Attitudes of oncologists, family doctors, medical students and lawyers to euthanasia

The purpose of this survey was to define attitudes and opinions of two types of physicians, medical students and lawyers in the area of euthanasia and related issues and problems. A questionnaire was used as the source of data. There were four groups of test persons: oncologists, home care physicians (family doctors), third-year medical students and lawyers. The questionnaire included 22 questions, 4 of which concerned general characteristics of tested persons (including religious belief), while 18 referred to the problems of euthanasia. The total number of tested persons was 123, 55 men and 68 women with a median age of 38 ±11 years (±SD). There were 30 test persons in the group of oncologists, 31 in the group of family doctors, 31 in the group of third-year students, and 31 in the group of lawyers. Between 97% and 100% of individuals gave scored responses to most items. More than half of the individuals (57%) were against euthanasia, and 61% are against the legalization of euthanasia. The views of doctors and medical students were similar (2/3 against) and significantly different from the view of lawyers (2/3 for, P<0.01). The legalization of euthanasia is favored by 61% of lawyers, in contrast to 43%, 30% and 23% of oncologists, family doctors and medical students, respectively. Overall, 31% sais they would apply euthanasia if they were asked for it, and 36% that would if it had been legalized. Lawyers are twice as willing to perform euthanasia as students or physicians. The least ready to apply euthanasia are physicians working as oncologists (only 1 in 5). Compared with oncologists, one-third of home-care physicians would perform euthanasia anyway, whether legalized or not. Most of the test persons were of the opinion that euthanasia should be performed in the case of children born with a severe anomaly. None of the tested groups considered invalidity or being a burden to the family important reasons for the termination of somebody's life. Approximately 40% of responders believed that the decision for euthanasia should be made by the patient alone. Only lawyers were of the opinion that the misuse of euthanasia could be controlled. Our study shows that it is probably more important to determine factors associated with behavior pertaining to euthanasia in physicians working closely with suffering patients. Reducing suffering and launching a hospice movement and palliative care services might be the most appropriate way to deal with the problem of euthanasia.     

Sunlight in Vitamin D Deficiency: Clinical Implications

Recent evidence shows that hypovitaminosis D can lead to increased morbidity and mortality. This article highlights the role of sunlight in vitamin D deficiency and its consequences for age-related diseases among older adults. The unique content of this article is the review of factors influencing vitamin D levels, primarily the lack of sun exposure whereby health providers’ strategies can impact the reduction of vitamin D deficiency and its complications. Recommendations for vitamin D₃ supplementation are discussed. Clinical trials are needed to investigate specific measures to increase exposure to sunlight, mobilizing providers to take action to eliminate vitamin D deficiency worldwide.     

Transport of vitamin D sterols in human plasma: effect of excess vitamin D, 25 hydroxyvitamin D and 1,25 dihydroxyvitamin D

Abstract. Vitamin D and its more active metabolites, 25 hydroxyvitamin D (25-OH-D) and 1,25-dihydroxy-vitamin D (1,25-(OH)₂-D), are transported in human plasma on a specific binding protein (DBP), which has been shown to have an α-globulin electrophoretic mobility. Since the concentration of DBP in normal human plasma is approximately 5 μmol/l, whereas that of all the vitamin D metabolites is less than 0·2 μmol/l, DBP is less than 3% saturated under physiological conditions. We have studied the transport of the above-mentioned metabolites in human plasma in vitro at normal and saturating concentrations. Human plasma was incubated with increasing amounts of vitamin D metabolites together with their radiolabelled tracers. Ultracentrifugation was used to isolate plasma lipoproteins (density, d < 1·21 g/ml) and agarose gel electrophoresis of lipoprotein-free plasma (d > 1·21 g/ml) to separate DBP (α globulin) from albumin. The recovery of the tracer in plasma proteins was always more than 80%. At physiological concentrations [³H]25-OH-D bound almost exclusively to DBP (98%), [³H]vitamin D or [¹⁴C]vitamin D bound both to DBP and to lipoproteins (40%), and [³H]1,25-(OH)₂-D bound to DBP (62%), to lipoproteins (15%) and also to albumin (23%). When the concentration of vitamin D metabolites was increased, DBP became saturated. The binding capacity of DBP was similar for all three sterols, about 5 μmol/l plasma, or one mole of sterol per mole of protein, but the saturating concentration was different for the three sterols (vitamin D > 1,25-(OH)₂-D > 25-OH-D). 25-OH-D had the greatest affinity for DBP, and it completely displaced both vitamin D and 1,25(OH)₂-D from DBP at higher concentrations. All sterols bound to both plasma lipoproteins and albumin: vitamin D preferentially to lipoproteins and both 25-OH-D and 1,25-(OH)₂-D to albumin. A similar binding pattern for vitamin D in plasma was observed previously by us in a child with vitamin D toxicity. The increased binding of vitamin D to lipoproteins and especially to albumin may help explain the pathogenesis of toxicity in hypervitaminosis D, where the plasma levels of the more active metabolites are insufficient to account for the clinical signs.     

