Aumento de la frecuencia de escorbuto en niños con selectividad alimentaria: serie de casos / Increase in the frequency of scurvy in children with food selectivity: A case series

El escorbuto es una enfermedad producida por déficit de vitamina C. Aunque es poco frecuente, en los últimos años observamos un incremento de casos en niños con trastornos de la conducta alimentaria. Sus manifestaciones son variadas, ya que esta vitamina actúa como cofactor en numerosos procesos, como la síntesis de colágeno. Las manifestaciones cutáneas características son las petequias, equimosis e hiperqueratosis. El compromiso mucoso se manifiesta como gingivitis con hipertrofia, hemorragias y pérdida de piezas dentarias. El diagnóstico es clínico y puede confirmarse mediante la determinación de la vitamina C plasmática. El objetivo de este trabajo es describir una cohorte de pacientes diagnosticados en los últimos años, manifestaciones clínicas y hallazgos en relación con su conducta alimentaria y trastornos del neurodesarrollo.

Scurvy is a disease caused by vitamin C deficiency. Although rare, in recent years, the number of scurvy cases in children with eating disorders has increased. Its manifestations are varied because vitamin C is a cofactor in numerous processes, such as collagen synthesis. The typical skin manifestations include petechiae, bruising, and hyperkeratosis. Mucosal involvement manifests as gingivitis with hypertrophy, bleeding, and loss of teeth. The diagnosis is based on clinical findings and may be confirmed by measuring plasma vitamin C levels. The objective of this study was to describe a cohort of patients diagnosed with scurvy in recent years, its clinical manifestations, and findings in relation to their eating behavior and neurodevelopmental disorders.

Alert for the high prevalence of vitamin D deficiency in adolescents in a large Brazilian sample

Abstract Objective: To estimate the prevalence of vitamin D deficiency and severe deficiency in children and adolescents, in a large Brazilian sample. Methodology: Results of 413,988 25(OH)D measurements in children and adolescents aged 0 to 18 years collected between 01/2014 and 10/2018 were obtained from the database of a Clinical Laboratory. In this population, 25 hydroxyvitamin D concentrations below 20 ng/mL are considered deficient, and below 12 ng/mL as severe deficiency. All measurements were performed by immunoassay and the results were distributed by gender, age group, seasonality, and latitude. Results: The mean of 25(OH)D levels was 29.2 ng/mL with a standard deviation of 9.2 ng/mL. Of the total samples, 0.8% had a concentration < 12 ng/mL, and 12.5% of the samples had a concentration < 20 ng/mL, with a higher prevalence in females. Children under 2 years of age had the lowest prevalence. The effects of latitude and seasonality were quite evident. In samples of female adolescents from the southern region in winter, 36% of vitamin D deficiency and 5% of severe deficiency were found. Conclusion: In this large number of measurements of 25(OH)D in children and adolescents, 12.5% had a deficiency and 0.8% had severe deficiency. A greater deficiency was observed among adolescents, especially females, which raises questions about the need for supplementation during this period of life.

Teratogenicity of Valproic Acid: Can Reverse its Possible Effects on Testicular Development with Vitamin E? / Teratogenicidad del Ácido Valproico: ¿Se Pueden Revertir sus Posibles Efectos sobre el Desarrollo Testicular con la Vitamina E?

Epilepsy is the chronic non-communicable disease of the nervous system most prevalent in the world. Valproic acid (VPA) is one of the most used drugs in the treatment of epilepsy but with various side effects. One of the organs that can be affected is the testis, where it has been seen that men treated with VPA reduce their fertility rates, in addition to causing endocrine disorders by decreasing androgens and gonadotropins. In animal models, it has been shown to reduce the weights of the glands attached to the male reproductive tract, as well as at the testicular level, decreasing sperm concentration and increasing apoptotic cell count. These effects are because VPA increases reactive oxygen species (ROS), causing damage to macromolecules and affecting all cellular processes sensitive to oxide reduction. Throughout testicular development, in utero, it has been seen that the expression of antioxidant enzymes such as superoxide dismutase, catalase and glutathione peroxidase, are lower during early embryonic development, as well as vitamin E (VE) is decreased. Therefore, they are not sufficient to reverse the toxic effects of ROS. The objective of this study was to review the use of VPA during pregnancy, its effect on testicular development, and to explore the potential protective role of vitamin E.

La epilepsia es una enfermedad crónica no transmisible que afecta al sistema nervioso más prevalente en el mundo. Dentro de los tratamientos, uno de los fármacos más utilizados es el ácido valproico (AVP), el que ocasiona diversos efectos secundarios. Entre los órganos que se pueden ver afectados se encuentra la gónada masculina, en donde se ha visto que hombres en tratamiento con AVP reducen sus tasas de fecundidad, además de causar trastornos endocrinos disminuyendo andrógenos y gonadotrofinas. En modelos animales, se ha visto que disminuye los pesos de las glándulas anexas al tracto reproductor masculino, como también a nivel testicular, disminuyendo la concentración espermática y aumentando el recuento de células apoptóticas. Estos efectos se deberían a que el AVP aumenta las especies reactivas de oxígeno (ROS), ocasionando daño en macromoléculas, afectando todos los procesos celulares sensibles a óxido reducción. A lo largo del desarrollo testicular, in utero se ha visto que la expresión de enzimas antioxidantes como superóxido dismutasa, catalasa y glutatión peroxidasa, son más bajos durante el desarrollo embrionario temprano, como también la vitamina E (VE) se encuentra disminuida. Por tanto, no resultan suficientes para revertir los efectos tóxicos de las ROS. El objetivo de esta revisión fue asociar el uso de AVP durante la gestación y sus efectos a nivel del desarrollo testicular y describir el potencial rol protector de la VE.

