Maternal seafood consumption and fetal growth: a birth cohort study in urban China.

BACKGROUND: Seafood is a good source of essential fatty acids which has a presumably beneficial effect on developing embryos and fetuses, although it is also a source of contaminants. In this context, pregnant women are faced with conflicting reports on the risk and benefits of seafood consumption. This study aims to assess whether the consumption of seafood during pregnancy was associated with fetal growth in an inland city in China. METHODS: This study included 10,179 women who delivered a singleton live birth in Lanzhou, China. Seafood consumption was assessed using a Food Frequency Questionnaire. Maternal data including birth outcomes and maternal complications information is extracted from the medical records. Associations between seafood consumption and fetal growth indicators were analyzed using multiple linear regression and multiple logistic regression. RESULTS: There was a positive association between total seafood consumption and birth weight (ß = 0.027, 95%CI:0.030-0.111) but no association concerning birth length or head circumference. Seafood consumption was associated with decreased risk of low birth weight (OR = 0.575, 95% CI: 0.480, 0.689). The frequency of seafood consumption during pregnancy showed a trend toward a positive association with low birth weight. Significantly reduced rates of low birth weight were found in women who consumed more than 75 g of seafood/week during pregnancy as compared to women with no or very low intakes (P for trend 0.021). A significant interaction was observed between pre-pregnancy BMI and seafood consumption on birth weight among underweight women, but not among overweight women. Gestational weight gain partially mediated the association between seafood consumption and birth weight. CONCLUSIONS: Maternal seafood consumption was associated with decreased risk of low birth weight and increased birth weight. This association was mainly driven by freshwater fish and shellfish. These results further corroborate the present dietary recommendation to the Chinese Nutrition Society for pregnant women, especially those with underweight pre-pregnancy BMI and inadequate GWG. In addition, our findings provide implications for future interventions to improve seafood consumption among pregnant women to prevent low birth weight babies in the inland city in China.

Research progress of radiation protection in interventional diagnosis and treatment of pediatric heart disease / 中国基层医药

Interventional diagnosis and treatment of heart disease is the gold standard to evaluate the anatomy and physiology of children with congenital heart disease. It plays an important role in the treatment of congenital heart disease. However, ionizing radiation is inevitably harmful to the health of children and surgery operators to varying degrees. More and more attention has been paid by surgery operators to children's unique characteristics, protective awareness and skills. This paper reviews recent literature regarding the application, radiation hazards, and research status of interventional surgery in children with congenital heart disease, which hope to help people to better understand the importance of ionizing radiation protection.

Characteristics of 185 thyroid micropapillary carcinoma patients undergoing 131I treatment / 中华核医学与分子影像杂志

Objective@#To compare the clinical features of papillary thyroid microcarcinoma (PTMC) and non-microcarcinoma papillary thyroid carcinoma (PTC).@*Methods@#Clinical data of 522 patients (156 males, 366 females, age: 16-77 years) with PTC treated with 131I from January 2014 to September 2018 were analyzed retrospectively. Patients were divided into PTMC group (46 males, 139 females, age: (38.5±6.5) years; tumor diameter≤1.0 cm) and non-microcarcinoma PTC group (110 males, 227 females, age: (40.5±4.5) years; tumor diameter>1.0 cm). General information and TNM status of patients were compared. The t′ test and χ2 test were used to analyze the data.@*Results@#Patients was relatively young in PTMC group (t′=2.20, P<0.05), but no difference was observed in gender between 2 groups (χ2=3.45, P>0.05; mostly females). The incidence of extraglandular invasion in PTMC group was significantly lower than that in PTC group (33.51%(62/185) vs 56.08%(189/337); χ2=24.37, P<0.01), mainly in peripheral muscle/fibrous adipose tissue (χ2=11.01, P<0.01) and tracheal infiltration (χ2=5.35, P<0.05). Nodular goiter and Hashimoto′s thyroiditis were commonly shown in both groups, and the tumor distribution was bilobar and/or multi-foci. The rate of regional lymph node metastasis was higher in non-microcarcinoma PTC group (88.43% (298/337) vs 82.16% (152/185); χ2=3.94, P<0.05), and central lymph node metastasis occurred more in PTMC group (χ2=5.75, P<0.05). Besides, non-microcarcinoma PTC group was likely to involve more lymph node areas (χ2=5.69, P<0.05) and distant metastasis (9.50% (32/337) vs 2.16% (4/185); χ2=10.00, P<0.01). There were no differences of extraglandular infiltration, tumor distribution or lymph node metastasis between moderate- and high-risk PTMC and non-microcarcinoma PTC groups (χ2 values: 0.01-3.33, all P>0.05).@*Conclusions@#Clinical characteristics of PTC can be influenced by tumor diameter. The features of primary tumor and lymph node metastasis between patients with moderate- and high-risk PTMC and non-microcarcinoma PTC patients are similar, which suggests that 131I therapy is necessary to patients with moderate- and high-risk PTMC.