大剂量普通维生素D和活性维生素D治疗甲状旁腺功能减退症的有效性和安全性比较

目的 比较大剂量普通维生素D和活性维生素D治疗甲状旁腺功能减退症的有效性和安全性.方法 将60例甲状旁腺功能减退症患者根据随机数字表法分为对照组与观察组,各30例.对照组给予活性维生素D,观察组给予大剂量普通维生素D.比较两组的实验室指标、临床疗效及不良反应发生情况.结果治疗后,两组的血钙水平、钙磷乘积均升高,血磷、全...     

Does an active sun exposure habit lower the risk of venous thrombotic events? A D‐lightful hypothesis

Summary.  Background : Venous and arterial thrombotic complications exhibit a seasonal variation, with risk peaking in winter and dropping to a nadir in summer. We sought a possible correlation between sun exposure habits and venous thromboembolism (VTE) events. Methods : This was a cohort study comprising 40 000 women (1000 per year of age from 25 to 64 years) who were drawn from the southern Swedish population registry for 1990 and followed for a mean of 11 years. Seventy-four per cent answered an inquiry at the inception of the study ( n  = 29 518), and provided detailed information on their sun exposure habits. Cox regression analysis was used with the presence of VTE as a dependent variable and selected demographics as independent variables. The main outcome was the relationship between VTE and sun exposure habits. Results : Swedish women who sunbathed during the summer, on winter vacations, or when abroad, or used a tanning bed, were at 30% lower risk of VTE than those who did not. Risk estimates did not change substantially after adjustment for demographic variables. The risk of VTE increased by 50% in winter as compared to the other seasons; the lowest risk was found in the summer. Conclusions : Women with more active sun exposure habits were at a significantly lower risk of VTE. We speculate that greater ultraviolet B light exposure improves a person's vitamin D status, which in turn enhances anticoagulant properties and enhances the cytokine profile.     

The clinical significance of vitamin D levels and vitamin D receptor mRNA expression in colorectal neoplasms

Background/AimThis study aimed to investigate the clinical significance of changes in vitamin D [25(OH)D] levels and vitamin D receptor (VDR) mRNA expression in colorectal adenoma development.MethodsPlasma concentrations of 25(OH)D and mRNA expression of VDR in tissues were determined by enzyme‐linked immunosorbent assay (ELISA) and real‐time fluorescence quantitative polymerase chain reaction (RT‐qPCR), respectively. In addition, the concentration of plasma 25(OH)D and levels of VDR mRNA in tissues were compared among healthy individuals and adenoma and adenocarcinoma patients.ResultsVitamin D receptor expression in colorectal adenocarcinoma tissues was significantly lower than that in para‐cancerous tissues that were >5 cm away from malignant tumor sites (p < 0.01). The level of VDR expression in normal colorectal tissues from healthy individuals was significantly higher than that in colorectal adenomas (p < 0.01) and colorectal adenocarcinomas (p < 0.01); however, the VDR expression was not significantly different between colorectal adenomas and colorectal adenocarcinomas (p = 0.106). The concentration of 25(OH)D in healthy individuals was significantly higher than that in patients with colorectal adenomas (p < 0.01) and colorectal adenocarcinomas (p < 0.01); however, the concentration of 25(OH)D was not significantly different between colorectal adenomas and colorectal adenocarcinomas (p = 0.489). A low concentration of 25(OH)D was considered a risk factor for colorectal adenoma and colorectal adenocarcinoma, with odds ratios of 4.875 and 2.925, respectively.ConclusionsThe 25(OH)D levels and VDR mRNA expression might be associated with the development of colorectal adenoma and its progression to adenocarcinoma.     

