoff value for s-ft of 77.2 ng/mL (sensitivity 63.6%, specificity 83.3%, area under the curve 0.76, 95% CI 0.55–0.96). Multivariable logistic regression also showed that only high s-ft was significantly elevated (9.46, 95% CI 1.42–63.30, p = 0.020). Conclusions: This study showed that changes in PLT were correlated with s-ft and amount of hematopoiesis. This suggests that an increase in PLT due to iron levels is less likely when s-ft is 77.2 ng/mL or higher at the time of switching from DA to Rox. In contrast, TIBC was only related to hematopoiesis in these patients. Control of s-ft before initiation of HIF-PHI treatment and gradual hematopoiesis might reduce the risk of thrombosis when switching from erythropoiesis-stimulating agents to HIF-PHI.

The Effect of Combination Use of Hemodialysis and Hemoperfusion on Microinflammation in Elderly Patients with Maintenance Hemodialysis

Background: Patients with maintenance hemodialysis (MHD) generally have a microinflammatory state. The aim of this study was to investigate the effects of hemodialysis (HD) combined with hemoperfusion (HP) on microinflammatory state in elderly patients with MHD. Methods: One hundred and fifty elderly patients with MHD were randomly divided into the control group and the observation group. The control group received simple HD treatment, and the observation group received combined HD + HP treatment on the basis of the control group. After 6 months of continuous treatment, the patients were evaluated to compare the quality of life, inflammation, adverse reactions, and nutritional indicators in the 2 groups before and after treatment. Results: There was no significant difference in the quality of life between the 2 groups before treatment. After treatment, the scores of psychological aspects, physiological aspects, social aspects, environmental aspects, and independent ability in the observation group were higher than those in the control group, with statistical significance (p < 0.05). There was no statistical significance in the level of inflammation between 2 groups before treatment. After treatment, the levels of hs-CRP, Hcy, IL-6, and TNF-α in the observation group were significantly lower than those in the control group, with statistical significance (p < 0.05). The incidence of dry mouth, skin reaction, neuritis, and subcutaneous tissue fibrosis in the observation group was lower than that in the control group, with statistical significance (p < 0.05). There was no statistical significance in nutritional level indexes between 2 groups before treatment (p₁ > 0.05). After treatment, the levels of hemoglobin, total protein, albumin, and transferrin in the observation group were significantly higher than those in the control group, with statistical significance (p < 0.05). Conclusion: The clinical effect of HD combined with HP in elderly MHD patients is significant, which can effectively reduce the incidence of adverse reactions and inflammation in the patients and improve the quality of life and nutritional indicators of the patients.

Iron Deficiency in Chronic Heart Failure Patients at the University Teaching Hospital in Lusaka, Zambia

Background: Iron plays a key role in oxygen uptake, transport, and storage, as well as oxidative metabolism in the muscle including myocardium and is essential for the formation of haemoglobin, myoglobin, cytochromes, cytochrome oxidase, peroxidase, and catalase. Iron deficiency (ID) often develop in chronic heart failure (CHF) patients due to depletion of iron stores, iron malabsorption and/or reduced availability of iron recycled in the reticuloendothelial system. Indeed iron content and transferrin receptor levels have been reported to be decreased in the myocardium of patients with ID. A cardinal manifestation of heart failure (both heart failure with reduced ejection fraction. HFrEF and heart failure with preserved ejection fraction, HFpEF) is impaired exercise capacity that is exaggerated in iron deficient patients. This easy fatigability is said to be a result of the reduced oxygen transport that is associated with the ID. ID leads to mitochondria and sarcomere dysfunction which reduces left ventricular functioning and hence reducing cardiac output. Reduced peak oxygen uptake has also been reported in patients withHFrEF.&#x0D; Objective: To determine iron status of CHF patients at University Teaching Hospital (UTH) in Lusaka.&#x0D; Methods: The study was conducted at UTH from May to August 2019. Using purposive sampling, data was collected from patients with CHF of New York Heart Association (NYHA) functional class II to IV. Information obtained included sex, age, height, weight and ejection fraction (reduced ifless than 45%). From the blood samples collected, serum iron levels, transferrin levels and ferritin concentration tests were done. The chi square test and logistic regression were used to analyze iron status in CHF patients.&#x0D; Results: Forty (40) patients were enrolled, 18 male and 22 female. The average age was 45.5 (19 to 60). 24 patients (60%) had (HFrEF) and 16 patients (40%) had (HFpEF). 22 patients (55%) had transferrin saturation of less than 20%, while 8 (20%) had ferritin concentration of less than l00ng/ml. Based on both factors, a total of22(55%) patients were iron deficient. Iron deficiency was negatively associated withHFrEF (p = 0.015).&#x0D; Conclusion: More than 55% of the participants in this study were iron deficient. However, ID may not be the primary cause of myocardial dysfunction as patients with HFrEF were less likely to be iron deficient. However, correction of ID in CHF patients in other studies has been reported to have clinical benefits. The observations of this study require further triangulation especially that the sample size was rather small.

