阿伦膦酸钠维D3与钙剂对老年脑梗死患者骨生化与转换指标的影响

目的：研究老年脑梗死患者应用阿伦膦酸钠维D3与钙剂等骨质疏松干预治疗前后骨密度、骨生化与转换相关指标变化。方法应用骨密度仪对受试者足踝部进行骨密度（BMD）测定。应用偶氮胂Ⅲ法检测血钙与钼酸盐法检测血磷,应用双抗体夹心法检测人25羟基维生素D3[25（OH）D3]、甲状旁腺素（PTH）、骨钙素（BGP）、1型胶原羧基末端肽（β-CTX）、1型前胶原氨基端肽（P1NP）、骨源性碱性磷酸酶（BALP）。结果干预组患者干预前后除血Ca2＋、血P3＋分别互相比较无统计学差异（t＝1．430,1．528,P＞0．05）外,25（OH）D3、PTH、BGP、P1NP、BALP与β-CTX分别互相比较均有统计学差异（t＝-25．964,-3．441,-3．079,-2．074,4．182,5．149,P＜0．05）。结论对老年脑梗死急性期后伴肢体瘫痪患者在常规应用脑梗死药物治疗基础上,进行肢体康复治疗同时给予阿伦膦酸钠维D3与钙剂等骨质疏松干预治疗,对促进骨形成和抑制骨吸收有一定作用。     

脓毒症/严重脓毒症患儿维生素D水平与预后

目的 了解儿童重症监护病房(pediatric intensive care unit,PICU)脓毒症/严重脓毒症患儿维生素D缺乏程度;分析患者入院时维生素D水平与预后之间的关系.方法 本研究为多中心、前瞻性、观察性研究.以2013年3月1日至2014年3月30日期间入住3家儿童医院PICU符合危重症标准的脓毒症/严重脓毒症患儿作为研究对象.入组患者入院24h内留取静脉血2 mL,采用酶联免疫法检测血清25 (OH)维生素D水平.根据维生素D水平,将患者分为维生素D充足、轻度维生素D缺乏和重度维生素D缺乏三组.分析入院时维生素D水平与PICU住院时间、总住院时间、出院病死率、28d病死率和经济费用之间的关系.结果 共纳入病例194例.其中男117例(60.3％),女77例(39.7％).脓毒症/严重脓毒症患分别为96例和98例.出院病死率和28 d病死率分别为6.7％和24.2％.入院时中位维生素D水平9.79 ng/mL (5.32,18.46) ng/mL,维生素D缺乏率77.8％ (151/194),其中重度维生素D缺乏率达50.5％ (98/194).入院时存在重度维生素D缺乏的患者出院病死率显著增加(P=0.011).维生素D水平与PICU住院时间、总住院时间和经济花费间没有进行相关分析.结论 PICU脓毒症/严重脓毒症儿童中维生素D缺乏率高达77.8％;重度维生素D缺乏患者,出院病死率更高.     

支气管哮喘患儿血清25羟维生素D3水平变化及补充维生素D治疗对患儿发病、预后的影响研究

目的 探讨分析支气管哮喘患儿血清25羟维生素D3( 25 - OH - D3 )水平变化及补充维生素D治疗对患儿发病、预后的影响.方法 回顾性选择2016年1月至2019年1月承德医学院附属医院收治的200例支气管哮喘患儿为研究对象,设为A组,同时选择200例呼吸道感染的非支气管哮喘患儿、200名体检健康儿童分别设为B...     

维生素D制剂干预对单纯性肥胖学龄前儿童免疫功能及血清脂肪因子水平的影响

目的 探讨维生素D制剂干预对单纯性肥胖学龄前儿童血清免疫球蛋白、T淋巴细胞亚群及脂肪因子(网膜素-1、趋化素、内脂素)水平的影响.方法 选取2018年2月至2019年2月诊治的单纯性肥胖学龄前儿童80例作为研究对象,均在饮食及运动干预基础上于每日早餐后口服维生素D制剂,连续服用6个月.观察干预前后体重指数(BMI)及B...     