绵阳地区妊娠期妇女25-羟维生素D水平的调查分析

目的了解绵阳地区妊娠期妇女(以下简称孕妇)25-羟维生素D[25(OH)D]水平,为临床科学指导维生素D补充提供依据。方法选择2017年9月至2019年5月在该院进行产检的健康孕妇3346例为研究对象,采用超高效液相色谱-串联质谱法(UPLC-MS/MS)检测血清25(OH)D水平,分析孕妇25(OH)D水平缺乏与不足情况。结果绵阳地区孕妇血清25(OH)D平均水平为(22.76±6.63)ng/mL;血清25(OH)D缺乏、不足与均衡人数分别为1191例(35.6%)、1710例(51.1%)、445例(13.3%)。孕早、中、晚期血清25(OH)D平均水平分别为(23.05±6.48)、(22.46±6.62)、(22.85±7.12)ng/mL,孕早、中期比较,差异有统计学意义(P<0.05)。不同年龄段孕妇25(OH)D缺乏率、不足率和均衡率比较,差异无统计学意义(P>0.05)。春、夏、秋、冬四季血清25(OH)D平均水平分别为(24.11±6.44)、(23.21±5.75)、(22.88±6.74)、(21.03±6.83)ng/mL;不同季节25(OH)D缺乏率与不足率比较,差异均有统计学意义(P<0.05)。结论绵阳地区孕妇普遍存在维生素D缺乏或不足情况,冬季尤为显著,应重视维生素D的科学补充,以预防维生素D缺乏。     

Structure-function relationships of vitamin D including ligand recognition by the vitamin D receptor

First, the general structure and function of nuclear receptors (NRs) are described briefly to help our understanding of the mechanism of action of vitamin D mediated by the vitamin D receptor (VDR), a member of the NRs. Then we discuss the structure-function relationship (SFR) of vitamin D on the basis of ligand structures and the interaction of the ligand with the VDR. The SFR of vitamin D side chain analogs is discussed extensively in terms of our active space group concept, which was derived from conformational analyses of the side chains of vitamin D analogs and from studies with conformationally restricted 22-methyl-1,25-(OH)(2)D(3) isomers. The mobile area of the side chain of vitamin D can be grouped into five regions (E, G, EA, EG, and F), and the SFR has been analyzed in terms of these spatial regions. The SFR of ligand/VDR interaction is discussed on the basis of the crystal structure of VDR-LBD(delta 165-215), docking of various vitamin D ligands into the ligand binding pocket (LBP) of the VDR, and functional analysis of amino acids lining the LBP. Finally, we discuss total SFR, combining the results of the two approaches, and future aspects of structure-based design of vitamin D analogs.     

围绝经期妇女血清维生素D水平与骨质疏松的相关性研究

目的：探讨深圳市龙岗地区围绝经期妇女维生素D水平与骨质疏松的关系。方法收集2012年8月至2013年8月参加体检的围绝经期妇女血清，采用串联质谱法检测血清维生素D、维生素D2及维生素D3水平，并使用双能X线吸收仪（DEXA）测定髋部及L1～4的骨密度。结果435例受试者中，血清维生素D水平缺乏情况普遍存在，且以维生素D3缺乏为主；严重缺乏组左侧股骨颈骨密度为（0．623±0．087）g/cm^2，明显低于维生素D不足组的（0．726±0．091）g/cm^2及充足组的（0．731±0．089）g/cm^2（P＜0．05）；wards三角骨密度为（0．391±0．054）g/cm^2，明显低于维生素D不足组的（0．492±0．061）g/cm^2及充足组的（0．524±0．075）g/cm^2，3个年龄组的左侧股骨颈、wards三角、L1～4、大粗隆、大转子区及左侧股骨上端骨密度均随着年龄增大而逐渐降低，差异有统计学意义（P＜0．05）。结论深圳龙岗地区围绝经期妇女普遍缺乏维生素D，需要加强宣教，低维生素D水平与骨骼中某些部位的低骨密度相关。     

