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Objective To explore the characteristics of blood uric acid levels and its correlation with calcium and phosphorus levels, and glucose and lipid metabolism in obese adolescents in weight-loss training camps. Methods In this study, 357 obese adolescents aged 12-18 were selected as the research subjects, and 135 normal-weight adolescents were selected as the controls. The body shape and blood uric acid characteristics of the subjects were measured and analyzed. Further, 59 subjects were selected from the obese adolescents for blood calcium, blood phosphorus and glucose and lipid metabolism index tests to analyze the correlation between blood uric acid level and calcium, phosphorus, and glucose and lipid metabolism indicators. Results The average blood uric acid level of obese adolescents was (527.12±122.94)μmol/L, (566.58±122.51)μmol/L for boys, and (468.35±97.79)μmol/L for girls. The blood uric acid level of the obesity group was significantly higher than that of the control group (P<0.001 for boys, P<0.05 for girls), and it was higher in boys than in girls (P<0.01). Obese adolescents with high uric acid accounted for 73.39%. The HOMA-IR of obese adolescents was 5.79±3.04. The blood uric acid level was significantly correlated with blood calcium, total cholesterol, and low-density lipoprotein cholesterol (P<0.05). Gender and low-density lipoprotein cholesterol were the main influencing factors of blood uric acid (P<0.05). Conclusion Obese adolescents have high blood uric acid levels, low calcium and high phosphorus in the body, and a higher incidence of insulin resistance. There exists a positive correlation between the blood uric acid level and the body's calcium and phosphorus metabolism and glucose and lipid metabolism in obese adolescents. Clinical monitoring of lipid metabolism indicators such as low-density lipoprotein has certain reference value for the prevention and treatment of hyperuricemia.
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Objective:To systematically evaluate the effects of low protein diet combined with α-keto acid on calcium and phosphorus metabolism and nutritional status in patients undergoing hemodialysis.Method:Randomized controlled Trials were searched in Cochrane Library, Web of Science, PubMed, Embase, CBM, CNKI, Wanfang and VIP databases from the establishment of respective database until July 2021, and meta-analysis is conducted using RevMan 5.4.Results:A total of 8 studies including 556 patients were selected. Meta-analysis showed that after receiving low protein diet combined with α-keto acid, patients demonstrated significantly reduced blood phosphorus [MD = -0.17, 95% CI (-0.25, -0.7), P < 0.01], calcium- phosphorus product [MD = -6.17, 95% CI (-6.67, -5.58), P < 0.01] and parathyroid hormone levels [MD = -35.36, 95% CI (-40.89, -29.83), P < 0.01]. There was no significant difference in serum calcium [MD = 0.03, 95% CI (-0.00, 0.07), P = 0.08] and serum albumin [MD = 0.41, 95% CI (-0.12, 0.95), P = 0.13]. Conclusion:Low protein diet combined with α-keto acid can reduce the levels of serum phosphorus, calcium-phosphorus product and parathyroid hormone in hemodialysis patients while the effects on serum calcium and serum albumin are undetermined and need further verification.