Oxidative Stress,Testosterone, Cortisol,and Vitamin D: Differences in Professional Soccer Players of African and Caucasian Origin

BackgroundUnder conditions of intense exercise, the production of free radicals and cortisol increases, whereas blood levels of testosterone and vitamin D decrease. The aim of the study was to evaluate the behavior of these parameters, ethnic differences, and their relationships with overtraining.Materials and MethodsFifty professional soccer players were studied. Oxidative stress, testosterone, cortisol, and vitamin D were collected in pre- and mid-competitive season, and their differences in Africans and Caucasians were evaluated.ResultsAn increase in oxidative stress was observed in mid-season in both groups, but this was more significant in Africans (386 ± 162.6 vs. 277.8 ± 106.9 UCarr, p = 0.005; 2,965.4 ± 815.8 vs. 2,560.6 ± 608.1 BAP, p = 0.035). Levels of testosterone and vitamin D were higher in August compared to February in all participants; in both months, testosterone levels were higher in Africans (11.5 ± 2.4 vs. 9.1 ± 2.6, p = 0.004; 10.3 ± 1.6 vs. 7.7 ± 2.3, p = 0.000), whereas vitamin D levels were higher in Caucasians (39.4 ± 11.1 vs. 33.4 ± 9.7, p = 0.048; 31.8 ± 9.7 vs. 27.4 ± 9.4, in August and February, respectively). Insufficient/deficient levels of vitamin D were more frequently observed in Africans, but the difference was close to significance only in August.ConclusionsAlthough lower levels of vitamin D and higher levels of cortisol and oxidative stress in mid-season in Africans could have a negative influence on performance, no symptoms of overtraining were observed, probably due to higher levels of testosterone which enable homeostatic balance.     

Holding and restraining children for clinical procedures within an acute care setting: an ethical consideration of the evidence

This critical reflection on the ethical concerns of current practice is underpinned by a systematic synthesis of current evidence focusing on why and how children are held or restrained for clinical procedures within acute care and the experiences of those present when a child is held against their wishes. Empirical evidence from a range of clinical settings internationally demonstrates that frequently children are held for procedures to be completed; younger children and those requiring procedures perceived as urgent are more likely to be held. Parents and health professionals express how holding children for procedures can cause feelings of moral distress expressed as uncertainty, guilt and upset and that this act breaches the trusting and protective relationship established with children. Despite this, children's rights and alternatives to holding are not always respected or explored. Children's experiences and perceptions are absent from current literature. Children and young people have a moral right to have their voice and protests heard and respected and for these to inform judgements of their best interests and the actions of health professionals. Without robust evidence, debate and recognition that children are frequently held against their wishes in clinical practice for procedures which may not be urgent, children's rights will continue to be compromised.     

Detection of Vitamin D Metabolites in Breast Milk: Perspectives and challenges for measurement by Liquid Chromatography Tandem-Mass Spectrometry

Breast milk is an emerging matrix for vitamin D assessment of breastfed infants and their mothers. It is considered a more reliable indicator of infant intake than the assessment of maternal circulating vitamin D. With the improved sensitivity of mass spectrometry-based technologies, this method principle has been the recent mainstay for the quantitation of various vitamin D metabolites in breast milk for population-based clinical trials. There are still several areas across the total testing process (pre-analytical, analytical and post-analytical) to be defined and harmonised to translate breast milk vitamin D measurement by liquid chromatography-tandem mass spectrometry (LC-MS/MS) from population-based research to routine clinical use and public health applications. Pre-analytically, the determination of the best form of vitamin D to measure in breast milk requires more evidence. Analytically, standardisation of the methods to allow for comparability of results is required. Post analytically, breast milk vitamin D decision limits are needed to turn the individual numerical outputs into clinically meaningful results. This review aims to synthesise the current evidence and utility of measurement of breast milk vitamin D by LC-MS/MS and to lead a future discussion on best practices to allow for its clinical utility beyond its current research-based use.     