过敏性紫癜患儿血清骨桥蛋白、可溶性基质溶素-2、维生素A、维生素D检测的临床意义

目的 探讨血清骨桥蛋白(OPN)、可溶性基质溶素-2(sST2)、维生素A(VitA)、维生素D水平与过敏性紫癜(HSP)患儿免疫功能以及HSP发病的关系.方法 选择2018年1月至2019年10月该院儿科收治的83例HSP患儿(HSP组)和50例体检健康儿童(对照组)为研究对象,检测血清OPN、sST2、VitA、2...     

Comparative analysis of the association between various serum vitamin D biomarkers and sarcopenia

BackgroundVitamin D status is associated with muscle strength and maintenance of muscle fibers. However, which serum vitamin D biomarker better reflects sarcopenia remains unclear. The aim of this study was to investigate associations between various serum vitamin D biomarkers (total 25‐hydroxy vitamin D [25(OH)D], bioavailable 25(OH)D, 24,25‐dihydroxyvitamin D [24,25(OH)₂D], and vitamin D metabolite ratio [VMR]) and sarcopenia.MethodsThe data for 83 hip fracture patients were finally included in the analysis. Sarcopenia was defined according to the Asia Working Group for Sarcopenia (AWGS) criteria. Measurements of 24,25(OH)₂D and 25(OH)D were made using solid‐phase extraction (SPE) and subsequent liquid chromatography‐tandem mass spectrometry (LC‐MS/MS). Vitamin D binding protein (VDBP) concentration was measured using an enzyme‐linked immunosorbent assay. The VMR was calculated by dividing serum 24,25(OH)₂D by serum 25(OH)D and then multiplying by 100. Based on total 25(OH)D, VDBP, and albumin concentrations, bioavailable 25(OH)D concentrations were calculated using the equations from the other previous studies.ResultsBioavailable 25(OH)D levels were significantly (p = 0.030) decreased in the sarcopenia group compared with the non‐sarcopenia group. Results of ROC analysis for the diagnosis of sarcopenia using serum level of bioavailable of 25(OH)D revealed that the cutoff point for bioavailable 25(OH)D was 1.70 ng/ml (AUC = 0.649, p < 0.001). In the group with a bioavailable 25(OH)D less than 1.70 ng/ml, the incidence of sarcopenia increased by 3.3 times (odds ratio: 3.33, p = 0.013).ConclusionWe demonstrated that bioavailable 25(OH)D was associated with sarcopenia among the various serum vitamin D biomarkers. Bioavailable vitamin D might be helpful for assessing the risk of sarcopenia.     

学龄前儿童维生素D水平的影响因素分析

目的分析扬州市健康儿童的维生素D水平,评价其营养状况,对其影响因素进行探讨。方法对2014年1~12月该院进行健康体检的学龄前儿童进行静脉末梢血血浆的血清25-羟维生素D[25-(OH)D]水平测定,使用SPSS17.0对获得数据进行分析。结果各年龄阶段的学龄前儿童维生素D水平差异有统计学意义(P0.05),季节变化、产妇的维生素D水平对学龄前儿童的维生素D水平也有一定的影响。结论扬州市学龄前儿童维生素D水平偏低,孕妇维生素D补充可以提高新生儿的维生素D水平,降低相关疾病的发生。     

Simultaneous quantification of vitamin D3, 25-hydroxyvitamin D3 and 24,25-dihydroxyvitamin D3 in human serum by LC-MS/MS

