Introduction Folate deficiency is commonly reported in beta-thalassemia. Individuals heterozygous for beta-thalassemia may have higher folate requirements than normal individuals. Objectives: To document the concentration of serum total folate and its forms in beta-thalassemia heterozygote users (beta-TmU) and nonusers (beta-TmN) of 5 mg folic acid/d; to determine whether folic acid (FA) consumption from fortified foods allows beta-Tm patients, who do not take FA supplements, to meet their dietary folate requirements; and to investigate the association between higher serum unmetabolized folic acid (UMFA) and inflammatory cytokine concentrations. Methods Serum total folate and forms were measured in 42 beta-Tm (13 beta-TmU and 29 beta-TmN) and 84 healthy controls. The mononuclear leucocyte mRNA expression of relevant genes and their products and hematological profiles were determined. Results beta-TmU had higher serum total folate, 5-methyltetrahydrofolate, UMFA, and tetrahydrofolate (THF) compared with beta-TmN. The beta-TmN had lower serum total folate and THF than controls. Plasma total homocysteine (tHcy) was lower in beta-TmU compared with both beta-TmN and controls, while beta-TmN had higher tHcy than controls. beta-TmU had higher IL-8 than their controls while beta-TmN had higher IL-6 and IL-8 than their controls. beta-TmU have higher levels of serum total folate, 5- methyltetrahydrofolate, UMFA, and THF than controls. There was no association between UMFA concentrations and cytokine levels. Conclusions Mandatory flour fortification with FA in Brazil may be insufficient for beta-TmN, since they have higher tHcy and lower serum total folate than controls. Furthermore, beta-TmN have higher IL-6 levels than beta-TmU. UMFA was not associated with inflammatory cytokine levels.

Purpose: Radical nephrectomy (RN) is the standard surgical type for pathological stage T3a (pT3a) renal cell carcinoma (RCC). Recently, some studies have suggested equivalence between partial nephrectomy (PN) and RN for oncologic control and have shown the benefits of PN for better renal function. We conducted this meta-analysis to assess oncologic outcomes, perioperative outcomes and renal function between two groups among patients with pT3a RCC. Materials and methods: PubMed, Scopus, Web of Science, Science Direct, Ovid MEDLINE, The Cochrane Library, Embase and Google Scholar were searched for eligible articles. The endpoints of the final analysis included overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), surgical complications, operative time, estimated blood loss (EBL), serum creatinine and estimated glomerular filtration rate (eGFR). Results: Twelve studies of moderate to high quality, including 14.152 patients, were examined. PN showed superiority for renal functional preservation, providing higher eGFR (WMD=12.48mL/min; 95%CI: 10.28 to 14.67; P <0.00001) and lower serum creatinine (WMD=-0.31mg/dL; 95%CI: -0.40 to -0.21; P <0.00001). There were no significant differences between PN and RN regarding operative time, EBL, surgical complications, OS, RFS and CSS. Despite inherent selection bias, most pooled estimates were consistent in sensitivity analysis and subgroup analysis. More positive margins were found in the PN group (RR=2.42; 95%CI: 1.25-4.68; P=0.009). Conclusions: PN may be more suitable for treating pT3a RCC than RN because it provides a similar survival time (OS or RFS) and superior renal function. Nevertheless, this result is still disputed, and more high-quality studies are required.