Utilidad de los anticuerpos anti-células parietales gástricas y anti-factor intrínseco en el estudio de la deficiencia de vitamina B12 asociada a gastritis autoinmune y anemia perniciosa / Usefulness of anti-gastric parietal cell and anti-intrinsic factor antibodies in the study of vitamin B12 deficiency associated with autoimmune gastritis and pernicious anemia / Utilidade de anticorpos anti-células parietais gástricas e anti-fator intrínseco no estudo da deficiência de vitamina B12 associada à gastrite autoimune e à anemia perniciosa

Resumen La gastritis autoinmune (GAI) es una afección inflamatoria progresiva de la mucosa oxíntica caracterizada por la destrucción de células parietales, pérdida de factor intrínseco, malabsorción de vitamina B12 (cobalamina), hierro y otros micronutrientes y puede progresar hacia un estado avanzado de anemia megaloblástica conocida como anemia perniciosa (AP). El objetivo de este estudio fue determinar la deficiencia de vitamina B12 debida a malabsorción utilizando la detección de anticuerpos anti-células parietales gástricas (ACPG) y anti-factor intrínseco (AFI). Se analizaron 2050 sueros de pacientes con un inmunoanálisis quimioluminiscente para vitamina B12 total y 2,8% de éstos con las pruebas de inmunofluorescencia indirecta para ACPG y enzimoinmunoanálisis para AFI. La deficiencia de vitamina B12 (<200 ng/mL) fue del 13,1%. En la detección de anticuerpos se encontró: 2 doble positivos ACPG/AFI, 17 simple positivos ACPG y 4 simple positivos AFI. Todas las muestras ACPG y/o AFI positivas tuvieron valores de vitamina B12 total <200 ng/mL. En 5 pacientes con ACPG positivos se diagnosticó gastritis crónica confirmada por biopsia. En los 6 pacientes AFI positivos se realizó el diagnóstico de AP y en 2 de ellos se confirmó por histopatología. La positividad de ACPG y/o AFI permitió la clasificación de pacientes con sospecha de GAI en candidatos para la examinación histológica y la aplicación de esquemas terapéuticos adecuados. Se destaca la importancia de las pruebas de laboratorio como parte de una estrategia de diagnóstico temprano y vigilancia endoscópica, para evitar las manifestaciones relacionadas con la deficiencia de hierro y vitamina B12 y las complicaciones de la enfermedad avanzada.

Abstract Autoimmune gastritis (AIG) is a progressive inflammatory condition of the oxyntic mucosa, characterised by gastric parietal cell destruction, loss of intrinsic factor, and malabsorption of vitamin B12 (cobalamin), iron and other micronutrients; conditioning progress to a state of megaloblastic anemia known as pernicious anemia (PA). The aim of this study was to determine vitamin B12 deficiency due to malabsorption utilizing anti-parietal cell (APCA) and anti-intrinsic factor (IFA) antibodies detection. 2050 patient serum samples were analised by chemiluminescent immunoassay for vitamin B12. A total of 2.8% of them were tested for APCA by indirect immunofluorescence and for IFA by enzyme immunoessay. Vitamin B12 deficiency (<200 ng/mL) was 13.1%. Regarding antibody detection: 2 APCA/IFA double positives, 17 APCA simple positives and 4 IFA simple positives were found. APCA and/or IFA positive samples had total vitamin B12 values <200 ng/mL. Chronic gastritis confirmed by biopsy was diagnosed in 5 patients with positive ACPG antibodies. All 6 IFA positive patients were diagnosed with PA, while 2 of them also received histopatologic confirmation. APCA and/or IFA confirmation allowed for the classification of patients with suspicion of AIG as possible candidates for histologic examination and application of appropriate therapeutic schemes. Importance of laboratory testing is to be noted; as part of a strategy that enables early diagnosis and adequate endoscopic surveillance, to avoid manifestations related to iron and vitamin B12 deficiency and the complications of advanced disease.

Resumo A gastrite autoimune (GAI) é uma doença inflamatória progressiva da mucosa oxíntica, caracterizada pela destruição das células parietais gástricas, perda do fator intrínseco, má absorção de vitamina B12 (cobalamina), ferro e outros micronutrientes pode progredir para um estado avançado de anemia megaloblástica conhecida como anemia perniciosa (AP). O objetivo deste estudo foi determinar a deficiência de vitamina B12 por má absorção usando a detecção de anticorpos anti-células parietais gástricas (ACPG) e anti-fator intrínseco (AFI). Foram analisados 2050 soros de pacientes com um imunoensaio quimioluminiscente para vitamina B12 total, 2,8% deles com testes de imunofluorescência indireta para ACPG e enzimaimunoensaio para AFI. A deficiência de vitamina B12 (<200 ng/mL) foi de 13,1%. Na detecção de anticorpos foram encontrados: 2 duplo positivos ACPG/AFI, 17 simples positivos ACPG e 4 simples positivos AFI. Todas as amostras ACPG e/ou AFI positivas apresentaram valores de vitamina B12 total <200 ng/mL. Gastrite crônica confirmada por biópsia foi diagnosticada em 5 pacientes positivos para ACPG. Nos 6 pacientes AFI positivos o diagnóstico de AP foi feito e em 2 deles foi confirmado por histopatologia. A positividade para ACPG e/ou AFI permitiu a classificação de pacientes com suspeita de GAI em candidatos para exame histológico e a aplicação de esquemas terapêuticos adequados. Destaca-se a importancia dos testes laboratoriais, como parte de uma estratégia de diagnóstico precoce e vigilância endoscópica, para evitar manifestações relacionadas à deficiência de ferro e vitamina B12 e complicações da doença avançada.