Accuracy of SPECT/CT fusion imaging in differential diagnosis of benign and malignant spinal lesions / 中国基层医药

Objective@#To analyze and discuss the clinical value of single photon emission computed tomography(SPECT)/CT fusion imaging in differentiating benign and malignant spinal lesions.@*Methods@#From January 2017 to January 2018, 70 cases with benign and malignant spinal lesions in Shanxida Hospital were studied.SPECT/CT fusion imaging and SPECT examination were used to compare the diagnosis results between the two groups.@*Results@#After SPECT diagnosis, a total of 98 bone metastatic lesions were detected, including 10 false positive lesions, 60 benign lesions and 28 false negative lesions.After SPECT/CT fusion imaging, there were 100 lesions, including 4 false positive lesions, 59 benign lesions and 37 false negative lesions.In this study, a total of 145 lesions were found in 70 patients with benign and malignant spinal lesions, including 95 benign lesions and 50 malignant lesions.The specificity, sensitivity and accuracy of SPECT/CT fusion imaging [95.79%(91/95), 92.00%(46/50), 93.79%(136/145)] were higher than those of the control group [82.11%(78/95), 64.00%(32/50), and 82.76%(120/145)], the differences were statistically significant(χ2=9.048, 11.422, 9.578, all P<0.05).@*Conclusion@#In the diagnosis of benign and malignant spinal diseases, SPECT/CT fusion imaging can accurately distinguish benign and malignant lesions, and clearly reflect the development of the disease, which lay a solid foundation for good treatment in the future.

Accuracy of SPECT/CT fusion imaging in differential diagnosis of benign and malignant spinal lesions / 中国基层医药

Objective To analyze and discuss the clinical value of single photon emission computed tomography(SPECT)/CT fusion imaging in differentiating benign and malignant spinal lesions.Methods From January 2017 to January 2018,70 cases with benign and malignant spinal lesions in Shanxida Hospital were studied.SPECT/CT fusion imaging and SPECT examination were used to compare the diagnosis results between the two groups.Results After SPECT diagnosis,a total of 98 bone metastatic lesions were detected,including 10 false positive lesions,60 benign lesions and 28 false negative lesions.After SPECT/CT fusion imaging,there were 100 lesions,including 4 false positive lesions,59 benign lesions and 37 false negative lesions.In this study,a total of 145 lesions were found in 70 patients with benign and malignant spinal lesions,including 95 benign lesions and 50 malignant lesions.The specificity,sensitivity and accuracy of SPECT/CT fusion imaging [95.79％ (91/95),92.00％ (46/50),93.79％ (136/145)] were higher than those of the control group [82.11％ (78/95),64.00％ (32/50),and 82.76％ (120/145)],the differences were statistically significant (x2 =9.048,11.422,9.578,all P ＜0.05).Conclusion In the diagnosis of benign and malignant spinal diseases,SPECT/CT fusion imaging can accurately distinguish benign and malignant lesions,and clearly reflect the development of the disease,which lay a solid foundation for good treatment in the future.

