vitamin-b-12 and Fibromyalgia

To observe the effectiveness of digital subtraction angiography (DSA) assisted musculoskeletal flap transplantation in the treatment of osteonecrosis of the femoral head (ONFH).. The clinical data of 15 patients with 15 hips of ONFH admitted between January 2016 and December 2019 were retrospectively analyzed. All patients were male, aged 20-45 years, with an average age of 31.6 years. There were hormone type in 9 cases and alcohol type in 6 cases. The disease duration ranged from 15 days to 3 years, with an average of 8 months. The Association Research Circulation Osseous (ARCO) staging: 4 hips in stage Ⅱ, 11 hips in stage Ⅲ. The preoperative visual analogue scale (VAS) score was 6.2±0.2, and the Harris score of the hip joint was 57.3±1.3. Preoperative DSA examination of the femoral head was performed to determine the location of vascular lesions of the femoral head. According to the results of the angiography, the surgical selection of the musculoskeletal flap was guided. For the patients with both superior and inferior retinaculum vessels developed, simple core decompression was performed. For the patients with superior retinaculum vessels developed but inferior retinaculum vessels not developed, anterolateral tensor fasciae flap was used. For the patients whose superior retinaculum did not develop and the inferior retinaculum developed, posterolateral quadratus femoris flap was used. The fibular flap with anastomotic vessels was used in the patients whose superior and inferior retinaculum vessels were not developed.. For patients with ONFH who need musculoskeletal flap transplantation, preoperative DSA of femoral head can determine the location of vascular lesions of femoral head, so as to guide the selection of musculoskeletal flap transplantation, which is of great significance for hip-conserving surgery.. 观察数字减影血管造影（digital subtraction angiography，DSA）技术辅助肌骨瓣移植治疗股骨头坏死（osteonecrosis of the femoral head，ONFH）的临床疗效。.. 回顾分析 2016 年 1 月—2019 年 12 月收治的 15 例 15 髋 ONFH 患者临床资料。患者均为男性，年龄 20～45 岁，平均 31.6 岁。病因：激素型 9 例，酒精型 6 例。病程 15 d～3 年，平均 8 个月。国际骨循环协会（ARCO）分期：Ⅱ期 4 髋，Ⅲ期 11 髋。术前疼痛视觉模拟评分（VAS）为（6.2±0.2）分，髋关节 Harris 评分为（57.3±1.3）分。术前行股骨头 DSA 检查确定股骨头血管病变部位，根据造影结果指导肌骨瓣移植术式的选择。对于股骨头上、下支持带血管均显影者行单纯髓芯减压术，对上支持带血管显影而下支持带血管未显影者采用前外侧入路的阔筋膜张肌骨瓣移植，对上支持带血管不显影而下支持带血管显影者采用经后外侧入路的股方肌骨瓣移植，对上、下支持带血管均未显影者行吻合血管的腓骨瓣移植。.. 对于需行肌骨瓣移植的 ONFH 患者，术前行股骨头 DSA 可明确股骨头血管病变部位，以此指导肌骨瓣移植术式的选择，对保髋手术具有重要意义。.

Topics: Adolescent; Adult; Aged; Angiography, Digital Subtraction; Bone Transplantation; Case-Control Studies; Fatigue; Female; Femur Head; Femur Head Necrosis; Ferritins; Fibromyalgia; Follow-Up Studies; Humans; Iron Deficiencies; Male; Middle Aged; Pain; Retrospective Studies; Sleep Quality; Surveys and Questionnaires; Treatment Outcome; Vitamin B 12; Vitamin D; Vitamins

Topics: Fatigue Syndrome, Chronic; Fibromyalgia; Folic Acid; Humans; Vitamin B 12

Topics: Adult; Aged; Female; Fibromyalgia; Humans; Male; Middle Aged; Vitamin B 12

Patients with myalgic encephalomyelitis (ME, also called chronic fatigue syndrome) may respond most favorably to frequent vitamin B12 injections, in vital combination with oral folic acid. However, there is no established algorithm for individualized optimal dosages, and rate of improvement may differ considerably between responders.. To evaluate clinical data from patients with ME, with or without fibromyalgia, who had been on B12 injections at least once a week for six months and up to several years.. 38 patients were included in a cross-sectional survey. Based on a validated observer's rating scale, they were divided into Good (n = 15) and Mild (n = 23) responders, and the two groups were compared from various clinical aspects.. Good responders had used significantly more frequent injections (p<0.03) and higher doses of B12 (p<0.03) for a longer time (p<0.0005), higher daily amounts of oral folic acid (p<0.003) in good relation with the individual MTHFR genotype, more often thyroid hormones (p<0.02), and no strong analgesics at all, while 70% of Mild responders (p<0.0005) used analgesics such as opioids, duloxetine or pregabalin on a daily basis. In addition to ME, the higher number of patients with fibromyalgia among Mild responders was bordering on significance (p<0.09). Good responders rated themselves as "very much" or "much" improved, while Mild responders rated "much" or "minimally" improved.. Dose-response relationship and long-lasting effects of B12/folic acid support a true positive response in the studied group of patients with ME/fibromyalgia. It's important to be alert on co-existing thyroid dysfunction, and we suspect a risk of counteracting interference between B12/folic acid and certain opioid analgesics and other drugs that have to be demethylated as part of their metabolism. These issues should be considered when controlled trials for ME and fibromyalgia are to be designed.