Anticoagulação Crônica em Pacientes com Fibrilação Atrial e COVID-19: Uma Revisão Sistemática e Metanálise / Chronic Anticoagulation in Patients with Atrial Fibrillation and COVID-19: A Systematic Review and Meta-Analysis

Resumo Fundamento: A doença por coronavírus 2019 (COVID-19) está associada à hipercoagulabilidade. Permanece incerto se a anticoagulação contínua para fibrilação atrial (FA) em pacientes que posteriormente contraem COVID-19 melhora os desfechos clínicos. Objetivos: Comparar a anticoagulação oral crônica com ausência de anticoagulação prévia em pacientes com FA que contraíram uma infecção por COVID-19 em relação aos desfechos de mortalidade por todas as causas, mortalidade por COVID-19, admissão em unidade de terapia intensiva (UTI) e hospitalização. Métodos: Buscamos sistematicamente no PubMed, Embase e Cochrane Library estudos elegíveis desde o início até dezembro de 2022. Incluímos estudos que compararam desfechos de COVID-19 em pacientes com e sem anticoagulação crônica prévia para FA. Foram agrupadas razões de risco (RR) com intervalos de confiança (IC) de 95% por meio de um modelo de efeitos aleatórios. O nível de significância foi estabelecido em p < 0,05. As avaliações da qualidade e do risco de viés foram realizadas de acordo com as recomendações da Cochrane. Resultados: Foram identificados 10 estudos abrangendo 1.177.858 pacientes com COVID-19 e FA, dos quais 893.772 (75,9%) estavam em anticoagulação crônica prévia para FA. Em pacientes com COVID-19, a anticoagulação crônica para FA reduziu significativamente a mortalidade por todas as causas (RR 0,75; IC 95% 0,57 a 0,99; p = 0,048; I2 = 89%) e a mortalidade relacionada à COVID-19 (RR 0,76; IC 95% 0,72 a 0,79; p < 0,001; I2 = 0%) quando comparada com a ausência de anticoagulação prévia. Em contrapartida, não houve diferença entre os grupos em relação à hospitalização (RR 1,08; IC 95% 0,82 a 1,41; p = 0,587; I2 = 95%) ou internação em UTI (RR 0,86; IC 95% 0,68 a 1,09; p = 0,216; I2 = 69%). Conclusões: Nesta metanálise, a anticoagulação crônica para pacientes com FA que contraíram COVID-19 foi associada a taxas significativamente mais baixas de mortalidade por todas as causas e mortalidade relacionada à COVID-19 em comparação com a ausência de anticoagulação anterior.

Abstract Background: Coronavirus disease 2019 (COVID-19) is associated with hypercoagulability. It remains uncertain whether ongoing anticoagulation for atrial fibrillation (AF) in patients who later contract COVID-19 improves clinical outcomes. Objectives: To compare chronic oral anticoagulation with no previous anticoagulation in patients with AF who contracted a COVID-19 infection concerning the outcomes of all-cause mortality, COVID-19 mortality, intensive care unit (ICU) admission, and hospitalization. Methods: We systematically searched PubMed, Embase, and Cochrane Library for eligible studies from inception to December 2022. We included studies comparing COVID-19 outcomes in patients with versus without prior chronic anticoagulation for AF. Risk ratios (RR) with 95% confidence intervals (CI) were pooled with a random-effects model. The level of significance was set at p < 0.05. Quality assessment and risk of bias were performed according to Cochrane recommendations. Results: Ten studies comprising 1,177,858 patients with COVID-19 and AF were identified, of whom 893,772 (75.9%) were on prior chronic anticoagulation for AF. In patients with COVID-19, being on chronic anticoagulation for AF significantly reduced all-cause mortality (RR 0.75; 95% CI 0.57 to 0.99; p = 0.048; I2 = 89%) and COVID-19-related mortality (RR 0.76; 95% CI 0.72 to 0.79; p < 0.001; I2 = 0%) when compared with no prior anticoagulation. In contrast, there was no difference between groups regarding hospitalization (RR 1.08; 95% CI 0.82 to 1.41; p = 0.587; I2 = 95%) or ICU admission (RR 0.86; 95% CI 0.68 to 1.09; p = 0.216; I2 = 69%). Conclusions: In this meta-analysis, chronic anticoagulation for patients with AF who contracted COVID-19 was associated with significantly lower rates of all-cause mortality and COVID-19-related mortality as compared with no previous anticoagulation.

Síndrome de Klinefelter, testosterona y sueño: a propósito de un caso clínico / Klinefelter's syndrome, testosterone and sleep: a clinical case

Se presenta un caso clínico de Síndrome de Klinefelter y se revisan que los aspectos en relación al sueño en estos pacientes, siendo relevante a ser abordado y estudiado debido a la relación causal entre el metabolismo de esteroides sexuales afectados. En especial la testosterona y cómo esto influye en la microarquitectura del sueño y la probabilidad de presentar síndrome de apnea obstructiva del sueño, con las repercusiones cognitivas que pueden sumarse a las ya descritas por el síndrome en si. De allí la importancia de un seguimiento y abordaje dirigido en este aspecto, al momento del diagnóstico y en el seguimiento a largo plazo.