A comparison of ventilation perfusion combined with pulmonary perfusion fusion tomography ima-ging and CT pulmonary angiography for diagnosis of pulmonary embolism / 中国医师杂志

Objective To compare the diagnostic value of ventilation/perfusion ( V/Q) combined with pulmonary perfusion single photon emission computed tomography combined with CT ( SPECT/CT) fu-sion tomography imaging and computed tomographic pulmonary angiography ( CTPA) in evaluation of pulmo-nary embolism. Methods We retrospectively analyzed 60 patients with clinically suspected pulmonary em-bolism diagnosed in Shanxi Dayi Hospital from May 2015 to May 2017. All patients underwent pulmonary V/Q imaging and lung perfusion SPECT/CT fusion tomography, and CTPA inspections were completed with-in 3 days. The final clinical diagnosis and follow-up confirmed the presence or absence of pulmonary embol-ism. The diagnostic efficacy of two imaging methods for pulmonary embolism were calculated and compared. Results Of the 60 cases of patients, 33 cases were diagnosed with pulmonary embolism; the sensitivity, specificity, and accuracy of V/Q combined with pulmonary perfusion SPECT/CT fusion tomography were 96. 97％ (32/33), 92. 59％ (25/27) and 95％ (57/60), respectively; the sensitivity, specificity, and accuracy of CTPA were 81. 82％ (27/33), 92. 59％ (25/27) and 86. 67％ (52/60), respectively; both have no diagnostic uncertainty, there was no significant difference in the qualitative diagnosis of pulmonary embolism between the two examination methods ( P >0. 05 ) . V/Q combined with pulmonary perfusion SPECT/CT fusion tomography found 253 lung segment and 50 unmatched sub-pulmonary segments, including 15 V/Q mismatch lung segment and 5 sub-segment caused by lung lesions which were confirmed by lung perfusion SPECT/CT fusion image ( 5 interlobular or pleural effusion, 4 local emphysema and pulmonary bulla, 3 interlobular hypertrophy, 8 pulmonary parenchymal inflammation); CTPA found 3 sub-segmental pulmonary filling defects, 6 cases of false-negative cases were multiple sub-pulmonary segment pulmonary embolism. Conclusions V/Q combined with pulmonary perfusion SPECT/CT fusion tomography is similar to CTPA in diagnosing pulmonary embolism, and both of them have better diagnostic efficacy; the former has advantages in the diagnosis of sub-pulmonary segment pulmonary embolism, and can exclude false-posi-tive diagnoses due to other lung lesions and provide additional diagnostic information for lung disease.

Characteristics of 185 thyroid micropapillary carcinoma patients undergoing 131I treatment / 中华核医学与分子影像杂志

Objective To compare the clinical features of papillary thyroid microcarcinoma (PTMC) and non-microcarcinoma papillary thyroid carcinoma (PTC). Methods Clinical data of 522 patients (156 males, 366 females, age:16-77 years) with PTC treated with 131 I from January 2014 to September 2018 were analyzed retrospectively. Patients were divided into PTMC group (46 males, 139 females, age:(38.5± 6. 5) years;tumor diameter≤1.0 cm) and non-microcarcinoma PTC group (110 males, 227 females, age:(40.5±4.5) years; tumor diameter>1.0 cm). General information and TNM status of patients were com-pared. The t' test andχ2 test were used to analyze the data. Results Patients was relatively young in PTMC group ( t'=2.20, P<0.05) , but no difference was observed in gender between 2 groups (χ2=3.45, P>0. 05;mostly females) . The incidence of extraglandular invasion in PTMC group was significantly lower than that in PTC group (33.51％(62/185) vs 56.08％(189/337);χ2=24.37, P<0.01), mainly in peripheral muscle/fibrous adipose tissue (χ2=11.01, P<0.01) and tracheal infiltration (χ2=5.35, P<0.05). Nodular goiter and Hashimoto's thyroiditis were commonly shown in both groups, and the tumor distribution was bilobar and/or multi-foci. The rate of regional lymph node metastasis was higher in non-microcarcinoma PTC group (88.43％ (298/337) vs 82.16％ (152/185);χ2=3.94, P<0.05), and central lymph node metastasis oc-curred more in PTMC group (χ2=5.75, P<0.05). Besides, non-microcarcinoma PTC group was likely to involve more lymph node areas (χ2=5.69, P<0.05) and distant metastasis (9.50％ (32/337) vs 2.16％(4/185);χ2=10.00, P<0.01). There were no differences of extraglandular infiltration, tumor distribution or lymph node metastasis between moderate-and high-risk PTMC and non-microcarcinoma PTC groups (χ2 values:0.01-3.33, all P>0.05) . Conclusions Clinical characteristics of PTC can be influenced by tumor diameter. The features of primary tumor and lymph node metastasis between patients with moderate- and high-risk PTMC and non-microcarcinoma PTC patients are similar, which suggests that 131 I therapy is neces-sary to patients with moderate-and high-risk PTMC.