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Objective@#To evaluate the dietary phosphorus intake of non-dialysis patients with chronic kidney disease (CKD) 3-5 stage, and to explore the relationship between dietary phosphorus intake, nutritional status, and calcium and phosphorus metabolism.@*Methods@#A cross-sectional study was conducted. Non-dialysis patients of CKD 3-5 stage in Huashan Hospital outpatient clinic were selected. Three-day dietary diaries, anthropometric indicators, subjective global assessment (SGA) scores, blood and 24-hour urine biochemical indicators were collected. According to the median dietary phosphorus intake (873 mg/d), the patients were divided into high phosphorus intake group (≥ 873 mg/d) and low phosphorus intake group (<873 mg/d). The differences of characteristics, anthropometric indicators, SGA scores, blood and urine biochemical indicators between the two groups were compared. Multivariate linear regression analysis was used to analyze the correlation between dietary phosphorus intake and different kinds of food intake.@*Results@#A total of 118 patients were enrolled. The daily energy intake was (25.48±4.45) kcal/kg, protein intake was (0.88±0.22) g/kg and phosphorus intake was(862.85±233.02) mg/d. There were no significant differences in body mass index and SGA scores between high phosphorus intake group and low phosphorus intake group. The waist circumference, hip circumference, waist-hip ratio and leg circumference of male patients in high phosphorus intake group were higher than those in low phosphorus intake group (all P<0.05). There were no significant differences in anthropometric indicators between the two groups of female patients. The serum levels of intact parathyroid hormone (iPTH), sodium, triglyceride, blood RBC count, alanine aminotransferase, 24-hour urine urea nitrogen, 24-hour urine creatinine and 24-hour urine phosphate in the high phosphorus intake group were higher than those in the low phosphorus intake group (all P<0.05). Multivariate regression analysis showed that pork and chicken contributed the most to dietary phosphorus intake, followed by fish and dairy.@*Conclusions@#The daily dietary phosphorus intake of non-dialysis of CKD 3-5 stage patients is slightly higher than the recommended intake. The increase of dietary phosphorus intake may lead to the increase of serum iPTH and sodium levels. Proper control of dietary phosphorus intake will not impair the nutritional status of CKD patients.
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OBJECTIVE： To establish the method for the content determination of astragaloside Ⅳ， emodin and chrysophanol in Jianpi yishen pills （JYP） and to investigate the effects of JYP on calcium， phosphorus metabolism and inflammatory factors in chronic renal failure （CRF） model rats. METHODS： HPLC method was adopted. The determination of astragaloside Ⅳ， emodin and chrysophanol was perform on Agilent Zorbax SB-C18， Agilent TC C18 column， respectively； mobile phase consisted of acetonitrile-water （36 ∶ 64， V/V） and methanol-0.1％ phosphoric acid solution （75 ∶ 25， V/V）； the detectors were evaporative light-scattering detector and diode-array detector （detection wavelength of 254 nm）； the column temperatures were set at 30 ℃and 25 ℃ at the flow rate of 1.0 mL/min； the sample sizes were 20 and 10 μL. SD rats were randomly divided into normal group， model group， Niaoduqing group （1.80 g/kg） and JYP low-dose， medium-dose and high-dose groups （1.71， 3.43， 6.85 g/kg）， with 10 rats in each group. Except for normal group， CRF model of other groups were established by 5/6 nephrectomy in other groups. Four months after modeling， normal group and model group were given constant volume of water intragastrically； admi- nistration groups were given relevant medicine intragastrically， once a day， for consecutive 12 weeks. The levels of serum creatinine （Scr）， urea nitrogen （BUN）， parathyroid hormone （PTH） and inflammatory factors （IL-6， TNF-α） were measured by ELISA. Methyl thymol blue colorimetric method and phosphomolybdic acid method were used to detect the contents of blood calcium and phosphorus. Correlation of inflammatory factors with related calcium and phosphorus metabolism indexes （blood calcium， blood phosphorus， PTH） were investigated with Pearson assay. RESULTS： The linear range of astragaloside Ⅳ， emodin and chrysophanol were 54.537-381.759， 2.960-20.720， 6.318-44.223 μg/mL， respectively. The limits of quantitation were 0.010， 0.288， 0.216 μg/mL； the limits of detection were 0.003， 0.096， 0.072 μg/mL. RSDs of precision， reproducibility and stability tests were all lower than 3.0％. The recoveries were 97.18％-102.33％（RSD＜3％，n＝9）. After modeling （before medication）， serum contents of Scr and BUN in model group and administration group were increased significantly， compared with normal group （P＜0.01）. After medication， above indexes of administration group were decreased significantly， compared with model group and the same group before medication （P＜0.01）. Compared with normal group， the content of blood calcium were decreased significantly， while the contents of IL-6 and TNF-α were increased significantly （P＜0.01）. Compared with model group， the content of blood calcium were increased significantly in JYP medium-dose and high-dose groups， while serum content of PTH in Niaoduqing group， serum contents of PTH and IL-6 in JYP medium-dose and high-dose groups as well as serum content of TNF-α in administration group were decreased significantly （P＜0.05 or P＜0.01）. JYP had no significant effect on blood phosphorus in rats， and there was no correlation of inflammatory factors with related calcium and phosphorus metabolism indexes （P＞0.05）. CONCLUSIONS： The established content determination method is simple， specific and sensitive， and can be used for content determination of astragaloside Ⅳ， emodin and chrysophanol in JYP. JYP can improve renal function of CRF model rats， relieve calcium metabolism disorder and inhibit the expression of inflammatory factors.