A clinical case of Klinefelter's Syndrome is presented and the aspects related to sleep in these patients are reviewed, being relevant to be addressed and studied due to the causal relationship between the metabolism of affected sex steroids, especially testosterone and how this influences the microarchitecture of sleep and the probability of presenting obstructive sleep apnea syndrome with the cognitive repercussions that can be added to those already described by the syndrome itself. Hence the importance of a targeted follow-up and approach in this aspect, at the time of diagnosis and in long-term follow-up.

Ingesta de calcio y vitamina D: relación con exceso de peso en población costarricense / Calcium and vitamin D intake, its relationship with weight excess in Costa Rican population

Introducción: La presencia de sobrepeso y obesidad aumentan la morbimortalidad de la población latinoamericana. La deficiencia de micronutrientes como el calcio y la vitamina D se han relacionado con un aumento del riesgo de obesidad. Objetivo: Determinar la relación entre la ingesta de vitamina D y de calcio con los factores de riesgo para obesidad en la población urbana costarricense incluidas en el Estudio ELANS. Materiales y métodos: Se incluyeron 798 participantes costarricenses del Estudio ELANS. Se determinó la distribución del consumo de calcio y vitamina D según las características socioeconómicas, la actividad física y los datos antropométricos. Se compararon los grupos con las pruebas U de Mann ­ Whitney y Kruskal-Wallis. Se realizaron modelos de regresión lineal y logística. Resultados: El consumo de calcio y vitamina D fue inadecuado en más del 98% de los participantes. Las mujeres, las personas con menor nivel socioeconómico, baja actividad física, de menor edad, con exceso de peso y obesidad abdominal presentaron un consumo menor de calcio y de vitamina D. El consumo de calcio y vitamina D es mayor en los grupos que tienen un menor IMC (p= 0,023 para calcio y p= 0,252 para vitamina D). Las personas con menor circunferencia de la cintura tuvieron más consumo de calcio y vitamina D (p= 0,002 para calcio y p= 0,008 para vitamina D). No hubo asociación del consumo en los modelos de regresión. Conclusiones: El consumo de calcio y vitamina D es deficiente en la población urbana costarricense y, presentó una relación inversa con el IMC(AU)

ntroduction: The presence of overweight and obesity increase the morbimortality of people in Latin America. Micronutrient deficiencies, such as calcium and vitamin D, are associated with an increased risk of obesity. Objective: To determine the relationship between vitamin D and calcium intake with risk factors for obesity in the Costa Rican urban population included in the ELANS Study. Materials and methods: For this analysis we used the 798 Costa Rican participants of the study (ELANS). The distribution of calcium and vitamin D intake was determined according to socioeconomic status, physical activity, and anthropometric measures. The Mann ­ Whitney and Kruskal-Wallis U tests were used, as well as linear and logistic regression models were performed. Results: Calcium and vitamin D intake was inadequate in more than 98% of the participants. Women, individuals with a lower socioeconomic level, low physical activity, younger age and those with excess weight and abdominal obesity presented lower consumptionofcalciumandvitamin D. Theconsumption of calcium and vitamin D was greater in the groups that have a lower BMI (p= 0.023 for calcium and p= 0.252 for vitamin D). The smaller the waist circumference, the greater the consumption of calcium and vitamin D (p= 0.002 for calcium and p= 0.008 for vitamin D). No association of the consumption of calcium and vitamin D was found in the regression models. Conclusions: Consumption of calcium and vitamin D is deficient in the Costa Rican urban population, and more prevalent among those with higher BMI. Arch Latinoam Nutr 2024(AU)

Vitaminas B1, B6, B12 y neuropatías periféricas: Consenso de expertos / Vitamins B1, B6, and B12 and peripheral neuropathies: International expert consensus

RESUMEN A partir de una revisión bibliográfica de la literatura se ha planeado y desarrollado un consenso de expertos internacionales sobre la utilización de las vitaminas B1, B6, B12 en sus déficits y en la neuropatía periférica que puede estar asociada a la misma, como tema que precia de esa aproximación aclaratoria para optimizar su manejo. Se plantearon varias cuestiones de discusión que se consideraron importantes y dignas de ser abordadas y aclaradas, conservando nueve de ellas para su discusión ulterior buscando el consenso en tres rondas consecutivas. Se han propuesto 41 recomendaciones sobre el manejo de estas condiciones, con unanimidad por parte de los participantes en el consenso. Con ellas se ha intentado aclarar puntos oscuros o controvertidos, facilitando la actitud del clínico ante ellos en la práctica médica actual.

ABSTRACT Based on a bibliographic review of the literature, a consensus of international experts has been carried out on the use of vitamins B1, B6, B12, in their deficiencies, and in the peripheral neuropathy that may be associated with them, to optimize the management of these conditions. Several questions considered important and worthy of being addressed and clarified were raised, retaining nine of them for further discussion to achieve consensus. Forty one recommendations on the management of these conditions have been proposed, with unanimity of the participants in the consensus. This has been an attempt to clarify controversial points, assisting the clinician's attitude in current medical practice.