Abstract

Introduction. Serum 25-hydroxy-vitamin D is the established biomarker of vitamin D status although serum concentrations of vitamin D and 24,25-dihydroxyvitamin D may also be of interest to understand the in vivo kinetics of serum 25-hydroxyvitamin D. Method. An LC-MS/MS method was developed and validated to quantify vitamin D₃, 25-hydroxyvitamin D₃ and 24,25-dihydroxyvitamin D₃ in serum. After protein precipitation of the serum it was loaded on a HybridSPE column to separate vitamin D metabolites from phospholipids. Vitamin D₃, 25-hydroxyvitamin D₃ and 24,25-dihydroxyvitamin D₃ in the eluate were derivatized by 4-phenyl-1,2,4-triazoline-3,5-dione to improve sensitivity in the following LC-MS/MS analysis. Results. Using only 100 μL serum the limit of quantification was < 0.2 ng/mL for vitamin D₃, 25-hydroxyvitamin D₃ and 24,25-dihydroxyvitamin D₃. The method was validated up to 100 ng/mL (260 nmol/L) for vitamin D₃, up to 100 ng/mL (240 nmol/L) for 24,25-dihydroxyvitamin D₃ and up to 200 ng/mL (499 nmol/L) for 25-hydroxyvitamin D₃. Precision was < 6.5% for vitamin D₃ and 25-hydroxyvitamin D₃ and < 10.2% for 24,25-dihydroxyvitamin D₃. Conclusion. We demonstrate that a method including not only serum 25-hydroxyvitamin D₃ but also vitamin D₃ and 24,25-dihydroxyvitamin D₃ could easily be implemented in most modern biochemical laboratories. The method could be used to study the metabolism of endogenous synthesized vitamin D₃ as well as vitamin D₃ in intervention studies.     

维生素D与系统性硬化病相关性研究

目的：探讨维生素 D 血清水平与系统性硬化病（SSc）的相关关系。方法选取2009年1月至2013年12月门诊和住院的 SSc 患者56例（SSc 组）和健康体检者（排除 SSc）60例（对照组），分别检测血清维生素 D2、维生素 D3和总维生素 D 水平，结合临床资料进行统计分析。结果SSc 组患者的3种维生素 D 水平均较低，其中总维生素 D 和维生素 D3水平低于对照组，差异有统计学意义（P ＜0．05）。结论维持血清维生素 D 较高浓度，可能对 SSc 有预防作用。     

儿童平均血小板体积、维生素D及免疫球蛋白E水平的相关性研究

目的探讨儿童平均血小板体积(MPV)、血清维生素D(VD)及免疫球蛋白E(IgE)水平之间的相关性。方法选取该院就诊患儿775例,按照MPV、VD及IgE水平诊断标准进行分组,采用相应检测方法分别检测MPV、VD及IgE水平变化,并分析3个指标之间的相关性。结果不同VD水平组间MPV水平比较差异有统计学意义(P0.05),不同IgE水平组间MPV水平比较差异有统计学意义(P0.05)。MPV与VD水平之间呈负相关(r2=0.026,P0.01),MPV与IgE水平之间呈正相关(r2=0.008,P0.01),IgE与VD水平之间呈负相关(r2=0.08,P0.01)。结论 VD水平与MPV、IgE水平之间呈负相关,IgE与MPV水平之间呈正相关,补充VD水平可抑制血小板活化和炎性反应,在预防和治疗超敏反应性疾病中有显著的临床价值。     

25-羟维生素D与妊娠期高血压疾病相关性的研究

目的研究25-羟维生素D(25-OH-VitD)与妊娠期高血压疾病之间的相关性。方法采用电化学发光免疫分析法筛查1 100例12~18孕周孕妇的血清中25-OH-VitD表达水平,同时分析25-OH-VitD与妊娠期高血压疾病发病的相关性。结果在该院筛查的1 100例孕妇中,在该院分娩的产妇有1 000例,其中101例产妇患妊娠期高血压疾病,其中妊娠期高血压41例,轻度子痫前期32例,重度子痫前期28例,发病率为10.1%。健康孕妇、轻度子痫前期孕妇、重度子痫前期孕妇的25-OH-VitD血清表达水平分别为(19.5±3.3)、(12.5±1.5)、(9.5±1.2)ng/mL。健康孕妇与妊娠期高血压患者外周血中的25-OH-VitD表达水平差异无统计学意义(P0.05),重度子痫前期患者与轻度子痫前期患者血清25-OH-VitD表达水平均明显低于健康孕妇,差异有统计学意义(P0.05)。结论 25-OH-VitD的降低与子痫前期的发病密切相关,并且在子痫前期临床症状发生之前出现异常,可能成为子痫前期的一项预测性标志物。