Relationship of iron overload to bone mass density and bone turnover in postmenopausal women with fragility fractures of the hip / 中华外科杂志

<p><b>OBJECTIVE</b>To study relationships between serum ferritin and bone metabolism in patients with hip fragility fractures.</p><p><b>METHODS</b>This cross-sectional study included 76 postmenopausal women with hip fracture from Feburary 2011 to June 2012. The mean age of the women was (73 ± 10) years (range, 55-93 years) and the mean duration of menstruation was (22 ± 10)years (range, 5-50 years). Serum concentrations of ferritin, transferrin, alkaline phosphatase (ALP), amino-terminal extension peptide of type I collagen (P1NP), C-terminal telopeptides of type I collagen (β-CTX)and femoral and lumbar bone mineral density by dual-energy X-ray absorptiometry were measured. Bone metabolism was compared between normal and elevated ferritin groups with t-test, Pearson linear, partial correlation and multiple regression analysis examined associations between iron- and bone-related markers.</p><p><b>RESULTS</b>Serum ferritin concentration raised to (230 ± 146)µg/L, transferrin concentration reduced to (1.89 ± 0.33)g/L. P1NP concentration raised to (61 ± 32) ng/L when the concentration of serum ALP and β-CTX were in the normal range. T-scores for bone mineral density in the femoral neck (-2.0 ± 1.1) and lumbar (-2.1 ± 1.2) were below the normal ranges(-1.0-1.0). The subjects were divided into two groups according to serum ferritin concentration, normal group(serum ferritin concentration ≤ 150 µg/L, n = 25) and elevated group(serum ferritin concentration > 150 µg/L, n = 51). Patients of elevated group had lower bone mineral density in femoral neck and lumbar than normal group(t = 3.13,2.89, P < 0.01), and higher P1NP, β-CTX concentration (t = -2.38, -3.59, P < 0.05) . In partial correlation analysis adjusted for confounders, serum ferritin concentration was correlated negatively with bone mineral density in both femoral neck and lumbar (r = -0.335,-0.295, P < 0.05), and positively with P1NP and β-CTX (r = 0.467,0.414, P < 0.05), but not correlated with ALP (r = 0.188, P > 0.05). Transferrin concentration tended to be correlated positively with bone mineral density in both femoral neck and lumbar (r = 0.444, 0.262, P < 0.05) and negatively with ALP, P1NP and β-CTX(r = -0.326,-0.285,-0.278, P < 0.05).</p><p><b>CONCLUSIONS</b>Iron overload has a high prevalence in postmenopausal women with fragility fracture. Increased iron stores, which might lead to bone loss and lower bone mineral density by enhancing the activity of bone turnover, could be an independent factor to take effects on bone metabolism on postmenopausal women.</p>

Clinical study of unrelated umbilical cord blood transplantation in 32 children patients / 中国实验血液学杂志

To evaluate the clinical efficacy of unrelated umbilical cord blood transplantation (UCBT) on the treatment of children with hematologic malignancies and nonmalignancies, between August 2001 and June 2004, 32 patients were transplanted by using unrelated umbilical cord blood supplied by Shandong Umbilical Cord Blood Bank. Out of them, 13 patients suffered from ALL, 9 from AML, 3 from AA, 3 from HAL, 2 from CML and 2 from NHL. The median age was 8 years (range 2-15), the median weight was 31.5 kg (range 14-55). All patients received ablative conditioning regiment according to the disease and the disease status. Conditioning regiments Cy/TBI were used for 4 patients and Bu/Cy for 21 patients, other for 7 patients. All patients received cyclosporin A and/or methotrexate for GVHD prophylaxis. The mean number of infused nuclear cells were 5.57 (2.16-12.3) x 10(7)/kg, CD34+ cells 1.78 (0.85-5.59) x 10(5). All of UCB units were tested for HLA-A, -B, and DRB1 using low and high resolution techniques. There were HLA-matched in 10, 5/6 in 16 and 4/6 in 6. The results showed that 20 out of 32 patients achieved complete engraftment. Median time of neutrophil > or = 0.5 x 10(9)/L, and platelet > or = 20 x 10(9)/L were 17 (9-38) and 42 (18-102) days respectively. The incidence of aGVHD II-IV and aGVHD III-IV were 35% and 15% respectively. After a median follow-up of 18 months (1.5-28.5), overall survival rate at one year was 59.4%, overall survival rate at two years was 40.6%. It is suggested that UCBT is promising for children patients who is lack of matched bone marrow donors.

