Vitamin D in hematological disorders and malignancies

Commonly known for its critical role in calcium homeostasis and bone mineralization, more recently vitamin D has been implicated in hematological cancer pathogenesis and shows promise as an anti‐cancer therapy. Serum levels of 25(OH)D₃, the precursor to the active form of vitamin D, calcitriol, are frequently lower in patients with hematological disease compared to healthy individuals. This often correlates with worse disease outcome. Furthermore, diseased cells typically highly express the vitamin D receptor, which is required for many of the anti‐cancer effects observed in multiple in vivo and in vitro cancer models. In abnormal hematological cells, vitamin D supplementation promotes apoptosis, induces differentiation, inhibits proliferation, sensitizes tumor cells to other anti‐cancer therapies, and reduces the production of pro‐inflammatory cytokines. Although the dosage of vitamin D required to achieve these effects may induce hypercalcemia in humans, analogs and combinatorial treatments have been developed to circumvent this side effect. Vitamin D and its analogs are well tolerated in clinical trials, and thus, further investigation into the use of these agents in the clinic is warranted. Here, we review the current literature in this field.     

Vitamin D Deficiency and Gestational Diabetes Mellitus in Relation to Body Mass Index

A relationship between vitamin D deficiency (VDD) and gestational diabetes mellitus (GDM) has been described. Considering that GDM prevalence depends on body mass index (BMI), our main objective was to determine if VDD is associated with GDM, independent of BMI. A cross-sectional study with 886 pregnant women was conducted in Elda (Spain) from September 2019 to June 2020. To assess the association, Poisson regression models with robust variance were used to estimate the prevalence ratio (PR). The observed GDM prevalence was 10.5%, while the VDD prevalence was 55.5%. In the crude model, both VDD and obesity were associated with GDM, but in the adjusted model, only VDD was statistically significant (PR = 1.635, p = 0.038). A secondary event analysis did not detect differences in VDD, but BMI yielded a higher frequency of births by cesarean section and newborns with a >90 percentile weight in the obesity group. In conclusion, VDD is associated with GDM, independent of BMI. Future longitudinal studies could provide information on causality.     

老龄大鼠2型糖尿病肾病对肾1-α羟化酶及骨质密度影响的实验研究

目的 观察老龄大鼠2型糖尿病肾病对肾1-α羟化酶及骨密度(BMD)的影响.方法 18月龄Wistar大鼠40只,分为正常对照组、糖尿病组、处理1组和处理2组,用放免法测定各组大鼠24 h尿白蛋白、血25-(OH)D3和1,25-(OH)2D3水平,双能X线骨密度测量仪(DEXA)测定各组大鼠腰椎、股骨BMD.结果 与正常组比较,其他3组24 h尿白蛋白显著升高,而BMD显著降低(P＜0.05),处理2组BMD高于处理1组和糖尿病组(P＜0.05).处理1组25-(OH)D,有升高趋势,无统计学意义(P＞0.05).处理2组1,25-(OH)2D3与正常对照组相当,高于糖尿病组和处理1组,差异有统计学意义(P＜0.05).糖尿病组大鼠1,25-(OH)2D3与尿白蛋白呈负相关(r=-0.770 5,P=0.009),与骨密度呈正相关(股骨r=0.870 7,P=0.001,腰椎r=0.882 7,P=0.007).结论 老龄大鼠2型糖尿病肾病致肾1-α羟化酶活性下降,肾1-α羟化酶活性下降与BMD降低关系密切.     

绝经后骨质疏松症患者血清NO-iNOS系统及相关激素水平变化的探讨

观察绝经后骨质疏松症(PMO)患者NO、诱导型一氧化氮合酶(iNOS)及E2、GH、PTH、25(OH)D3等相关激素,探讨NO-iNOS系统及相关激素在骨质疏松发病机制中的作用和意义.80例绝经1年以上女性,根据扫描骨密度(BMD),Tscore值,分为骨质疏松组(OP组)34例,非骨质疏松组(NOP组)46例,及绝...     