Topics: Analgesics; Fatigue Syndrome, Chronic; Female; Fibromyalgia; Folic Acid; Genotype; Humans; Methylenetetrahydrofolate Reductase (NADPH2); Prescription Drugs; Vitamin B 12

Vitamin B6 is an essential vitamin needed for many chemical reactions in the human body. It exists as several vitamins forms but pyridoxal 5'-phosphate (PLP) is the phosphorylated form needed for transamination, deamination, and decarboxylation. PLP is important in the production of neurotransmitters, acts as a Schiff base and is essential in the metabolism of homocysteine, a toxic amino acid involved in cardiovascular disease, stroke, thrombotic and Alzheimer's disease. This report announces the connection between a deficit of PLP with a genetically linked physical foot form known as the Morton's foot. Morton's foot has been associated with fibromyalgia/myofascial pain syndrome. Another gene mutation methylenetetrahydrofolate reductase (MTHFr) is now being recognized much commonly than previous with chronic fatigue, chronic Lyme diseases and as "the missing link" in other chronic diseases. PLP deficiency also plays a role in impaired glucose tolerance and may play a much bigger role in the obesity, diabetes, fatty liver and metabolic syndrome. Without the Schiff-base of PLP acting as an electron sink, storing electrons and dispensing them in the mitochondria, free radical damage occurs! The recognition that a phenotypical expression (Morton's foot) of a gene resulting in deficiency of an important cofactor enzyme pyridoxal 5'-phosphate will hopefully alert physicians and nutritionist to these phenomena. Supplementation with PLP, L5-MTHF, B12 and trimethylglycine should be used in those patients with hyperhomocysteinemia and/or MTHFR gene mutation.

Topics: Fibromyalgia; Foot Deformities; Humans; Methylenetetrahydrofolate Reductase (NADPH2); Mitochondria; Mutation; Myofascial Pain Syndromes; Neurotransmitter Agents; Phenotype; Pyridoxal Phosphate; Schiff Bases; Vitamin B 12

Iron is essential for a number of enzymes involved in neurotransmitter synthesis. Analysis of cerebrospinal fluid in fibromyalgia syndrome (FMS) has shown a reduction in the concentration of biogenic amine metabolites, including dopamine, norepinephrine and serotonin. This study aimed to investigate the association of ferritin with FMS.. A total of 46 patients with primary FMS participated in this case-control study, and 46 healthy females who were age matched to the patients were used as the control group. Venous blood samples collected from all subjects were used to evaluate serum ferritin, vitamin B12 and folic acid levels.. The mean serum ferritin levels in the fibromyalgia (FM) and control groups were 27.3+/-20.9 and 43.8+/-30.8 ng/ml, respectively, and the difference was statistically significant (P=0.003). Binary multiple logistic regression analysis with age, body mass index, smoking status and vitamin B12, as well as folic acid and ferritin levels showed that having a serum ferritin level <50 ng/ml caused a 6.5-fold increased risk for FMS.. Our study implicates a possible association between FM and decreased ferritin level, even for ferritin in normal ranges. We suggest that iron as a cofactor in serotonin and dopamine production may have a role in the etiology of FMS.

Topics: Anemia, Iron-Deficiency; Biogenic Amines; Case-Control Studies; Dopamine; Female; Ferritins; Fibromyalgia; Folic Acid; Humans; Iron Deficiencies; Logistic Models; Middle Aged; Risk Factors; Serotonin; Vitamin B 12

Twelve outpatients, all women, who fulfilled the criteria for both fibromyalgia and chronic fatigue syndrome were rated on 15 items of the Comprehensive Psychopathological Rating Scale (CPRS-15). These items were chosen to constitute a proper neurasthenic subscale. Blood laboratory levels were generally normal. The most obvious finding was that, in all the patients, the homocysteine (HCY) levels were increased in the cerebrospinal fluid (CSF). There was a significant positive correlation between CSF-HCY levels and fatiguability, and the levels of CSF-B12 correlated significantly with the item of fatiguability and with CPRS-15. The correlations between vitamin B12 and clinical variables of the CPRS-scale in this study indicate that low CSF-B12 values are of clinical importance. Vitamin B12 deficiency causes a deficient remethylation of HCY and is therefore probably contributing to the increased homocysteine levels found in our patient group. We conclude that increased homocysteine levels in the central nervous system characterize patients fulfilling the criteria for both fibromyalgia and chronic fatigue syndrome.

Topics: Adult; Cystathionine; Fatigue Syndrome, Chronic; Female; Fibromyalgia; Homocysteine; Humans; Methionine; Middle Aged; Models, Biological; Vitamin B 12