Comparison of effectiveness and safety of high-dose native vitamin D versus active vitamin D in the treatment of hypoparathyroidism / 中华内分泌代谢杂志

Objective@#To investigate the effectiveness and safety of high-dose native vitamin D versus active vitamin D by retrospective analysis of clinical data in patients with non-surgical hypoparathyroidism (ns-HP) in our hospital.@*Methods@#ns-HP patients with stable therapeutic schedule in recent three years were included. According to the vitamin D agents used, patients were divided into three groups: active vitamin D group, native vitamin D group, and mixed vitamin D group. The effectiveness was evaluated by analysis of markers including post-treatment serum calcium, incidence of hypocalcemia, hypocalcemic symptoms and signs. The safety was evaluated in various groups by analyzing incidences of hypercalcemia and hypercalciuria, glomerular filtration rate, percentage of thiazide diuretic use, nephrocalcinosis or renal stone.@*Results@#Patients in active vitamin D group were more likely to experience episodes of hypocalcemia compared with those in native group (32.94%±21.46% vs 24.86%±10.1%, P<0.05). No significant differences in other indexes for assessing effectiveness and safety were found among three groups (P>0.05).@*Conclusions@#Under the circumstance of regular follow-up, both high-dose native vitamin D and active vitamin D could treat ns-HP effectively and safely. Native vitamin D may be better in maintaining eucalcemia and reducing incidence of hypocalcemia compared with active vitamin D.

Comparison of effectiveness and safety of high-dose native vitamin D versus active vitamin D in the treatment of hypoparathyroidism / 中华内分泌代谢杂志

Objective To investigate the effectiveness and safety of high-dose native vitamin D versus active vitamin D by retrospective analysis of clinical data in patients with non-surgical hypoparathyroidism ( ns-HP) in our hospital. Methods ns-HP patients with stable therapeutic schedule in recent three years were included. According to the vitamin D agents used, patients were divided into three groups: active vitamin D group, native vitamin D group, and mixed vitamin D group. The effectiveness was evaluated by analysis of markers including post-treatment serum calcium, incidence of hypocalcemia, hypocalcemic symptoms and signs. The safety was evaluated in various groups by analyzing incidences of hypercalcemia and hypercalciuria, glomerular filtration rate, percentage of thiazide diuretic use, nephrocalcinosis or renal stone. Results Patients in active vitamin D group were more likely to experience episodes of hypocalcemia compared with those in native group (32.94% ± 21.46% vs 24.86% ± 10.1%, P＜0.05). No significant differences in other indexes for assessing effectiveness and safety were found among three groups ( P＞0.05). Conclusions Under the circumstance of regular follow-up, both high-dose native vitamin D and active vitamin D could treat ns-HP effectively and safely. Native vitamin D may be better in maintaining eucalcemia and reducing incidence of hypocalcemia compared with active vitamin D.

Active vitamin D3 plays a protective role in podocytes of diabetic rats by regulating autophagy activity / 中华内分泌代谢杂志