A randomized controlled trial of an at-home preparation programme for Japanese preschool children: effects on children's and caregivers' anxiety associated with surgery

Objectives  To determine whether the implementation of at-home psychological preparation programme for children and family prior to surgery can reduce anxiety for Japanese preschool children undergoing herniorrhaphy and their caregivers assessed as an appropriate outpatient care.
Methods  Patients were randomly assigned to either of two groups: the usual care group or the at-home preparation group. Both two groups viewed a patient-educational video for herniorrhaphy once as outpatients with other patients prior to hospitalization. The control group later underwent surgery without any further preparation. The experimental group watched the same educational video at home again with an auxiliary booklet prior to hospitalization. Children's anxiety was measured by the Wong–Baker FACES Rating Scale (FACES Rating Scale), while caregivers' anxiety was measured by the Spielberger's State Trait Anxiety Inventory (STAI). Both outcomes were measured repeatedly from pre-intervention to 1 month after surgery.
Results  Of the eligible 161 patients participating, 158 (98.1%) were randomly assigned to the control group ( n  = 81) and the experimental group ( n  = 77), and 144 (89.4%) completed the study. The experimental group gained more information and knowledge about surgery from parents and showed significantly lower scores than the controls for FACES and STAI.
Conclusion  A specially designed at-home preparation programme as an outpatient care is effective to encourage parent–child verbal interaction concerning surgery and reduce both children and caregivers' anxiety associated with surgery.     

Developmental surveillance of infants and toddlers by maternal and child health nurses in an Australian community-based setting: promoting the early identification of autism spectrum disorders

Although signs of autism spectrum disorders (ASDs) are evident during the first year of life, few children are diagnosed prior to 3 years. The objective in this article is to highlight the role that primary health care professionals can play in the early identification of ASDs by briefly outlining the successful implementation of The Social Attention and Communication Study. Maternal and child health nurses were trained on the early signs of ASDs, which enabled them to identify these children prior to 2 years. The training procedure used will be outlined, and the early signs that were monitored will be explained in detail. It is recommended that routine monitoring for ASDs in infancy and toddlerhood become standard practice among all primary health care professionals.     

Enhancement of Calcium/Vitamin D Supplement Efficacy by Administering Concomitantly Three Key Nutrients Essential to Bone Collagen Matrix for the Treatment of Osteopenia in Middle-Aged Women: A One-Year Follow-Up

Two vitamins and proline (CB₆Pro), three nutrients essential for bone collagen, were used in combination to a 1000 mg calcium/250 IU vitamin D (Ca/D) daily supplement to treat osteopenia as a preventive measure against osteoporosis later in life. Middle-aged women not using estrogen were screened for osteopenia using the WHO criteria and divided into three groups (n = 20 each): 1) placebo healthy controls with normal bone mineral density (BMD); 2) control Ca/D-treated osteopenic patients; and 3) Ca/D + CB₆Pro-treated osteopenic patients. The three groups were comparable at baseline except for BMD. After one-year treatment, cortical diaphyseal BMD remained constant in each group, but trabecular bone loss persisted (at 5 lumbar sites) in osteopenic group 2. No further bone loss was detected in osteopenic group 3. A loss of 2% was evidenced in the placebo group at one lumbar site. Markers of bone formation (which increase in coupling to resorption) decreased significantly in both osteopenic groups. Although biomarkers of resorption did not change, hormone (PTH and 1,25(OH)₂D₃)-induced osteoclastic activity was significantly reduced. No decline in BMD occurred at any bone site in osteopenic group 3, highlighting the importance of improving the quality of bone matrix concomitantly to mineral replacement.