Preparation and in vivo Distribution of Essential Oil from Alpinia zerumbet Fructus Encapsulated Nanoemulsions / 中国实验方剂学杂志

ObjectiveTo prepare oral nanoemulsions encapsulating essential oil from Alpinia zerumbet fructus（EOFAZ） and to investigate its pro-absorption effect in vitro and distribution in vivo. MethodThe proteoglycan conjugate polysaccharides of vinegar-processed Bupleuri Radix-bovine serum albumin（VBCP-BSA） was prepared by Maillard reaction of VBCP and BSA. Taking VBCP-BSA as emulsifier， vitamin B12（VB12） as absorption enhancer， and medium chain triglycerides mixed with EOFAZ as oil phase， the nanoemulsions loaded with EOFAZ was prepared by high energy emulsification method. The particle size， particle size distribution， surface Zeta potential， EOFAZ content and appearance and morphology of the nanoemulsions were characterized， and fluorescein tracer method was used to investigate the absorption effect of fluorescein-labeled EOFAZ nanoemulsions in vitro and their distribution in vivo. ResultVBCP-BSA was formed by Maillard reaction for 48 h with high grafting rate. Using VBCP-BSA as emulsifier， the homogeneous pink nanoemulsions was prepared and denoted as EOFAZ@VBCP-BSA/VB12. The particle size of the nanoemulsions was less than 100 nm and the particle size distribution was uniform. The surface of the nanoemulsions was a weak negative charge， and the shape was spherical. The encapsulation rate of the nanoemulsions for EOFAZ was greater than 80%， which had a good absorption effect in vitro and could enhance liver accumulation after oral administration. ConclusionThe designed proteoglycan nanoemulsions can effectively load EOFAZ， promote oral absorption and enhance liver distribution， which can provide experimental basis for the development of oral EOFAZ liver protection preparations.

Effect of vitamin C intravenous injection on prognosis of patients with sep-sis or septic shock:A Meta-analysis of randomized controlled trial / 中国感染控制杂志

Objective To evaluate the efficacy of vitamin C intravenous injection in the treatment of patients with sepsis.Methods PubMed,Embase,Scopus,Cochrane Library,and Clinical Trial databases were retrieved,with a retrieval period from database establishment to December 2022.English literatures on randomized controlled trial(RCT)of vitamin C intravenous injection for the treatment of sepsis or septic shock were collected.Meta-analysis was conducted using RevMan 5.3 software and Stata 15.0 software after literature screening,extraction,and evalua-tion of the bias risk included in the studies by two researchers independently.Results A total of 16 RCT studies involving 3 301 patients were included in the analysis.In terms of main outcomes,the 28-day mortality of patients in the vitamin C treatment group was slightly lower than that of the control group,but the difference was not statis-tically significant(RR=0.86,95％CI[0.72-1.03],P=0.10;I2=44％,P=0.10).In terms of secondary out-comes,vitamin C intravenous injection can reduce the duration of vasoactive drug usage time(MD=-23.44,95％CI[-30.53--16.35],P＜0.01;I2=0,P=0.97),but has no significant effect on the 90-day mortality,inten-sive care unit mortality,hospital mortality,duration of mechanical ventilation,difference in estimated sequential organ failure assessment score at 72 hour,length of stay in ICU,and total length of hospital stay of patients(P＞0.05).Conclusion Intravenous vitamin C injection can significantly reduce vasoactive drug usage time,but the available evidence is insufficient to support that intravenous vitamin C can improve the prognosis of patients with sepsis or septic shock.More high-quality,multicenter randomized controlled trial is needed to provide more substantial evidence about the efficacy of vitamin C in treating sepsis or septic shock.

Expression and prognostic value of serum VitD,FRT and HB-EGF in sep-sis patients / 中国感染控制杂志

Objective To explore and analyze the expression and prognostic value of serum vitamin D(VitD),fer-ritin(FRT)and heparin-binding epidermal growth factor(HB-EGF)in sepsis patients.Methods 86 sepsis patients who were admitted to the intensive care unit(ICU)of a hospital from January 2021 to January 2022 were selected as the case group,and 60 non-sepsis patients in the ICU were selected as the control group.According to the prognosis of sepsis patients one month later,patients were divided into survival group and death group.Patient's serum upon admission was taken,levels of serum VitD,FRT and HB-EGF were detected,the correlation with the prognosis of sepsis patients was analyzed,and the prognostic value was evaluated by area under curve(AUC)of receiver opera-ting characteristic curve.Results Levels of white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-1β and FRT of case group were all higher than those of non-sepsis patients in the control group,while the VitD and HB-EGF levels were lower than those of non-sepsis patients in the control group,differences were all statistically significant(all P＜0.05).One month follow-up on the prognosis of sepsis patients showed that 55 patients survived and 31 died.Acute physiology and chronic health evaluationⅡ(APACHE IⅡ)score,sequential organ failure assessment(SOFA)score,PCT,TNF-α,L-1βand FRT score in patients in the death group were all higher than those in patients in the survival group,while VitD and HB-EGF were lower than patients in the survival group,differences were all statistically significant(all P＜0.05).The Pearson correlation analysis results showed that VitD were negatively correlated with APACHE Ⅱ score,SOFA score,WBC,CRP,PCT and TNF-α(all P＜0.05),HB-EGF was negatively correlected with APACHE Ⅱ,score,CRP,PCT,TNF-α,IL-6 and IL-1β(all P＜0.05);while FRT was positively correlated with APACHE Ⅱscores,CRP,PCT,TNF-α,IL-6 and IL-1β(all P＜0.05).The AUC,sensitivity,and specificity of combined de-tection of serum VitD,FRT and HB-EGF in predicting the prognosis of sepsis patients were 0.82(95％CI:0.72-0.86),84.39％,and 69.35％,respectively.Conclusion Serum levels of VitD and HB-EGF are lower and FRT is higher in sepsis patients,their expression levels are closely related to patient prognosis,and have good predictive value for predicting the prognosis of sepsis patients.