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@#Vitamin D is an essential nutrient in the body. In recent years, increasing attention has been paid to its role in regulating immunity and anti-inflammatory effects. However, the application of vitamin D in vivo may produce some side effects, such as hypercalcemia and hypercalciuria. Some analogs of vitamin D obtained through molecular modification can reduce the side effects while retaining a similar regulatory action as that of vitamin D. The supplementation of vitamin D or the use of vitamin D analogs may contribute to the prevention and treatment of immune inflammatory diseases. This article reviews the role of vitamin D and its analogues in the prevention and treatment of oral mucosal diseases and periodontal diseases. The literature review results show that vitamin D and its analogues can protect the integrity of the oral mucosal barrier, prevent or delay the occurrence of oral lichen planus, and provide a reference value for the prevention and treatment of periodontitis.
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Objective To observe the effect of different hemodialysis methods on calcium and phosphorus metabolism in uremic patients .Methods 130 patients with uremia who underwent hemodialysis were divided into maintenance hemodialysis group ( HD group ) and maintenance hemodialysis filtration group ( HDF group ) according to different dialysis methods ,65 cases in each group .The HD group was treated with maintenance hemodialysis .The HDF group received high -throughput polysulfone membrane dialyzer ,the two groups received dialysis for 6 months. The Ca2+,serum phosphorus (P3+),parathyroid hormone (iPTH),1,25 dihydroxyvitamin D[1,25(OH)2D] were measured before and after treatment in both two groups .Results The total effective rate was 76.92％ in the HD group and 84.62％in the HDF group.There was no statistically significant difference between the two groups (χ2 =1.25,P=0.535).After treatment,Ca2+in the two groups was statistically significantly increased compared with before treatment(t=4.841,P=0.00;t=8.600,P=0.00),and Ca2+in the HDF group was higher than that in the HD group (t=4.410,P=0.00).After treatment,P3+in the two groups was significantly decreased compared with before treatment(t=14.580,P=0.00;t=19.260,P=0.00),and P3+in the HDF group was lower than that in the HD group(t=6.500,P=0.00).After treatment,iPTH in the two groups was significantly decreased compared with before treatment(t=58.800,P=0.00;t=65.730,P=0.00),and iPTH in the HDF group was significantly lower than that in the HD group (t=8.380,P=0.00).After treatment,the 1,25(OH)2D levels in the two groups were significantly higher than those before treatment (t=18.970,P=0.00;t=21.650,P=0.00),and 1,25(OH)2D level in HDF group was significantly higher than HD group (t=3.250,P=0.001).Conclusion Compared with maintenance hemodialysis , maintenance hemodialysis filtration has more positive effect on calcium and phosphorus metabolism in uremic patients ,and it has significant effect on lowering blood phosphorus and increasing serum calcium level,so it is more suitable for clinical use .
