Hepcidin may play a critical role in the response of patients with anemia to iron and erythropoiesis-stimulating agent therapy. To evaluate the factors affecting serum hepcidin levels and their relation to other indexes of anemia, iron metabolism and inflammation, as well as the dose of erythropoietin, we studied 80 maintenance hemodialysis (MHD) patients treated with recombinant human erythropoietin and their serum hepcidin levels were specifically measured by using a competitive enzyme-linked immunosorbent assay. In linear regression analysis, ferritin was found to be a significant predictor of hepcidin levels in all the study patients. In the absence of apparent inflammation, serum hepcidin levels correlated exclusively with ferritin levels in MHD patients, and it was also an independent marker of inflammation as highly sensitive C-reactive protein.

Fibroblast growth factor 23 (FGF-23) is a recently discovered regulator of phosphate and mineral metabolism and has been associated with both progression of CKD and mortality in dialysis patients. To evaluate the association between serum FGF-23 levels and echocardiographic measurements in long-term HD (HD) patients without cardiac symptoms, we studied 90 consecutive patients treated in a single HD center (51 males, 39 females; mean age 41.5 ± 14.2 years, mean HD duration 71.2 ± 14.2 months). Comprehensive echocardiography was performed after HD and blood samples were obtained before HD. The serum FGF-23 level in dialysis patients was 95.7 ± 88.4 pg/mL. In univariate analysis, serum calcium levels (r = 0.33, P <0.05), serum creatinine (r = 0.34, P <0.05), serum albumin (r = 0.35, P <0.05) and left ventricular mass index (LVMI) (r = 0.33, P <0.001) were correlated weakly with the FGF-23 levels. Neither s. phosphorus nor calcium x phosphorus product correlated with FGF-23. In univariate regression analysis, only LVMI [β = 0.42, P <0.05, confidence interval (CI) 0.3-4.3], serum calcium (β= 0.87, P <0.001, CI 0.8-7.3), serum albumin (β= 0.87, P < 0.001, CI 0.8-7.3) and serum creatinine (β= 0.67, P <0.05, CI 0.5-6.5) significantly correlated with FGF-23. FGF-23 was identified as a factor that is weakly associated with LVMI. Thus, FGF-23 alone may not be a parameter that can be used for evaluation of the cardiac status in HD patients.

Introduction Extended endoscopic approaches to suprasellarmeningiomas have been proposed recently as a viable option or alternative to traditional microsurgical transcranial approaches. Endoscopic approaches have been presented as a minimally invasive route to such formidable lesions of the skull base, obviating the need of large craniotomies & brain retraction. Endoscopic approaches were shown to provide comparable rates of gross total resection, in selected cases, better visual outcomes than transcranial approaches, on the other hand high CSF leak rate was a major cornerstone for criticism for endoscopic approaches. Objective Assessing the feasibility & safety of extended endoscopic approaches to suprasellarmeningiomas. Methods Interventional prospective study including 23 patients harboring suprasellarmeningiomas assessed for gross total resection, visual outcome, CSF leak rates & other surgical morbidities. Results 23 patients 18 females (78%) & 5 males (22%); mean age was 59 years with range of 37-86 years. Tuberculumsellae meningioma compromised 15 cases (65%), planumsphenoidale 2 cases (9%) &planum/tuberculum 6 patients (26%) of the studied patients. Gross total resection wash achieved in 17 patients (74%).Vision was improved in 80% of patients presenting with visual symptoms & was stable in 20% post-operatively. All patients (100%) without pre-operative visual deficit were able to preserve their pre-operative visual state. CSF leak was the most common compilation occurring in 4 patients (17%). Lumbar drainage was sufficient to control the CSF leak in 2 patients while the other 2 patients required surgical repair of the skull base reconstruct. Transient DI was encountered in 2 patients (9%). Conclusion Extended endoscopic approach to suprasellarmeningiomas is safe & feasible. Comparable outcomes regarding gross total resection with superior visual outcome can be attained in carefully selected patients. CSF leak is major limitation of endoscopic approaches, however the introduction of vascularized naso-septal flaps helped overcome this issue.