Clinical research on sensitivity to thyroid hormones and its association with nutrition and metabolism: progress and perspectives / 中华临床营养杂志

Thyroid hormones are crucial for energy metabolism. Thyroid dysfunction is closely related to a variety of metabolic disorders. However, evaluation relying solely on thyroid function indicators may come up short, considering the complex relationship between thyroid hormones and metabolic issues. There has been a growing recognition of sensitivity to thyroid hormones as a measure of thyroid function complementary to traditional indices. The indicators of thyroid hormone sensitivity include free triiodothyronine/free thyroxine, thyrotroph thyroxine resistance index, thyroid-stimulating hormone index and thyroid feedback quantile-cased index. It has been reported that impaired sensitivity to thyroid hormones can potentially interact with various nutritional imbalances and metabolic abnormalities, such as metabolic syndrome, osteoporosis and decreased vitamin D, which are not only of concern to those with thyroid dysfunction, but also to euthyroid individuals in terms of prevention and prophylaxis. With the aim of providing comprehensive insights, this review is intended to systematically summarize the existing evidence on the association between sensitivity to thyroid hormones and metabolic disorders.

Effect of vitamin D on the structure and diversity of intestinal flora in spontaneously diabetic rats / 中国比较医学杂志

Objective To investigate the effect of vitamin D(VD)on intestinal flora in spontaneously diabetic rats.Methods Zucker diabetic fatty rats(ZDF rats)were randomised to control(Con)group,VD control(VD)group,model(T2DM)group,and VD intervention(VD+T2DM)group.Fasting blood glucose profiles and oral glucose tolerance levels were determined in rats of each group.16S rDNA sequencing was used to assess changes in rat intestinal flora.OTU analysis(Venn diagram),α diversity analysis(chao1,observed species,PD whole tree,and shannon and simpson),βdiversity analysis(principal coordinate analysis(PCoA)),flora structure,and colony species variability analysis(linear discriminant analysis and influence factor(LEfSe)analysis)were also performed.Results VD intervention significantly improved fasting blood glucose levels and insulin resistance in T2DM rats(P＜0.05).α diversity showed no significant differences in chao1,observed species,PD whole tree,and shannon and simpson indices between T2DM and VD+T2DM groups(P＞0.05).β diversity analysis showed that the VD+T2DM group had more species similarity to the Con group than the T2DM group.The dominant bacteria of rat intestinal flora in each group were significantly different.In comparison to the T2DM group,the VD+T2DM group showed a decrease in abundance of Bacteroidetes and increases in abundances of Firmicutes and Clostridium XIVa.Conclusions VD improves fasting glucose elevation and insulin resistance in T2DM rats.VD improves the structure of intestinal flora,decreases Bacteroidetes,and elevates Firmicutes and Clostridium XIVa abundances in T2DM rats.

Kinetics and molecular mechanism of vitamin K3 as xanthine oxidase activator / 中国药理学与毒理学杂志

OBJECTIVE To investigate the activation of xanthine oxidase(XO)from the human liver by vitamin K3 and the mechanism.METHODS Using human liver S9(0.1 g·L-1)as the source,XO was incubated with substrate xanthine of 0,2,4,8,and 16 μmol·L-1 at 37℃ for 90 min.The Michaelis constant(Km)of the reaction of xanthine oxidation was determined using the liquid chromatography diode array method.At the concentration of Km,the three-point method(1,10 and 100 μmol·L-1)was used to detect the activity of vitamin K3 activators.The multi-point method(vitamin K3 1,2,5,10,20,50,100,200 and 400 μmol·L-1)was adopted to determine the half effective concentration(EC50)of activated XO.Kinetic parameters(Km and Vmax)and the fit of double reciprocal curves were determined via vitamin K3 of 1/2EC50,EC50 and 2EC50.The changes in kinetic behavior at different concentrations of vitamin K3 were observed and their types of activation were analyzed.The interactions between XO and activator vitamin K3 were explored via molecular docking.RESULTS The Km of XO-mediated xanthine oxidation reac-tion was 4.71 μmol·L-1.As an activator of this reaction,vitamin K3 activated XO in a concentration-dependent manner(according to the logistic fitting formula y=A2+(A1-A2)/(1+(x/x0)

Clinical efficacy and safety evaluation observation of vitamin D combined with atomoxetine hydrochloride in the treatment of attention deficit hyperactivity disorder in children / 中国药师

Objective To evaluate the clinical efficacy and safety of vitamin D combined with atomoxetine hydrochloride in the treatment of attention deficit hyperactivity disorder(ADHD)in children.Methods A retrospective analysis was performed for the data of children with ADHD admitted to Huzhou First People's Hospital from September 2022 to September 2023,and the children were divided into combination group and control group according to the diagnosis and treatment plan.The efficacy of treatment and cognitive function[Mini-Mental State Examination Scale(MMSE)and Wechsler Intelligence Scale for Children,Fourth Edition(WISC-IV.)],behavioral dysfunction[Conners]and neurofilament markers[neurential-specific enolase(NSE)and neurofilament light chain protein(NFL))before and after 3 months of treatment were observed and compared after treatment.The occurrence of adverse reactions during the treatment period was observed and recorded,and the safety was evaluated.Results A total of 101 children with ADHD were enrolled,including 51 in the combined group and 50 in the control group.After treatment,the total effective rate of the combination group was significantly higher than that of the control group(P<0.05).Before treatment,there were no significant differences in MMSE score,WISC-IV.score,Conners score,serum NSE level and serum NFL level between the two groups(P>0.05).After treatment,the MMSE score,WISC-IV.score,Conners score,serum NSE level and serum NFL level of the two groups were significantly improved compared with those before treatment(P<0.05),and the improvement degree in the combination group was better than that in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups during treatment(P>0.05).Conclusion Compared with atomoxetine hydrochloride monotherapy,vitamin D combined with atomoxetine hydrochloride has better efficacy in children with ADHD,and can improve cognitive function,behavioral dysfunction and neurological impairment,with high safety.