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Objective To investigate whether serum sclerostin level is an indicator of the prognosis in patients with maintenance hemodialysis(MHD).Methods The clinical data of MHD patients treated in Yan′an University Affiliated Hospital in recent 3 years were collected to record their basic information and routine blood biochemical indexes.Serum Sclerostin levels were measured by ELISA calcaneus,while bone mineral density(BMD)was measured by quantitative ultrasound(QUS);correlation analysis was applied to screen the indicators affecting BMD.Logiest regression was used to look for protective factors and risk factors of low bone density;The correlation between serum sclerostin level and bone mineral density was analyzed,and ROC curve was used to explore whether serum sclerostin level could be used to predict low level bone mineral density.Results The median serum sclerostin concentration of 62 patients was 166.74(105.87,311.90)pmol/L.Spearman correlation analysis showed that serum sclerostin levels were positively correlated with BMI,serum calcium and 25(OH)VitD levels(r= 0.327,0.323,0.257,P= 0.010,0.049,0.044),while negatively correlated with lg[iPTH],spKt/v,triglyceride(TG),low density lipoprotein cholesterol(LDL-C)(r=-0.254,-0.279,-0.186,-0.314,P=0.046,0.012,0.027,0.031).Serum Sclerostin level was not related with serum phosphorus,alkaline phosphatase(AKP),high density lipoprotein cholesterol(HDL-C)and LDL(P>0.05) .Correlation analysis showed serum sclerostin levels were significantly and positively correlated with BMD(r=0.328,P=0.009).Logistic regression showed that serum sclerostin level was a risk factor for BMD(OR=1.17,95%CI(0.928~1.474);P=0.008).The ROC curve was established,and the area under the curve of serum sclerostin diagnosis was 87.9%.Conclusion Serum sclerostin levels are positively correlated with bone mineral density.And serum sclerostin levels may become a marker to predict the prognosis in MHD patients.
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OBJECTIVE:To investigate the effects of lanthanum carbonate on calcium and phosphate metabolism in maintenance hemodialysis(MHD)patients with high calcium and high phosphorus. METHODS:A total of 40 MHD patients with high calcium and high phosphorus in our hospital during May 2014-May 2015 were divided into control group(22 cases)and observation group (18 cases)according to therapy plan. Both groups received diet guidance and MHD treatment. Control group was given Hydrotalcite chewable tablets 1 g,during meal,tid. Observation group was additionally given Lanthanum carbonate chewable tablets 500 mg(for patients with blood phosphorus ≥2.26 mmol/L)or 250 mg(for patients with blood phosphorus <2.26 mmol/L),during meal,tid (adjusting after 4 weeks).Both groups received treatment for 3 months.The calcium and phosphorus metabolism indexes[blood calci-um,blood phosphorus,calcium and phosphorus product,immunoreactive parathyroid hormone(iPTH)and alkaline phosphatase] and phosphorus reducing efficacies were observed in 2 groups before and after treatment,and the occurrence of ADR was recorded. RE-SULTS:Before treatment,there was no statistical significance in calcium and phosphorus metabolism indexes between 2 groups(P>0.05).After treatment,there was no statistical significance in calcium and phosphorus metabolism indexes of control group,iPTH or alkaline phosphatase of observation group compared to before treatment(P>0.05);blood calcium,blood phosphorus,calcium and phosphorus product of observation group were significantly lower than before treatment and also lower than control group at corre-sponding time,with statistical significance(P<0.05).Total response rate of phosphorus reducing in observation group(88.89%)was significantly higher than control group(40.91%),with statistical significance(P<0.05). There was no statistical significance in the incidence of ADR between observation group(11.11%)and control group(4.55%)(P>0.05). CONCLUSIONS:The lanthanum carbonate can effectively decrease blood calcium and blood phosphorus levels in MHD patients with good safety.