Association of serum 3-nitrotyrosine with carotid atherosclerosis in newly diagnosed type 2 diabetic patients / 中华内分泌代谢杂志

To investigate the association of serum 3-nitrotyrosine ( 3-NT ) with carotid atherosclerosis in newly diagnosed type 2 diabetic patients. 96 patients with newly diagnosed type 2 diabetes mellitus treated in the department of endocrinology of Tangshan Gongren Hospital were recruited, and were divided into two groups depending on their carotid atherosclerosis status as carotid atherosclerosis group ( CAS group, n = 54 ) and non-carotid atherosclerosis group ( NCAS group, n=42); while 51 healthy subjects without type 2 diabetes mellitus from the medical examination center were recruited as normal control group ( NC group, n=51) . Demographic and clinical data of all subjects were collected. Serum 3-NT levels were measured by Enzyme-Linked Immunosorbent Assay ( ELISA) . ( 1) The levels of 3-NT in CAS group and NCAS group were all higher than those in NC group, and the level of 3-NT in CAS group was higher than that in NCAS group (all P<0.05);(2) In type 2 diabetic patients, 3-NT was positively correlated with HbA1C and low density lipoprotein-cholesterol ( both P<0. 05); ( 3) Logistic regression analysis showed that age (OR=1.271, P=0.023), HbA1C(OR=1.812, P=0.005) , Hcy (OR=1.194, P=0.019), and 3-NT (OR=1.593, P=0.011) were risk factors of CAS in type 2 diabetic patients. Serum 3-NT was closely correlated with carotid atherosclerosis in newly diagnosed type 2 diabetic patients, suggesting that serum 3-NT may be involved in the carotid atherosclerosis of newly diagnosed type 2 diabetic patients.

Clinical analysis of neuroendoscopy treatment of the third ventricle cysticercosis / 中国内镜杂志

Objective To investigate the surgical method of treating the third ventricle cysticercosis with neuroendoscopy and to discuss the related problems. Methods Clinical data of 7 cases of the third ventricle cysticercosis from July 2009 to December 2014 were retrospectively analyzed. Patients aged from 12 to 49 and all of them received endoscopic resection of the third ventricle cysticercosis and orally taken Albendazole after surgery. Results The symptoms of high intracranial pressure in patients show different levels of releasing, except 1 case with postoperative fever symptoms, the other patients had no other palpable complications. After rechecked by CT and MRI, the size and shape of ventricle of all patients improved to varying degrees and hydrocephalus symptoms was relieved that all cases were satisfactory. Conclusions The treatment of neuroendoscopy aimed to the third ventricle cysticercosis is simple, safe and with less postoperative complications, which should be the preferred treatmnt to the third ventricle.

The Efficacy Analysis of Endoscopic Third Ventriculostomy in Infantile Hydrocephalus

OBJECTIVE: To investigate the efficacy of endoscopic third ventriculostomy (ETV) for infantile hydrocephalus. METHODS: Retrospectively reviewed the 17 infantile hydrocephalus cases who were treated with ETV between July 2009 and June 2013. The study includes 17 patients (4 Han and 13 Hui) between the ages of 51 and 337 days. Five cases with encephalitis history and 2 cases with cerebral hemorrhage, with the remaining 10 cases congenital hydrocephalus. ETVs were performed for all patients with 1 case failing because the severe ventricle inflammatory adhesion, excessive exudation, and vague basilar artery. RESULTS: Among the 16 successful cases 7 cases improved remarkably : heads and ventricles reduced and cerebral cortexes thickening morphologically. The ventricles of the remaining cases were unchanged. CONCLUSION: The ethnic minority account for the majority of the patients in this study. ETV is effective for infantile obstructive hydrocephalus.