Effect of ultrasound-guided intraparathyroid injection of vitamin D3 on calcium-phosphorus metabolism and muscle function of patients with hyperparathyroidism associated with Vitamin D deficiency and(or)insufficiency / 中国医学装备

Objective:To explore the effect of intraparathyroid injection of 1,25 bishydroxyvitamin D3[1,25(OH)2D3]under the guidance of B-mode ultrasound on calcium-phosphorus metabolism and muscle function of patients with hyperparathyroidism associated with vitamin D deficiency and(or)insufficiency.Methods:A total of 60 patients with hyperparathyroidism associated with vitamin D deficiency and(or)insufficiency who were diagnosed at the 904th hospital of People's Liberation Army Joint Service Support Force from January 2020 to June 2022 were selected,and they were divided into observation group and control group according to random number table,with 30 cases in each group.Patients in the observation group received intraparathyroid injection of 1,25(OH)2D3,and those in the control group received oral 1,25(OH)2D3.Before and after 2 weeks of treatment,the characteristics of ultrasound images of two groups were observed,and the calcium-phosphorus level,parathyroid hormone(PTH),alkaline phosphatase(ALP),25 hydroxyvitamin D(25 OHD),1,25(OH)2D3,and urinary calcium(UCa)and urinary phosphorus(UP)at 24h of them were detected.In addition,the skeletal muscle strengths and functions of the two groups were measured.Results:Before treatment,ultrasound images showed the dorsal side of the inferior pole of left lobe of thyroid gland were hypoechoic lesion,and they appeared uniform high enhancement at the arterial phase.After treatment,there was no significant enhancement in the arterial phase of the lesion,which appeared"cavity".The blood calcium levels[(2.06±0.11)mmol/L and(2.21±0.12)mmol/L]of observation group and control group after treatment were significantly higher than those[(1.92±0.02)mmol/L and(1.93±0.03)mmol/L]before treatment,while the blood phosphorus levels[(0.92±0.11)mmol/L and(1.11±0.07)mmol/L]of them after treatment were significantly lower than those[(1.24±0.02)mmol/L and(1.25±0.03)mmol/L]before treatment,and the differences were significant(t=6.859,12.399,15.677,10.069,P<0.05),respectively.Both blood calcium level and blood phosphorus level after treatment of observation group were significantly lower than those of control group,and the differences were statistically significant(t=5.047,7.982,P<0.05),respectively.The PTH and ALP levels of two groups after treatment were significantly lower than those before treatment,and the PTH and ALP levels after treatment of observation group were significantly lower than those of control group,and the differences were statistically significant(t=28.125,12.605,P<0.05),respectively.The blood 25OHD,1,25(OH)2D3 and UCa level at 24 h of two groups after treatment were significantly higher than those before treatment,while the UP level at 24-hour after treatment was lower than that before treatment.The blood 25OHD,1,25(OH)2D3 and UCa at 24 h after treatment in observation group were significantly higher than those in control group,while the UP level at 24h after treatment in observation group was significantly lower than that in control group,with statistical significance(t=9.6763,5.269,45.086,3.387,P<0.05),respectively.The bone density values of L1-4 and femoral neck of two groups after treatment were significantly higher than those before treatment,and the bone density values of L1-4 and femoral neck after treatment in observation group were significantly higher than those in control group,with statistical significance(t=26.944,2.355,P<0.05).The grip strength and walking speed of the skeletal muscles of two groups after treatment were significantly higher than those before treatment,and the above indicators after treatment in the observation group were significantly higher than those in the control group,with statistical significance(t=2.711,3.093,P<0.05),respectively.Conclusion:There will be calcification in the gland of patient with hyperparathyroidism associated with vitamin D deficiency and(or)insufficiency,whose ultrasound appearance is strong echo with different shapes.B-mode ultrasound-guided intraparathyroid injection of 1,25(OH)2D3 can reduce the incidence of fracture.

Impact of maternal serum vitamin D status on fetal long bone development / 中华内分泌代谢杂志

Objective:To investigate the effect of maternal serum vitamin D on fetal long bone development.Methods:A retrospective collection of 1 193 first-time pregnant women who visited our hospital′s prenatal diagnosis center from July 2018 to June 2020 was conducted. All underwent prenatal fetal ultrasound examination and serum vitamin D level detection. Based on the dosage of vitamin D administered after the first vitamin D test, participants were divided into the basic dosage group(vitamin D 3, 1 600 IU/d, orally) and the adequate supplementation group(vitamin D 2 injection 600 000 IU/2 weeks, intramuscular injection). The serum 25-(OH)D levels of the two groups of pregnant women were compared at 12 and 24 weeks of treatment, as well as the long bone growth of their fetuses. Multivariable logistic regression analysis was used to analyze the factors influencing fetal long length. Results:Compared to the basic dosage group, the adequate supplementation group showed a significant increase in serum 25-(OH)D levels in pregnant women at 8 weeks, 12 weeks, and 24 weeks of treatment. The adequate supplementation group also significantly increased fetal long bone length at 12 weeks[(4.93±0.75) cm vs(4.61±0.73) cm, P<0.05] and 24 weeks of treatment [(7.92±0.84) cm vs(7.25±0.92) cm, P<0.05], with the difference between the two groups being more pronounced at 24 weeks of treatment. Maternal height, basal vitamin D level, and vitamin D level at 24 weeks of gestation were positively correlated with fetal long bone length. Conclusion:Pregnant women should maintain a relatively high level of basal vitamin D, and pay attention to the effect of vitamin D level on the fetus. A sufficient amount of vitamin D supplementation is of great significance for the long bone development of the fetus.