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Metabolic bone disease of prematurity (MBDP) is an important chronic disease in the neonates. The metabolic abnormalities of calcium, phosphorus, vitamin D and others in premature can lead to decline of bone mineral content, decrease of trabecular bone quantity, thinning of cortical bone, etc., which can cause rickets in severe cases and even fracture. Low gestational age and low birth weight of premature are important risk factors for metabolic bone disease. The diagnosis relies on clinical features as well as laboratory, radiological and ultrasonographic examinations. The treatment includes reinforcement of the passive movement, supplementiation of the calcium, phosphorus and vitamin D, better prevention and so on. Early detection, early diagnosis, and early treatment can reduce the incidence of sequelae of metabolic bone disease, and reduce the long-term impact on premature infants.
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OBJECTIVE:To investigate the effects of lanthanum carbonate on calcium and phosphate metabolism in maintenance hemodialysis(MHD)patients with high calcium and high phosphorus. METHODS:A total of 40 MHD patients with high calcium and high phosphorus in our hospital during May 2014-May 2015 were divided into control group(22 cases)and observation group (18 cases)according to therapy plan. Both groups received diet guidance and MHD treatment. Control group was given Hydrotalcite chewable tablets 1 g,during meal,tid. Observation group was additionally given Lanthanum carbonate chewable tablets 500 mg(for patients with blood phosphorus ≥2.26 mmol/L)or 250 mg(for patients with blood phosphorus <2.26 mmol/L),during meal,tid (adjusting after 4 weeks).Both groups received treatment for 3 months.The calcium and phosphorus metabolism indexes[blood calci-um,blood phosphorus,calcium and phosphorus product,immunoreactive parathyroid hormone(iPTH)and alkaline phosphatase] and phosphorus reducing efficacies were observed in 2 groups before and after treatment,and the occurrence of ADR was recorded. RE-SULTS:Before treatment,there was no statistical significance in calcium and phosphorus metabolism indexes between 2 groups(P>0.05).After treatment,there was no statistical significance in calcium and phosphorus metabolism indexes of control group,iPTH or alkaline phosphatase of observation group compared to before treatment(P>0.05);blood calcium,blood phosphorus,calcium and phosphorus product of observation group were significantly lower than before treatment and also lower than control group at corre-sponding time,with statistical significance(P<0.05).Total response rate of phosphorus reducing in observation group(88.89%)was significantly higher than control group(40.91%),with statistical significance(P<0.05). There was no statistical significance in the incidence of ADR between observation group(11.11%)and control group(4.55%)(P>0.05). CONCLUSIONS:The lanthanum carbonate can effectively decrease blood calcium and blood phosphorus levels in MHD patients with good safety.
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Hemodialysis is one of the main treatment methods for patients with end stage renal disease (ESRD),and conventional hemodialysis (CHD) is the most widely used one.With the development of dialysis technology,the survival time of hemodialysis patients is significantly prolonged,but the mortality remains high.Nocturnal hemodialysis (NHD) was proposed in 1963 as a new type of dialysis,and it has greatly extended time of dialysis as compared with CHD.NHD has advantages in controlling blood pressure and cardiovascular function,correcting anemia,improving calcium and phosphorus metabolism and nutritional status,and enhancing quality of life of hemodialysis patients.
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Hemodialysis is one of the main treatment methods for patients with end stage renal disease (ESRD), and conventional hemodialysis (CHD) is the most widely used one. With the development of dialysis technology, the survival time of hemodialysis patients is significantly prolonged, but the mortality remains high. Nocturnal hemodialysis (NHD) was proposed in 1963 as a new type of dialysis, and it has greatly extended time of dialysis as compared with CHD. NHD has advantages in controlling blood pressure and cardiovascular function, correcting anemia, improving calcium and phosphorus metabolism and nutritional status, and enhancing quality of life of hemodialysis patients.