Objective To investigate the protective effect and mechanism of active vitamin D3 on podocyte injury in type 1 diabetic rats.Methods Animals were randomly divided into normal control group (NC group),diabetic nephropathy group (DN group),diabetes nephropathy plus active vitamin D3 group (DN + VD group).Random tail vein blood glucose was measured and 24 hours of urine was collected every 3 weeks to observe the dynamic changes of blood glucose and 24-hour urine volume and urinary albumin.Rats were sacrificed at the end of 18th week,the kidney weight to body weight ratio,serum creatinine,blood urea nitrogen,serum calcium,and serum phosphorus levels were measured.Pathological in glomeruli were observed by PAS staining.Immunohistochemistry and Western blotting were used to observe the expression of slit diaphragms proteins including Nephrin,Podocin,and vitamin D receptor protein VDR.The mRNA level of autophagy-related protein P62 was detected by realtime quantitative PCR,and expression of autophagy-related protein including LC3B/A,Beclin1,and P62 were detected by Western blotting.Ultrastructure of podocytes and autopbagosomes in podocytes were observed by electron microscopy.Results Levels of serum creatinine,blood urea nitrogen,and blood glucose in diabetic rats were higher than those in NC group (P＜0.05),but without significant difference between DN and DN+VD groups (P＞0.05).Compared with the DN group,the urinary protein and kidney weight to body weight ratio in the DN +VD group were significantly lower (P＜ 0.05).Mesangial matrix hyperplasia and basement membrane thickening were improved,and podocyte fusion and shedding were partially reversed.The expressions of Nephrin,Podocin,VDR,LC3B/A and Beclin1 were increased,and P62 mRNA and protein were down-regulated (P ＜ 0.05).The number of autophagosomes in podocytes increased.Besides,positive correlations were found between Nephrin and Beclin 1 (r =0.939 8,P＜0.05),as well as Nephrin and VDR (r=0.948 3,P＜0.05),and Beclin1 andVDR (r=0.9093,P＜0.05).Conclusion Active vitamin D3 inhibits the injury of diabetic nephropathy podocytes by up-regulating VDR expression and enhancing autophagy activity,thereby reducing proteinuria and delaying the development of diabetic nephropathy.

Observational studies of active vitamin D supplements for promoting postoperative lumbar functional rehabilitation in postmenopausal women / 中国实用护理杂志

Objective@#To explore the effect of active vitamin D supplements on promoting postoperative lumbar functional rehabilitation in postmenopausal women.@*Methods@#From January 2015 to January 2017, selecting 120 postmenopausal women patients who underwent lumbar posterior surgery with age from 50 to 80 years, randomly divided into control group and observation group, control group and observation group suffer traditional nursing and treatment, meanwhile, observation group was supplied with active vitamin D, over a follow-up period of six months, using the Visual Analogue Scale(VAS)score, Japanese Orthopedic Association Scores(JOA)score, back stretch height to assess the effect of active vitamin D supplements.@*Results@#Back stretch height of patients in the observation group was (25.4 ± 2.6) cm, which was significantly better than (20.7 ± 2.1) cm of the control group after 6 months (t=-10.90, P<0.01); the observation group JOA score and VAS score were significantly better than the control group (JOA score: 25.8±2.0 vs. 24.6±1.8, t=-3.50, P<0.01; VAS score: 1.6±0.9 vs. 2.1±1.1, t=-3.10, P<0.01).@*Conclusion@#Active vitamin D supplements can improve the patient′s waist discomfort, enhance the muscle strength, improve the quality of life, and get better functional rehabilitation.

Impact of 1,25(OH)2VD3 on expression levels of IL-9 and PU.1 in rats with pulmonary fibrosis / 中国免疫学杂志

Objective:To explore the function of IL-9 and PU.1 on genesis and development of pulmonary fibrosis,and the effect of active vitamin D3[1,25(OH)2VD3] on the expression levels of this two factors during the pathogenesis of fibrosis.Methods: 90 male SD rats were randomly divided into model group,treatment group,control group (n=30).Bleomycin(5 mg/kg) was injected into the trachea of rats to establish the model of pulmonary fibrosis in the model group and treatment group,while the control group was injected with isopyknic sterile saline.The treatment group,the model group and the control group were injected intraperitoneally with active vitamin D3,solvent of vitamin D3 (propylene glycol) and sterile saline on the 2nd day after surgery respectively.All injections were carried out once every other day.10 rats were euthanized at 14th,21st and 28th day in each group in turn.After obtaining lung tissues from experimental rats,the pathological change of lung was compared by hematoxylin-eosin staining.The difference of collagen fiber and hydroxyproline content were compared by the Masson staining and basic-hydrolysis method respectively.The mRNA and protein expression of IL-9 and PU.1 in lung tissue were detected by Real-time PCR and immunohistochemical technology respectively.The expression of IL-9 in serum was detected by ELISA.Results: Fibrosis appeared in lungs of experimental rats treated with bleomycin after 14 days,and more and more aggravated with time.At three time points,the hydroxyproline content in model group and treatment group were significantly higher than that of control group,and the treatment group was significantly lower than the model group.At three time points,the expression of IL-9 and PU.1 in model group and treatment group were risen gradually,and obviously higher than that in control group.On the 14th and 21st day,the expression of two factors in treatment group was significantly lower than model group;on the 28th day,there was no statistically significant difference between treatment group and model group(P>0.05).In model group and treatment group,the expression of two factors on 21st day was significantly higher than that on 14th day;there was no statistically significant difference between the 28th day and the 21st day.Conclusion: IL-9 and PU.1 may play a profibrotic role at early stage of pulmonary fibrosis induced by bleomycin.The active vitamin D3 may lower the expression level of PU.1,and then reduce the secretion of IL-9,thus may play an inhibiting effect on genesis and development of pulmonary fibrosis in rats.