Research progress in the relationship between vitamin D deficiency and central precocious puberty in children / 中国儿童保健杂志

Central precocious puberty (CPP) is an endocrine disease of children due to the early onset of hypothalamic-pituitary-gonadal axis function. This leads to increased secretion of gonadotropin release impulse, causing the development of internal and external genitalia and the presentation of secondary sex characteristics. Studies have found that the onset of CPP in children may be related to vitamin D deficiency. Vitamin D, affected by sunlight duration, acts on neurons and neurotransmitters in the hypothalamic-pituitary-gonadal axis, promotes obesity and affects the expression level of insulin-like growth factor-1, which are four factors involved in the occurrence and development of CPP. The overall effect of vitamin D combined with gonadotropin-releasing hormone analogues on CPP is significant. This article reviews the correlation between vitamin D deficiency and CPP, as well as the possible mechanism of action, in order to provide some theoretical basis for researchers.

Serum vitamin D level of children aged 0 to 3 years and its correlation with nutritional knowledge, attitude and behavior of caregivers in Yibin / 中国儿童保健杂志

【Objective】 To explore the correlation of serum vitamin D level of children aged 0 to 3 years with their caregivers′ nutritional knowledge, attitude and practice (KAP) in Yibin, in order to provide reference for the prevention of vitamin D deficiency in children. 【Methods】 A total of 783 children aged 0 to 3 years who underwent child health care at the First People′s Hospital of Yibin from January to December 2020 were selected into this study. Children′s general conditions (feeding, growth and development, lifestyle, etc.) were collected, and venous blood samples were taken to detect serum 25-(OH)D concentration using the chemiluminescence method. The caregivers′ nutritional KAP was investigated using a self-designed knowledge-attitude-practice questionnaire. The relationship between the children′s vitamin D nutritional status and their caregivers′ nutritional KAP was analyzed using pearson correlation analysis. 【Results】 1) The exclusive breastfeeding rate of children aged 0 to 3 years was about 62.2%. Significant differences were found in outdoor activity time and average vitamin D supplementation among different age groups (t=9.030, 10.260, P<0.05). 2) The average concentration of serum 25-(OH)D was (36.8±8.7)ng/mL, and the incidence of vitamin D deficiency was 21.84%. Significant differences were found in serum 25-(OH)D level and the incidence of vitamin D deficiency among children of different ages, body shapes, outdoor activities, and vitamin D supplementation (t/F: 2.220 - 6.302, χ2: 5.346 - 33.134, P<0.05). 3) The caregivers′ nutritional KAP scores were 78.9±9.9, 88.1±8.3, and 78.3±11.8, respectively, with parents scoring higher than other caregivers (P<0.05). 4) Serum 25-(OH)D level was positively correlated with the nutritional knowledge, attitude, and behavior scores of caregivers (r=0.805, 0.650, 0.831, P<0.05). The caregivers′ nutritional KAP grade was correlated with vitamin D deficiency (P<0.05). 5) Overweight/obesity was a possible risk factor for vitamin D deficiency in children (OR=2.126, 95%CI: 1.162 - 3.887). Outdoor activity duration ≥2h/d (OR=0.592, 95%CI: 0.392 - 0.895), regular vitamin D supplementation (OR=0.618, 95%CI: 0.456 - 0.838), and good nutritional behavior of caregivers(OR=0.725, 95%CI: 0.563 - 0.933) were protective factors for vitamin D deficiency in children (P<0.05). 【Conclusions】 The prevalence of vitamin D deficiency is high among children aged 0 to 3 years in Yibin, and it is related to the nutritional KAP of their caregivers. Improving the nutritional KAP of caregivers can help prevent and manage vitamin D deficiency in children.

Serum vitamin K2 level in children and its correlation with bone mineral density / 中国儿童保健杂志

【Objective】 To analyze the clinical characteristics of serum vitamin K2 in children and its correlation with bone mineral density, so as to provide reference for the prevention of insufficient bone strength in children. 【Methods】 A total of 4 145 children who underwent serum vitamin K2 testing and physical examination at pediatric outpatient clinics of several municipal and county hospitals in Chongqing from January 2020 to March 2023 were retrospectively selected into this study for serum vitamin K2-related analysis.Further 844 school-age children who completed serum 25-(OH)D and lumbar bone densitometry measurements were screened to analyze the correlation between vitamin K2level and bone mineral density 【Results】 The overall serum vitamin K2 deficiency rate was 61.6% (2 553/4 145), and the difference in serum vitamin K2 deficiency rate between different age groups was statistically significant (χ2=39.364, P<0.05).The vitamin K2 level of children was significantly influenced by season and maternal education level (χ2=45.310,9.990, P<0.05).There were significant differences in age (Z=3.416), gender (χ2=9.218) and serum vitamin K2 deficiency rate (χ2=5.826) between normal bone mass development group and insufficient bone mass development group (P<0.05).Multivariate Logistic regression analysis suggested that vitamin K2 deficiency was an independent risk factor for insufficient bone mass development in school-age children (OR=1.37,95%CI:1.03 - 1.83, P=0.030). 【Conclusions】 There is a higher serum vitamin K2 deficiency rate among children, especially infants and school-age children.Decreased bone mineral density in school-age children may be associated with serum vitamin K2 deficiency.