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Metabolic bone disease of prematurity (MBDP) is an important chronic disease in the neonates. The metabolic abnormalities of calcium, phosphorus, vitamin D and others in premature can lead to decline of bone mineral content, decrease of trabecular bone quantity, thinning of cortical bone, etc., which can cause rickets in severe cases and even fracture. Low gestational age and low birth weight of premature are important risk factors for metabolic bone disease. The diagnosis relies on clinical features as well as laboratory, radiological and ultrasonographic examinations. The treatment includes reinforcement of the passive movement, supplementiation of the calcium, phosphorus and vitamin D, better prevention and so on. Early detection, early diagnosis, and early treatment can reduce the incidence of sequelae of metabolic bone disease, and reduce the long-term impact on premature infants.
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Objective: To investigate the protecting and regulatory effects of water extract from Fructus Ligustri Lucidi (FLL) on bone structure and bone metabolism in osteoporosis rats. Methods: SD female rats were bilaterally ovariectomized to establish osteoporosis model, and Sham operated rats only cut the fat around the ovary. Experimental rats were divided into four groups: Sham operation (SHAM) group, model (OVX) group, alendronic acid sodium (ALN) group, and Fructus Ligustri Lucidi (FLL) group, with nine rats in each group. The rats in FLL group were given FLL water extract (3.5 g/kg) and rats in ALL group were given ALN suspension (0.12 g/kg) by ig administration for 12 weeks. At the end of the experiments, the contents of serum and urine calcium (S-Ca) and phosphorus (S-P), urine creatinine (U-Ca/Cr and U-P/Cr), serum high density lipoprotein (HDL-C) cholesterol, low density lipoprotein (LDL-C) cholesterol, total cholesterol (TC), and triglyceride (TG) were measured by biochemical methods. The levels of collagen I amino terminal peptide (PINP), collagen I carboxyl terminal peptide (CTX-I), osteocalcin (OCN), and urine deoxypyridinoline (DPD) were measured with ELISA. The determination of alkaline phosphatase (ALP) was by radioimmunoassay method. To evaluate the change of bone tissue structure, the bone density instrument, VivaCT, and a universal testing machine were used. Results: FLL could inhibit the increased body weight of ovariectomy (OVX) rats, increase S-Ca, S-P, serum HDL and PINP contents, reduce urinary U-Ca/Cr and U-P/Cr ratios, reduce serum LDL-C, TC, TG, ALP, OCN, CTX, and reduce urinary DPD content (P < 0.05 or 0.01) in OVX rats. Meanwhile, FLL can elevate the femur head and vertebral bone mineral density, bone micro-structure and bone strength in OVX rats. Conclusion: FLL can improve the bone density and bone strength in OVX rats by regulating Ca and P metabolism, collagen and non-collagen metabolism.
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Este estudo foi conduzido com o objetivo de avaliar os níveis de fitase em rações para suínos em crescimento selecionados para deposição de carne. Foram utilizados 64 suínos mestiços (32 machos castrados e 32 fêmeas), híbridos comerciais, com peso médio inicial de 23,311±2,254 kg, distribuídos em delineamento de blocos casualizados, com quatro tratamentos, oito repetições e dois animais (um macho e uma fêmea) por unidade experimental. Os tratamentos foram constituídos por uma ração controle de origem vegetal, sem inclusão de fosfato bicálcico e fitase, contendo 0,100% de fósforo disponível; e de outras três rações obtidas pela inclusão de 300, 600 e 1200 unidades de fitase (UFT kg-1) à ração controle. Os níveis de fitase influenciaram de forma linear o ganho de peso diário e consumo de ração, aumentando até o nível de 293 e 307 UFT kg-1 de ração, respectivamente, a partir do qual permaneceram em um platô. A conversão alimentar diminuiu até 255 UFT kg-1 de ração, a qual permaneceu em um platô. Os níveis de fitase não influenciaram os teores de cinzas e fósforo no metacarpo dos animais. Houve efeito linear decrescente dos tratamentos sobre o resultado bioquímico de fosfatase alcalina. Os melhores resultados de ganho de peso, consumo de ração e conversão alimentar foram obtidos, respectivamente, com os níveis de 293, 307 e 255 UFT kg-1 de ração, em suínos de alto potencial genético para deposição de carne na fase dos 55 aos 90 dias de idade.