Study on the Correlation Factors for Active Vitamin D3 Intervention for Elderly Patients with Sarcopenia in Plateau Regions / 昆明医科大学学报

Objective To observe the correlation between active vitamin D3 level and sarcopenia development in elderly patients in plateau regions and the changes in the correlation factors for sarcopenia under the invention of active vitamin D3 (Calcitriol,Cal),and to observe whether Cal could improve the muscle function.Methods 90 patients were assigned to the normal control (Con) arm,and 120 patients with sarcopenia were assigned to the sarcopenia (Sar) arm to receive different oral doses of Cal as intervention (0.25 ug/d for low dose group including 60 patients and 0.25ug bid for high dose group including 60 patients) Before and after the intervention,levels of 1,25-(OH)2D3 and the inflammatory factors TNF-α,IL-6,IL-10,and hs-CRP were detected using ELISA;HOMA-IR,BMI,and ASMI were calculated;and walking speed and grip strength were measured to observe the correlation between 1,25-(OH) 2D3 level and sarcopenia,the changes in these indicators from before to after intervention,and the efficacy and safety of oral Cal for sarcopenia.Results Prior to intervention,compared with the Con arm,1,25-(OH)2D3 level,IL-10 level,ASMI,walking speed and grip strength were significantly reduced (P＜0.01),and HOMA-IR,IL-6,TNF-α and hs-CRP were significantly elevated (P＜0.01) in both dose groups;intervention with Cal produced significant increases in 1,25-(OH)2D3 and IL-10 levels,significantly improved walking speed and grip strength (P ＜0.05),significant decreases in HOMA-IR,IL-6,TNF-α,and hs-CRP (P＜0.05),which were more marked with higher dose,but no significant changes in ASMI.From before to after intervention,there were no significant changes in BMI or hepatic/renal function,blood calcium,or blood phosphorus in either group.Conclusions The development of sarcopenia is associated with reduced 1,25-(OH)2D3 level.Cal can lower the inflammatory factors IL-6,TNF-α,and hs-CRP,and elevate IL-10,providing anti-inflammatory and immunoregulatory actions;improve muscle function and strength;and improve insulin resistance.BMI is irrelevant to the management of sarcopenia.Cal is safe at the oral dose up to 0.5 tμg/d.

Chronic Kidney Disease-mineral Bone Disorder and Active Vitamin D Analogs for Treating Severe Hyperparathyroidism in Children Receiving Chronic Peritoneal Dialysis

