Daniel proved to be the most talented of Lei Kung's students. Over the course of many years, he conditioned his fists by plunging them into buckets of sand, gravel and rock. At the age of 19, Daniel was given the chance to attain the power of the Iron Fist by fighting and defeating the dragon known as Shou-Lao the Undying, which guarded the molten heart that had been torn from its body. During the battle, Daniel threw himself against the scar of Shou-Lao, burning a dragon tattoo into his chest. After killing Shou-Lao, he entered its cave and plunged his fists into a brazier which contained the creature's molten heart, and emerged with the power of the Iron Fist. It is later revealed that there have been many Iron Fists before Daniel, making him the modern warrior of a long lineage of Iron Fists.
Laboratory evaluation is fundamental for a definitive diagnosis of iron deficiency and IDA. As the etiology of anemia includes various causes, the diagnosis cannot be based only on Hb values. For diagnostic clarification, it is necessary to evaluate red blood count and serum ferritin (SF) levels. The most reliable parameter to revel iron deficiency is SF, and screening of SF concentration at the beginning of pregnancy is recommended.59 If SF is
Iron Fist V1, V2, V3, V4
If the level of ferritin is normal, a serum transferrin value
Another parameter that could be useful to detect iron deficiency during pregnancy, in the case of normal ferritin values and elevated CRP, is transferrin receptor (sTfR). It shows an increase in cases of iron deficiency or greater iron cellular demand. During pregnancy, the increase of sTfR values is related to increased stimulation of erythropoiesis and a major iron requirement due to iron-dependent cell proliferation. Low concentrations of sTfR in the first period of pregnancy seem to be associated with an inhibited erythropoiesis in the first trimester, as some studies have shown. Moreover, sTfR concentration is not influenced by infections or inflammatory reactions.53,62
Previous formulations of IV iron were responsible for undesirable and sometimes severe side effects such as anaphylaxis, shock, and death that led to their limited use. Conversely, the new type of iron complexes developed in the last years guarantees a higher efficacy, safety, and better compliance. The use of iron dextran has been limited in pregnancy due to the high rate of adverse reactions, even serious ones. No severe adverse effects have been shown with the use of iron gluconate; however, this approach is not very practical as it requires multiple infusions with high healthcare costs and reduced patient compliance.69 The maximum single dose is 125 mg. It has low molecular stability and is not indicated for use during the first trimester.60 As the IV iron bypasses intestinal iron absorption and the link to protein binding, it represents an optimal alternative to oral iron therapy. The new formulations bind iron more tightly to the carbohydrate core, so favoring a decrease of free iron released, which is toxic. Free iron leads to cell and tissue damage due to peroxidation, as it causes the production of reactive oxygen species such as hydroxide and oxygen radicals; therefore, the severe consequences related to free iron are limited. The most recent products of IV iron allow the use of high doses in a single administration.73
The use of liposomal iron might represent a promising strategy of oral iron treatment in pregnant women with IDA. This compound shows a high gastrointestinal absorption and bioavailability and a low incidence of side effects. Therefore, liposomal iron presents good tolerability and favors better compliance than iron salts.3,72
In pregnancy, a frequent alternative treatment to oral iron, when it is not indicated, is IV iron. The new formulations of IV iron therapy promote a higher, as well as faster, increase of Hb concentration and SF levels than oral iron supplementation, as was already shown in different studies.60,61 In comparison to oral iron, ICM guarantees a more rapid correction of anemia and also an evident improvement of quality life with a lower rate of symptoms such as fatigue and depression. It also presents higher tolerability and, consequently, greater compliance than oral iron. As the carbohydrate moiety binds the elemental iron more tightly, high doses of FCM (about 1000 mg in a single administration with a short infusion time) are allowed, thus guaranteeing an improvement in compliance and an abatement of costs due to repeated administrations. Compared to IS, FCM shows greater effectiveness and a comparable rate of safely profile, despite the dosage in a single administration is much higher. On the contrary, the maximum dose of IS in a single administration should not exceed 200 mg doses, because the sucrose portion binds elemental iron less tightly.53,60,61,78
Liposomal iron, a preparation of ferric pyrophosphate associated with ascorbic acid and conveyed within a phospholipid membrane, is a new-generation oral iron which shows a high bioavailability and a low incidence of side effects, due to lack of any direct contact with intestinal mucosa.3,72
Encapsulation of iron in a micronized form in liposomes represents a new promising strategy for oral iron therapy, and it is associated with better gastrointestinal absorption, higher bioavailability, and a lower incidence of side effects.13
The 699 is the successful culmination of Sub 70's desire to offer an iron that uses the latest in game improvement technology but retains the sleekness of a traditional player's club, inspiring confidence at address and power at delivery.
The fully two-dimensional Peierls barrier map of screw dislocations in body-centered cubic (bcc) iron has been calculated using the first-principles method to identify the migration path of a dislocation core. An efficient method to correct the effect of the finite size cell used in the first-principles method on the energy of a lattice defect was devised to determine the accurate barrier profile. We find that the migration path is close to a straight line that is confined in a 1 1 0 plane and the Peierls barrier profile is single humped. This result clarifies why the existing empirical potentials of bcc iron fail to predict the correct mobility path. A line tension model incorporating these first-principles calculation results is used to predict the kink activation energy to be 0.73 eV in agreement with experiment. 2ff7e9595c
Comments