A Preliminary Study on Predicting the Bone Rapair Effect of Zoledronic Acid in the Treatment of Breast Cancer Metastasis by 99m Tc-MDP Bone Scan / 医学研究杂志

Objective To explore the correlation between the change of CT value of osteolytic bone metastasis after the treatment of zoledronic acid and bone metabolism before treatment in breast cancer patients.Methods Twenty breast cancer patients with osteolytic bone metastases were diagnosed by 99m Tc-MDP bone scintigraphy and 99m Tc-MDP SPECT/CT ( contain 16-slice spiral CT) for the first time entered this study.After treatment of zoledronic acid for 3-12 months with the same method, 99m Tc-MDP bone scintigraphy and 99mTc-MDP SPECT/CT were peformed in the 20 breast cancer patients again with the same CT scan parameters(voltages:120kV, tube currents:80mA, pitches:3.75mm).With using regions of interesting (ROI)technique, the T/NT value of osteolytic bone metastases in the first 99m Tc-MDP bone scintigraphy were measured.The CT value of same ROI before and after zoledronic acid therapy were measured (CT1 and CT2), and the change of CT value (△CT,△CT=CT2-CT1) were calculated.The correlation between them were analyzed. SPSS 16.0 was applied for variance and linear correlation analyses.Results (1)A total of 30 lesions of osteolytic bone metastases were detected in the 20 breast cancer patients by the first 99m Tc-MDP bone scintigraphy and 99m Tc-MDP SPECT/CT.The CT value before therapy was significantly higher than that after therapy(425 ±152HU vs 120 ±73HU, t=9.95, P<0.01).(2)The change of CT value after therapy was positively correlated with and the T/NT value of osteolytic bone metastasis(r=0.907, P<0.01).(3)The change of CT value of positive lesions after therapy was significantly higher than that of negative lesions by 99mTc-MDP bone scan(W=15,P=0.001). Conclusion 99m Tc-MDP bone scintigraphy provides an effective method to predict the efficacy of zoledronic acid for breast cancer pa-tients with osteolytic bone metastases.The breast cancer patients with high bone metabolism should be recommended zoledronic acid thera-py, conversely should not be recommended.

Awareness and protection of ultraviolet irradiation among people in Urumqi area / 中华医学美学美容杂志

Objective To survey the knowledge of the Urumqi population in Xinjiang on the awareness and the protection of ultraviolet (UV) irradiation.Methods Three hundred and twentyfour subjects from Urumqi were investigated with a questionnaire about the basic knowledge of UV,the UV protection methods,the awareness and application of sunscreens,and the channels through which they acquired the knowledge.Results A total of 324 subjects completed the questionnaire.Only 78.0％ knew the harmful effects of UV,62.0％ of them knew that UV could lead to skin photo-aging,and 54.9％ knew that UV irradiation could cause skin cancer.Sunscreens were the main choice for UV protection (58.0％).Regarding sunscreens,38.3％ subjects knew the meaning of SPF,and only a small percentage of subjects (17.3％) were aware of the meaning of PA.About 25.3％ of subjects applied sunscreens every day,43.2％ used sunscreens sometimes,and 18.5％ did not use it at all.The main factor of choosing sunscreens was brand popularity and the main information sources to get the knowledge of UV and UV protection were TV advertisements.Conclusions This study shows that the knowledge of UV and UV protection of the Urumqi population is acceptable,but the protections are insufficient,which should be strengthened and guided through dermatologists and multiple media.

Budesonide attenuates airway remodeling and the expression of TGF-β1 in bronchoalveolar lavage fluid and lung tissue of asthmatic rats / 临床儿科杂志

Objectives To explore the effects of budesonide (BUD) on airway remodeling and the levels of transforming growth factor-β1 (TGF-β1) in bronchoalveolar lavage fluid (BALF) and its expression in lung tissue of asthmatic rats. To provide a theoretical basis for the intervention and treatment of asthma. Methods Sixty healthy adult male Wistar rats were randomly divided into 3 groups: control group, asthma model group and BUD treated group, 20 rats in each group. A rat asthma model was established by ovalbumin (OVA) challenging. BUD treated group was treated with inhaled BUD 1 mg/kg in 30 min per serving every other day for two weeks. After OVA challenge finished, the rats were anesthetized and sacrificed for BALF and lung tissue collection. The level of TGF-β1 in BALF was measured by enzyme-linked immunosorbent assay. TGF-β1 expression and collagen deposition in the lung tissue were tested with immunohistochemical determination and Masson stain respectively. The computer image analysis system was used for measuring respiratory bronchiole smooth muscle thickness (μm) and the extent of epithelial damage score and other indicators of airway remodeling. Results Compared with that in the control group, TGF-β1 in BALF and lung tissue of asthma model group increased and were correlated significantly with the indicators of airway remodeling (P < 0.01) ;while that of BUD treated group reduced statistically significant than model group (P < 0.05). Pathology examination on asthma rat airway epithelial tissue showed the thickness of airway smooth muscle, the airway deposition of collagen in BUD treated group reduced obviously than asthma model group. Conclusions The expression of TGF-β1 in the rat asthma airway worsens the airway remodeling. The effects of BUD on ameliorating the progression of airway remodeling may be partially made by reducing the expression of TGF-β1. (J Clin Pediatr,2010,28(2):173-177)