Prediction of acute GVHD after umbilical cord blood transplantation by HLA three-dimensional structure matching / 中国实验血液学杂志

To explore a method of predicting acute graft versus host disease (aGVHD) after unrelated cord blood transplantation (UCBT), the HLA-A, -B, -DRB1 molecular three-dimensional structures in 25 patients with blood disorder who underwent UCBT and their donors were modeled by using molecular modeling technique. First, full amino acid sequences of each HLA antigen from HLA data banks were loaded down, and then amino acid sequence of extracellular antigen binding region was chosen. Third step, SPDBV software of SWISS-MODEL server was used to modeling the three-dimensional structures of each different allele of HLA-A, -B and -DRB1 between patients and donors and the parameter "root mean square deviation" (RMSD) was used to indicate the structure differences. Last, RMSD of each different HLA allele of each donor-patient pair were added together to get total RMSD. The 25 patients were divided into 3 groups: the first group did not develop aGVHD; the second group developed aGVHD graded I-II and the third group developed aGVHD graded III-IV. The results showed that in the 25 patients divided into three groups, 8 patients in the first group did not develop aGVHD (32%); 13 patients in the second group developed grade I-II of aGVHD (52%) and 4 patients in the third group developed aGVHD III-IV (16%). The total RMSDs of each group were 0.24 +/- 0.15, 0.25 +/- 0.14 and 0.47 +/- 0.22 respectively. The total RMSD of the third group was significantly higher than that of the other two groups. In conclusion, utilization of modeling HLA molecular three-dimension can predict the severe aGVHD after UCBT quickly, simply and accurately. It provides scientific basis in choosing a optimal cord blood donor to avoid severe aGVHD for physicians and the cord blood banks. And it is instructive too to direct the application of immunosuppressive agents after transplantation in clinic.

Distribution features of HLA-DRB1 allele frequencies in normal cord blood donors of 3 438 Shandong Hans / 中国实验血液学杂志

The objective of the study was to research the distribution features of HLA-DRB1 alleles in Shandong Hans' population and explore the possibility of finding the cord blood donor of HLA-DR matched to perform the stem cell transplantation for more patients from larger region of China and even other areas in the world. The subjects of the study were drawn from 3 438 Shandong Hans donors in Shandong Umbilical Cord Blood Bank and were tested by PCR-SSP technique for HLA-DR low resolution typing. The result indicated that the most prevalent five alleles of HLA-DRB1 locus were DRB1 * 15 (0.1817), * 07 (0.1369), * 09 (0.1221), * 04 (0.1084) and * 12 (0.1038). The DR18 has the lowest gene frequency 0.0003, while DRB1 * 10, * 16 and * 01 showed lower gene frequencies (GF), which GF were 0.0151, 0.0262, and 0.0322 respectively. As compared the HLA-DRB1 GF of Shandong Hans with those of other Han Chinese and other ethnic populations, there were unique distributed features of DRB1 alleles among various races populations, and those among the studied population groups from various regions with the same race origin. The difference from various regions in the same race was less than that among different races. In conclusion, a patient of Han Chinese is easier to search a DR-matched cord blood donor in Shandong Umbilical Cord Blood Bank, especially from northern Hans. No DRB1 allele is unique to single racial group and majority of DRB1 low-resolution phenotypes are common to all studied groups. It is reasonable for some patients from other races including Caucasian and Japanese to receive a transplant of cord blood stem cell matched with HLA-DR in Shandong Umbilical Cord Blood Bank.