Thiol/disulfide homeostasis and ischemia-modified albumin as oxidative stress markers in patients with embedded fragments

The aim of this study was to investigate oxidative stress markers in patients with embedded fragments (PEF) using thiol-disulfide homeostasis and ischemia-modified albumin (IMA). The study consisted of a PEF group and a control group. Blood or urine metal concentrations were determined using inductively coupled plasma mass spectrometry (ICP-MS). Plasma thiol/disulfide homeostasis parameters and IMA levels were assessed. In PEF, the concentrations of all metals, including antimony (Sb), arsenic (As), copper (Cu), mercury (Hg), cadmium (Cd), lead (Pb), manganese (Mn), nickel serum (Ni), iron (Fe), cobalt (Co), and selenium (Se), were significantly higher than those in the control group, except chromium (Cr). 64.86% of PEF had elevated concentrations of at least one of these metals: Sb, As, Cu, Cd, Pb, Mn, Ni, and Fe, concerning reference values. It was also found that 64.86% (72/111) of PEF had elevated concentrations of metals, such as Sb, As, Cu, Cd, Pb, Mn, Ni, and Fe, in urine or blood, in accordance with the BEI values recommended by ACGIH and clinical laboratory reference values. The disulfide/native thiol, disulfide/total thiol, and total thiol/native thiol ratios were significantly higher in PEF. There was a strong positive correlation between Pb, Cd, and disulfide and a negative correlation between native thiol and Cd, Pb, and Co. Albumin levels were significantly lower, and IMA levels were significantly higher in the PEF group than in the control group. Metal abnormality was approximately 2.7 times higher in PEF who had retained fragments for longer than 20 years. The increased metal body burden resulting from the embedded fragments may pose significant systemic health effects by inducing oxidative stress. Continuous surveillance of patients with retained fragments is essential to combat chronic metal toxicity.