Iron Deficiency in Chronic Heart Failure Patients at the University Teaching Hospital in Lusaka, Zambia

Background: Iron plays a key role in oxygen uptake, transport, and storage, as well as oxidative metabolism in the muscle including myocardium and is essential for the formation of haemoglobin, myoglobin, cytochromes, cytochrome oxidase, peroxidase, and catalase. Iron deficiency (ID) often develop in chronic heart failure (CHF) patients due to depletion of iron stores, iron malabsorption and/or reduced availability of iron recycled in the reticuloendothelial system. Indeed iron content and transferrin receptor levels have been reported to be decreased in the myocardium of patients with ID. A cardinal manifestation of heart failure (both heart failure with reduced ejection fraction. HFrEF and heart failure with preserved ejection fraction, HFpEF) is impaired exercise capacity that is exaggerated in iron deficient patients. This easy fatigability is said to be a result of the reduced oxygen transport that is associated with the ID. ID leads to mitochondria and sarcomere dysfunction which reduces left ventricular functioning and hence reducing cardiac output. Reduced peak oxygen uptake has also been reported in patients withHFrEF.&#x0D; Objective: To determine iron status of CHF patients at University Teaching Hospital (UTH) in Lusaka.&#x0D; Methods: The study was conducted at UTH from May to August 2019. Using purposive sampling, data was collected from patients with CHF of New York Heart Association (NYHA) functional class II to IV. Information obtained included sex, age, height, weight and ejection fraction (reduced ifless than 45%). From the blood samples collected, serum iron levels, transferrin levels and ferritin concentration tests were done. The chi square test and logistic regression were used to analyze iron status in CHF patients.&#x0D; Results: Forty (40) patients were enrolled, 18 male and 22 female. The average age was 45.5 (19 to 60). 24 patients (60%) had (HFrEF) and 16 patients (40%) had (HFpEF). 22 patients (55%) had transferrin saturation of less than 20%, while 8 (20%) had ferritin concentration of less than l00ng/ml. Based on both factors, a total of22(55%) patients were iron deficient. Iron deficiency was negatively associated withHFrEF (p = 0.015).&#x0D; Conclusion: More than 55% of the participants in this study were iron deficient. However, ID may not be the primary cause of myocardial dysfunction as patients with HFrEF were less likely to be iron deficient. However, correction of ID in CHF patients in other studies has been reported to have clinical benefits. The observations of this study require further triangulation especially that the sample size was rather small.

Cardiometabolic risk profile in non-obese children with obstructive sleep apnea syndrome.

Taken together, these findings suggested a worse cardiometabolic profile in non-obese children with OSAS. Given the pivotal pathogenic role of inflammation both for hypoxiemia and metabolic derangements, therapeutic strategies for OSAS might also counteract the increased cardiometabolic risk of these patients, by improving their long-term quality of life. • Pediatric OSAS has shown a close relationship with obesity and its cardiometabolic comorbidities. • Inflammation represents the hallmark of both obesity and OSAS. • Non obese children with OSAS presented with a worse cardiometabolic risk profile. • OSAS treatment might serve as an effective approach also for the increased cardiometabolic risk of these children.