Decreased cortical bone density and mechanical strength with associated elevated bone turnover markers at peri-pubertal peak height velocity: a cross-sectional and longitudinal cohort study of 396 girls with adolescent idiopathic scoliosis.

Decreased cortical bone density and bone strength at peak height velocity (PHV) were noted in girls with adolescent idiopathic scoliosis (AIS). These findings could provide the link to the previously reported observation that low bone mineral density (BMD) could contribute as one of the prognostic factors for curve progression that mostly occurs during PHV in AIS. INTRODUCTION: As part of the studies related to aetiopathogenesis of AIS, we assessed bone qualities, bone mechanical strength and bone turnover markers (BTMs) focusing at the peri-pubertal period and PHV in AIS girls. METHODS: 396 AIS girls in two separate cohorts were studied. Skeletal maturity was assessed using the validated thumb ossification composite index (TOCI). Bone qualities and strength were evaluated with high-resolution peripheral quantitative computed tomography (HR-pQCT) and finite element analysis (FEA). RESULTS: Cohort-A included 179 girls (11.95 ± 0.95 years old). Girls at TOCI-4 had numerically the highest height velocity (0.71 ± 0.24 cm/month) corresponding to the PHV. Subjects at TOCI-4 had lower cortical volumetric BMD (672.36 ± 39.07 mg/mm3), cortical thickness (0.68 ± 0.08 mm) and apparent modulus (1601.54 ± 243.75 N/mm2) than: (a) those at TOCI-1-3 (724.99 ± 32.09 mg/mm3 (p < 0.001), 0.79 ± 0.11 mm (p < 0.001) and 1910.88 ± 374.75 N/mm2 (p < 0.001), respectively) and (b) those at TOCI-8 (732.28 ± 53.75 mg/mm3 (p < 0.001), 0.84 ± 0.14 mm (p < 0.001), 1889.11 ± 419.37 N/mm2 (p < 0.001), respectively). Cohort-B included 217 girls (12.22 ± 0.89 years old). Subjects at TOCI-4 had higher levels of C-terminal telopeptide of type 1 collagen (1524.70 ± 271.10 pg/L) and procollagen type 1 N-terminal propeptide (941.12 ± 161.39 µg/L) than those at TOCI-8 (845.71 ± 478.55 pg/L (p < 0.001) and 370.08 ± 197.04 µg/L (p < 0.001), respectively). CONCLUSION: AIS girls had decreased cortical bone density and bone mechanical strength with elevated BTMs at PHV. Coupling of PHV with decreased cortical and FEA parameters could provide the link to the previously reported observation that low BMD could contribute as one of the prognostic factors for curve progression that mostly occurs during PHV in AIS.

Association of serum 25(OH)Vit-D levels with risk of pediatric fractures: a systematic review and meta-analysis.

The association between the risk of fractures and suboptimal vitamin D (Vit-D) status remains controversial in children. This meta-analysis suggested that serum 25(OH)Vit-D levels were lower in pediatric cases with fractures. 25-hydroxyvitamin D (25(OH)Vit-D) levels less than 50 nmol/L were associated with increased fracture risk in children. INTRODUCTION: This study aimed to assess the association between serum 25(OH)Vit-D and the risk of fractures in children, and to explore the sources of heterogeneity and investigate their impact on results. METHODS: Systematic review and meta-analysis were conducted for observational studies comparing serum 25(OH)Vit-D levels between fracture and non-fracture pediatric cases. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: Analysis on 17 case-control and 6 cross-sectional studies (2929 fracture cases and 5000 controls) suggested that 25(OH)Vit-D was lower in fracture cases than in controls (pooled mean difference (MD) = - 3.51 nmol/L; 95% confidence interval (CI): - 5.60 to - 1.42) with a heterogeneity (I2) of 73.9%. The sensitivity analysis which merged the case-control studies that had a NOS score ≥ 4 showed a pooled MD of - 4.35 nmol/L (95% CI: - 6.64 to - 2.06) with a heterogeneity (I2) of 35.9%. Pooled odds ratio of fracture in subjects with 25(OH)Vit-D ≤ 50 nmol/L compared to subjects with 25(OH)Vit-D > 50 nmol/L was 1.29 (95% CI: 1.10 to 1.53; I2 < 1%). CONCLUSION: This study indicated that serum 25(OH)Vit-D levels were lower in pediatric patients with fractures. 25(OH)Vit-D ≤ 50 nmol/L was associated with increased fracture risk in children.

[Relationship between decreased expression of inhibin B and spermatogenesis dysfunction in rats testis].