This study was carried out to determine the phytase levels in diets for growing swine selected for meat deposition. Sixty-four crossbred swine (32 barrows and 32 females), with an average initial weight of 23.311±2.254 kg were distributed in a block design with four treatments and eight replications of two animals (one male and one female) each. The treatments consisted of a control diet with vegetables ingredients, without dicalcium phosphate and phytase inclusion, containing 0.100% available phosphorus and three other diets obtained by the inclusion of 300, 600 and 1200 phytase units (FTU kg-1) to the control diet. Levels of phytase influenced linearly the daily weight gain and feed intake, increasing to the level of 293 and 307 FTU kg-1 diet, respectively, from which remained on a plateau. Feed conversion ratio decreased to 255 FTU kg-1 diet, and remained on a plateau. Levels of phytase did not affect the levels of ash and phosphorus in animal bone. There was decreasing linear effect of treatments on the biochemical results of alkaline phosphatase. The best results in weight gain, feed intake and feed conversion were obtained, respectively, with levels of 293, 307 and 255 FTU kg-1 of feed for pigs of high genetic potential for lean deposition during the 55 to 90 days of age.
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Chronic kidney disease-mineral and bone disorder (CKD-MBD) refers to a series of clinical symptoms and biochemical and imaging abnormalities caused by minerals and calcium phosphorus metabolic disorder,which is associated with chronic kidney disease (CKD).Since 2006 ,the concept of CKD-MBD was put forward for the first time,doctors are increasingly paying more attention to it.This review introduces the epidemiological characteristics, clinical manifestation, examination methods, diagnostic criteria and the research progress of treatment and prevention of CKD-MBD.
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OBJECTIVES: Discuss pathophysiological aspects of cerebral calcifications (CC) and highlight its importance related to the occurrence of neuropsychiatric syndromes. METHOD: Single case report. RESULT: Man 52 years old, 20 years after going through a total thyroidectomy, starts showing behavioral disturbance (psychotic syndrome). He was diagnosed as schizophrenic (paranoid subtype) and submitted to outpatient psychiatric treatment. During a psychiatric admission to evaluate his progressive cognitive and motor deterioration, we identified a dementia syndrome and extensive cerebral calcifications, derived from iatrogenic hypoparathyroidism. CONCLUSION: The calcium and phosphorus disturbances, including hypoparathyroidism, are common causes of CC. Its symptoms can imitate psychiatric disorders and produce serious and permanent cognitive sequelae. The exclusion of organicity is mandatory in any psychiatric investigative diagnosis in order to avoid unfavorable outcomes, such as in the present case report.
OBJETIVOS: Discutir aspectos fisiopatológicos das calcificações cerebrais (CC) e ressaltar sua importância na ocorrência de síndromes neuropsiquiátricas. MÉTODO: Relato de caso individual. RESULTADO: Homem 52 anos de idade, 20 anos após tireoidectomia total, iniciou com alteração comportamental (síndrome psicótica), foi diagnosticado como portador de esquizofrenia paranoide e encaminhado para ambulatório de psiquiatria. Durante internação psiquiátrica, para avaliação de importante deterioração cognitivo e motora, foi verificada a vigência de síndrome demencial e extensas CC, secundários a hipoparatiroidismo iatrogênico. CONCLUSÃO: Os distúrbios do metabolismo do cálcio e do fósforo, incluindo o hipoparatiroidismo, são causas frequentes de CC. Seus sintomas podem mimetizar transtornos psiquiátricos e provocar sequelas cognitivas permanentes. A exclusão de organicidade é mandatória durante toda investigação diagnóstica na psiquiatria, a fim de evitar desfechos desfavoráveis, como no presente relato de caso.
