Establishment of a stable sampling method to assay mercaptoalbumin/non-mercaptoalbumin and reference ranges.

Oxidative stress is reportedly associated with many diseases such as cancer, arteriosclerosis, diabetes and aging, but no practical biomarkers are currently available in actual clinical practice. Human mercaptoalbumin (HMA) and human non-mercaptoalbumin (HNA) are expected to become markers of oxidative stress, but the stability of HMA/HNA has been problematic. We investigated the conditions for stabilizing HMA/HNA and found that HMA/HNA was stable at room temperature for 25 h if whole blood samples were mixed with a citrate buffer so that the citric acid concentration after mixing was 70 mM or higher and the pH of the added buffer was less than pH 6.0. Whole blood samples were then collected under the above conditions, and the reference range for HNA was set at 21.8% ±â€¯7.4% (HMA, 78.2% ±â€¯7.4%) based on samples from 65 volunteers (28 males and 37 females; average age, 55.0 ±â€¯13.8 years). The clinical usefulness of HMA/HNA as an oxidative stress marker should be clarified for specific pathological conditions using the previously reported, highly accurate measurement method under the conditions required for HMA/HNA stability.

Evaluation of human nonmercaptalbumin as a marker for oxidative stress and its association with various parameters in blood.

Oxidative status of albumin was not a useful biomarker for oxidative stress in practical use due to time-consuming measuring method. We evaluated oxidized, human nonmercaptalbumin measured more quickly than ever by a novel method using anion-exchange HPLC. In 60 subjects taking a general health examination, mean serum human nonmercaptalbumin level was 25.1 ± 3.0% with no gender difference but positive correlation with age. There were no links between human nonmercaptalbumin and C-reactive protein, γ-glutamyltransferase or iron, reportedly associated with oxidative stress. Human nonmercaptalbumin correlated with systolic blood pressure, pulse pressure and body mass index among physical findings. Positive correlations were observed between human nonmercaptalbumin and AST, LDH, BUN, or creatinine, suggesting that oxidative stress may link with liver injury and renal function. Human nonmercaptalbumin correlated with uric acid in female but not in male, suggesting that higher uric acid levels may be associated with increased oxidative stress only in female. As another gender difference, white blood cell counts correlated with human nonmercaptalbumin in female, while the parameters for red blood cells correlated with human nonmercaptalbumin in male. In conclusion, serum human nonmercaptalbumin level in healthy subjects was approximately 25% as previously reported. Oxidative stress may be closely associated with hypertension, obesity, liver injury, renal function, and anemia.

[A 94-year-old woman with nontuberculous mycobacterium who developed small intestinal intussusception associated with a percutaneous endoscopic jejunostomy tube].

We report a 94-year-old woman, who underwent percutaneous endoscopic Jejunostomy (PEJ) tube feeding for enteral nutrition, developed the intussusception of the small intestine. She suffered from nontuberculous mycobacterium (NTM), and her lung inflammation deteriorated due to aspiration pneumonia and malnutrition. Because of old age, dysphagia, esophageal hiatus hernia, gastro-esophageal reflux and her bedridden condition due to severe osteoporosis, oral nutritional supplementation is nearly impossible. To reduce the aspiration risk, we chose PEJ instead of percutaneous endoscopic gastrostomy (PEG) as the route of tube feeding. Six months after the placement of a PEJ tube, aspiration pneumonia was diagnosed and she was readmitted to our hospital. During hospitalization, she had sudden diarrhea, vomiting, and lower abdominal pain. Abdominal CT scan and radiographs using contrast medium showed small intestinal intussusception related to the PEJ tube. We observed the clinical course without performing surgery, pulling it back towards the stomach and placing an ileus tube, because the small intestine was not completely obstructed. Two months later, although she suffered from aspiration pneumonia once more, she remained in a stable condition without further intervention so that she could move to aother hospital. Recently PEJ has been expected to prevent aspiration pneumonia, but we believe that it can be a risk factor for intussusception. Although the PEJ can be a good parenteral nutrition route for frail elderly with dysphagia, we need to consider possible complications including intussusception.