Objective: To explore the effects of varicocele on the expressions of inhibin B in rat testes and the relationship between expression of inhibin B and spermatogenesis dysfunction. Methods: Twenty specific-pathogen-free Sprague-Dawley (SD) male rats were randomly divided into two groups with random number table: 4-week control group (C4) and 4-week experimental group(V4). Experimental varicocele was created by partial ligation of left renal vein in the V4 group; vein isolation without ligation was performed in the C4 group.Spermatogenetic function in the two groups were assessed. The expression of inhibin B in the rat testis was analyzed by immunohistochemistry, the expressions of inhibin B, Fas and Fas ligand(FasL)mRNA measured by reverse transcription-polymerase chain reaction(RT-PCR), and the inhibin B protein expression by Western blot. Results: In comparison of spermatogenetic function in left rat testes, the Johnsen scores in the V4 group were significantly lower than those in the C4 group (9.79±0.05 vs 9.97±0.02, P=0.023), the seminiferous epithelium in the V4 group was significantly thinner than that in the C4 group [(48.35±0.99)µm vs (57.58±1.98)µm, P=0.000], and the number of sperms in the left epididymis was significantly lower than in the right one in the V4 group [(933±161)×106/(ml·g) vs(1 552±184)×106/(ml·g), P=0.017]. Both Western blot and immunohistochemical assay showed that the expression of inhibin B in the rat testes was significantly lower in the V4 group than in the C4 group(0.407±0.053 vs 0.608±0.076, P=0.038; 0.161±0.004 vs 0.183±0.005, P=0.008). RT-PCR also detected reduced expression of inhibin B mRNA in the V4 group compared with the C4 group(0.522±0.050 vs 1.106±0.210, P=0.003. Compared to the C4 group, the expression of Fas mRNA in the V4 group was significantly lower, while the expression of FasL mRNA in the V4 group was significantly higher(P=0.019, 0.015). Conclusions: Varicocele can lead to decreased expressions of inhibin B in rat testes and cause spermatogenesis dysfunction. There may be a close correlation between down-regulation ofinhibin B expression and spermatogenesis dysfunction.Inhibin B may play a significant rolein the mechanisms underlying male infertility due to varicocele.

Eczema phenotypes are associated with multiple vitamin D pathway genes in Chinese children.

BACKGROUND: Vitamin D is increasingly recognized to play crucial roles in cutaneous immunity, and vitamin D treatment improved eczema control in small clinical trials. Several vitamin D-related genes were associated with asthma, but there are no data for eczema. METHODS: Twenty-three single-nucleotide polymorphisms (SNPs) of five vitamin D-related genes (CYP27A1, CYP2R1, CYP27B1, GC and VDR) were genotyped in 1442 Chinese children with eczema and 1231 non-allergic controls. SNPs that followed Hardy-Weinberg equilibrium and yielded ≥ 95% genotyping call-rate were included. Haplotypic associations and SNP-SNP interactions for eczema diagnosis and subphenotypes were analysed. RESULTS: Atopic eczema was associated with rs4674343 of CYP27A1 (odds ratio 0.66, 95% confidence interval 0.53-0.83, P = 0.0004). Increased eosinophil percentage was associated with CYP2R1 rs2060793A (P = 0.001) and rs1933064A (P = 0.001). Two CYP2R1 haplotypes increased eczema risk whereas one VDR haplotype lowered eczema risk. GC rs7041 and CYP2R1 rs7935792 interacted to modulate total IgE (cross-validation consistency 10/10, P = 0.047). Specifically, high-risk eczema patients had higher log-transformed total IgE than low-risk patients (2.76 ± 0.76 vs 2.60 ± 0.80, P = 0.002). CONCLUSION: A vitamin D-related SNP rs4674343 on CYP27A1 was found to be protective against atopic eczema. CYP2R1 and VDR haplotypes altered eczema susceptibility and eosinophil percentage, and GC and CYP2R1 interacted to determine total IgE among eczema patients.

[Precautionary education against extracorporeal shock wave lithotripsy complication].

The purpose of precautionary education against Extracorporeal Shock Wave Lithotripsy complication in urinary system is to help patients build knowledge, trust, and collaboration. The methods of the education include 1) group education--reading pamphlet which we specially provide and receiving regular information, 2) individual education--giving advice prior to treatment and something special to the patient's needs. Educational content include drinking water, physical adjustment and postural drainage. Three years clinical practice showed that precautionary education could reduce unnecessary complication after Extracorporeal Shock Wave Lithotripsy and it needs further attention in this field.