Mandibular rescue: Application of the ALT fascia free flap to arrest osteoradionecrosis of the mandible

ObjectivesTo evaluate the use of the anterolateral thigh fascia free flap for use in neovascularization of mandibular bone in moderate osteoradionecrosis (ORN). All patients had ORN secondary to prior radiation therapy that was not severe enough to warrant segmental resection and reconstruction.Study designCase series.SettingTertiary medical center.MethodsIRB approval was obtained, and a retrospective chart review performed of all mandibular rescue procedures performed from 2011 to 2014. Patients with a minimum of two years of follow-up were included in the study.ResultsAll surgeries were performed by the senior surgeon (MF). Eight patients underwent the mandibular rescue procedure with resolution of pain and return to oral feeding in all patients, and no evidence of ORN progression on follow-up imaging. A total of 9 ALT free flaps were performed (one patient had 2 surgeries). Gender was distributed evenly (4 female/4 male). The average age was 66 (58-78), average length of hospitalization was 2.8 days (1–7), and average follow-up was 46.5 months (25–63).ConclusionsThe mandibular rescue procedure is a novel technique using the ALT fascia lata free flap to provide coverage and nutrient blood flow to mandible devascularized secondary to radiation therapy. The flap provides the advantages of low morbidity, ease of harvest, two-team approach to ablation and reconstruction, and quick recovery resulting in ‘short-stay’ free flap surgery. Although conclusions must be tempered in this small case series, our early clinical experience shows the ALT fascia lata flap holds promise in halting the destructive progression of ORN that is not yet advanced enough to require a segmental resection and reconstruction.     

Developing an international standard for the classification of surface anatomic location for use in clinical practice and epidemiologic research

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2型糖尿病新发患者血清25羟维生素D_3的水平及临床意义

目的探讨2型糖尿病(T2DM)新发患者血清25羟维生素D_3[25-(OH)D_3]的水平,以及25-(OH)D_3与B细胞功能、胰岛素抵抗的关系。方法选取2013年1月至2016年6月于南京市中医院住院的T2DM新发患者48例为观察组,同时选取同期年龄匹配的健康体检者40例为对照组,留取血清及血浆标本测定空腹血糖(FBG)、空腹胰岛素(FIns)、血脂、糖化血红蛋白(HbA1c)以及血清25-(OH)D_3水平。比较两组间胰岛素抵抗指数(HOMA-IR)、胰岛B细胞功能指数(HOMA-β)及25-(OH)D_3等指标的差异,并分析25-(OH)D_3与HOMA-IR、HOMA-β的相关性。结果观察组FBG、血脂、HbA1c、HOMA-IR均高于对照组,且差异具有统计学意义(P0.05),而血清25-(OH)D_3水平、HOMA-β均低于对照组,且差异具有统计学意义(P0.05)。新发T2DM组患者血清25-(OH)D_3水平与FBG、HbA1c、HOMA-IR呈负相关(r值分别为-0.30,-0.34,-0.23,P0.05),与HOMA-β呈正相关(r=0.27,P0.05)。结论新发T2DM患者较对照组存在25-(OH)D_3水平低下,且血清25-(OH)D_3水平的降低与胰岛素抵抗和胰岛B细胞分泌功能下降有关。补充维生素D可能使患者获益。     

1,25(OH)2D3口服冲击与血液灌流对维持性血液透析患者继发甲状旁腺功能亢进的疗效对比与护理

目的:比较1,25(OH)2D3口服冲击与血液灌流对维持性血液透析患者继发甲状旁腺功能亢进(SHPT)的疗效与护理。方法:将维持性血液透析SHPT患者42例随机分成A组[1,25(OH)2D3口服冲击组]及B组(血液灌流组)各21例。A组在1周3次血液透析治疗基础上给予1,25(OH)2D3口服冲击;B组给予1周3次血液灌流串联血液透析治疗。比较治疗后两组血清全段反应性甲状旁腺激素(iPTH)和皮肤瘙痒等改善情况,并探讨护理要点。结果:治疗12周后两组患者iPTH与治疗前相比具有显著性(P0.01),但B组下降程度较A组更为显著(P0.01)。结论:血液灌流对维持性血液透析患者SHPT的疗效比1,25(OH)2D3口服冲击更明显,且皮肤瘙痒等症状好转,值得临床推广。