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Objective To investigate disorders in calcium and phosphorus metabolism and abnormity in parathyroid function and their related factors in maintenance hemodialysis(MHD)patients.Methods We collected serum Hb,SCr,BUN,calcium,phosphorus,iPTH,high sensitivity C-reactive protein(hs-CRP),albumin and calculated albumin-corrected Ca and Kt/V from 198 patients with MHD in Jing'an District Central Hospital,Shanghai from Jan.2009 to Dec.2010.The calcium and phosphorus metabolism and parathyroid function were evaluated according to the guidelines of bone metabolism and controlling of bone disease in Kidney Disease Outcome Quality Initiative(KDOQI)recommended by National Kidney Foundation of the United States.198 patients were classified into the standard group(150-300 ng/L),lower than the standard group(＜150 ng/L)and higher than the standard group(＞ 300 ng/L)according to serum iPTH levels.Results In the 198 cases,110 cases were normal in serum Ac-Ca(55.6％); 118 cases were normal in serum phosphorus (59.6％); 143 cases were normal in Ca × P(72.3％); 39 cases were normal in iPTH(19.7％).All four items up to the standard were 28 cases(14.1％)among 198 cases.However,132(66.7％)patients showed lower than 150 ng/L in serum iPTH.The average serum iPTH gradually decreased with age.The senior patients demonstrated the highest average serum Hs-CRP,the lowest average serum phosphorus and the lowest albumin.There were no statistical significance in sex,hemodialysis duration,diabetes,blood pressure,Hb,Bun,SCr,Ac-Ca and Kt/V among three groups.Conclusion The disorders in calcium and phosphorus metabolism and abnormity in parathyroid function is common in the MHD patients.We should pay attention to hypofunction of parathyroid gland in the patients with MHD,which may be related to aging,malnutrition and potential infection.These findings need further investigation.
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Objective To investigate the early intervention to improve calcium and phosphorus metabolism in chronic kidney disease patients left ventricular hypertrophy. Methods 116 cases of non-dialysis patients with chronic kidney disease were randomly divided into 3,4-intervention group and control group, intervention group patients with calcium and phosphorus metabolism in early intervention were observed in patients with calcium, phosphorus, and left ventricular mass index changes. Results Patients in the intervention group after the intervention of phosphorus,calcium and phosphorus product,serum parathyroid hormone were significantly lower than the control group,the difference was all statistically significant (all P＜0.05 );intervention group of LVMI was significantly lower than before the intervention, but also significantly lower than the control group, the difference was statistically significant (P＜0.05). Conclusion Patients with chronic renal calcium and phosphorus metabolism of early intervention can improve symptoms in patients with left ventricular hypertrophy is beneficial to the improvement of patients with the disease.
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Bone turnover is regulated by local concentrations of cytokines such as osteoprotegerin (OPG) and receptor activator of nuclear factor kappaB ligand (RANKL). To explore the in vivo biological function of Opg and the mechanism of osteoporosis due to deficiency of Opg, Opg knockout mice have been generated through homologous recombination. Opg-/- mice exhibit a sharply decrease in bone density and strength as expected. The number of osteoclasts in Opg-/- mice significantly increases. Morphologically, osteoclasts appear more cuboidal in shape in Opg-/- mice than those of wt mice, suggesting that active osteoclastogenesis occurs in the absence of Opg. In consistent with this finding, an increase of osteoblast activity was also observed with accelerated mineral accumulation rate by histomorphometric measurement and elevated serum alkaline phosphatase activity (ALP) in Opg-/- mice. Interestingly, more than 50% of 2-month-old Opg-/- mice manifest medial calcification of aorta with comparable serum concentrations of calcium and phosphorus to wt mice. In conclusion, Opg-/- mice have a high-bone-rurnover type osteoporosis. The aortic calcification in Opg-/- mice is not due to abnormality of calcium and phosphorus metabolism. The mechanism underlying aortic calcification in Opg-/- mice needs to be further investigated.