The change and correlation of glycogen phosphorylase isoenzyme BB in neonates with asphyxia complicated with myocardial injury / 临床儿科杂志

Objective To study the change of glycogen phosphorylase isoenzyme BB(GPBB)in neonates with asphyxia complicated with myocardial injury and its correlation with various perinatal factors. Methods Sixty-four neonates with asphyxia(including 39 mild asphyxia and 25 severe asphyxiated neonates,30 neonates with and 34 without myocardial injures)were enrolled and 25 healthy neonates were studied as control. The plasma levels of GPBB were measured by enzyme-linked immunosorbent assay(ELISA). Myocardial enzymes,cardiac troponin I,electrocardiogram,chest X-ray were performed simultaneously. Results The plasma GPBB levels were significantly higher in neonates with myocardial injury(13.84,7.57 ng/ml)than those without myocardial injury(4.97,3.24 ng/ml)and control group(4.95,1.99 ng/ml)( P ＜ 0.01). The sensitivities of GPBB,cTnI and CK-MB in diagnosing myocardial injury were 90%,66.7% and 83.3%,respectively. The sensitivity of GPBB was significantly higher than that of cTnI(χ~2 ＝ 4.812,P ＜ 0.05),with no statistical difference between GPBB and CK-MB(χ~2 ＝ 0.577,P ＞ 0.05). The specificities of GPBB,cTnI and CK-MB in diagnosing myocardial injury were 88.2%,91.2% and 67.6%,respectively. The specificity of GPBB was significantly higher than that of CK-MB(χ~2 ＝ 4.191,P ＜ 0.05),with no statistical difference between GPBB and cTnI(χ~2 ＝ 0.159,P ＞ 0.05). Plasma GPBB levels were significantly higher in neonates with severe asphyxia(14.67,6.09 ng/ml)than those with mild asphyxia(5.61,3.56 ng/ml)and control group(P ＜ 0.01). GPBB levels were higher in mildly asphyxiated neonates than those in control neonates,but with no statistical significance(P ＞ 0.05). Spearman rank correlation analysis showed that plasma GPBB levels positively correlated with the cloudiness of the amniotic fluid(r ＝ 0.500,P ＜ 0.001)and negatively correlated with Apgar score(r ＝ -0.520,P ＜ 0.001). Conclusions This study indicated that GPBB can be used as an ideal biomarker of myocardial ischemia injury in neonates with asphyxia. The determination of GPBB in early neonatal period is useful in detecting and assessing the severity of myocardial injury.

Study on the association between vitamin D receptor gene polymorphism and vitamin D deficiency rickets in infants / 中国综合临床

Objective To study the association of vitamin D receptor(VDR) gene BsmI polymorphism and the genetic susceptibility of vitamin D deficiency rickets in infants and to explore a new way of diagnosis and treat-ment. Methods Case-control study was adopted. 56 infants confirmed with rickets (case group) and 76 cases of normal infants (control group) were chosen as the subjects. PCR-RFLP was applied to examine VDR gene BsmI site polymorphism. The frequencies of the VDR genotype and allele were compared between the two groups. Results Frequencies of BB,Bb and bb genotypes were 3.6% (2/56),21.4% (12/56) and 75.0% (42/56) in the rickets group,and 1.3% (1/76),18.4% (14/76) and 80.3% (61/76) in the control group respectively(χ20.521,P> 0.05),frequencies of B,b alleles were 14.3% (16/112),85.7% (96/112) in the rickets group and 10.5% (16/152),89.5% (134/152) in the control group respectively(χ20.783,P>0.05). Multiple logistic regression analysis showed that VDR gene polymorphism Bsml had not higher risk of vitamin D deficiency rickets in Infants. Conclusion VDR gene polymorphism BsmI doesn't appear to pose risk on infants in developing vitamin D deficien-cy rickets.