PURPOSE: The aims of this study were to assess the clinical and laboratory profiles of chronic kidney disease-mineral bone disorder (CKD-MBD) and to assess the effects of treatment of active vitamin D analogs on severe hyperparathyroidism (SHPT) in pediatric patients on chronic peritoneal dialysis. METHODS: This is a retrospective study included 53 patients who had been undergoing dialysis for more than 1 year, between January 2003 and December 2012. RESULTS: Even after treatment with phosphate binders and active vitamin D analogs, the mean+/-standard deviation of the percentage of time during peritoneal dialysis that the patients' serum concentrations of phosphorus, corrected total calcium, and parathyroid hormone (PTH) fell within the Kidney Disease Outcomes Quality Initiative recommended ranges was 25.06+/-17.47%, 53.30+/-23.03%, and 11.52+/- 9.51%, respectively. Clinical symptoms or radiological signs of CKD-MBD were observed in 10 patients (18.9%). There were significant differences in percentage of time that the serum intact PTH concentration was outside of the recommended range between patients with and without symptoms or signs of CKD-MBD (below recommended range, 11.74+/-7.37% vs. 40.77+/-25.39%, P<0.001; above the recommended range, 63.79+/-27.86% vs. 37.09+/-27.76%, P=0.022). Of the 25 patients with SHPT, high-dose alfacalcidol treatment was required in 13 patients that controlled SHPT in 7 of these patients, without marked complications. CONCLUSION: Despite our efforts to manage CKD-MBD, patients' met the recommended ranges from relevant guidelines at a low frequency. The treatment of high-dose active vitamin D analogs was required in about half of the patients with SHPT and effective in about half of them.

Effect of exercises plus active vitamin D treatment on the bone mass of the elderly patients with osteoporosis / 中华物理医学与康复杂志

Objective To study the effect of exercises plus active vitamin D on the bone mass of the elderly osteoporosis patients. Methods Eighty nine cases of elderly osteoporosis were divided into 2 groups at random, with 45 cases in Group A (control group) and 44 in Group B (treatment group). Every patients in these two groups takes 600mg calcium and 0.25?g ? D 3 daily. At the same time, Group B conducts regular exercises. Results After the simple ? D 3 treatment, the lumbar BMD increased significantly and the level of osseous formation index BGP increased, but the osseous absorption index PYD/Cr did not change significantly. However, after the combined treatment with ? D 3 and exercise, the BMD at both the lumbar vertebra and the hip increased significantly, the level of osseous formation index BGP increased greatly and the osseous absorption index PYD/Cr decreased. Conclusion ? D 3 treatment is more favorable for aged osteoporosis patients in stimulating osseous formation than in inhibiting osseous absorption, and it is advantageous in increasing the bone mass of the lumbar vertebra. The ? D 3 treatment combined with aerobic exercise is helpful not only in increasing the bone mass of the lumbar vertebra and the hip in the elderly patients with osteoporosis, but also in stimulating osseous formation and inhibiting the osseous absorption.

Effects of Tibolone and Active Vitamin D Combined Treatment on Bone Mineral Density in Korean Postmenopausal Women / 대한내분비학회지

BACKGROUND: Tibolone is a novel synthetic compound with tissue-specific effects in bone, breast tissue and the endometrium. Tibolone, and active vitamin D, effectively prevent bone loss, and the maintain skeletal integrity of postmenopausal women. The aim of the present study was to examine the effect of tibolone, and active vitamin D (1-hydroxyvitamin D3), therapies given alone, or in combination, against bone loss in postmenopausal women. METHODS: One hundred and three postmenopausal women were treated with tibolone (n=40), alphacalcidol (n=27) or both drugs (n=36) for 12 months. All subjects took supplemental calcium carbonate (500 mg daily). The bone mineral densities (BMD) of the lumbar spine and proximal femur were measured by dual-energy x-ray absorptiometry (DXA) at the baseline and after 12 months. RESULTS: Tibolone therapy produced significant increase of 4.1 and 1.8% in the BMD at the lumbar spine (p<0.001) and femoral neck (p=0.009), respectively. The combination of tibolone and active vitamin D increased the BMD by 8.0 and 4.4% (p<0.001) at the spine and femoral neck, respectively. The differences in the change of BMD from the baseline at the lumbar spine was significant (p=0.038) in the combination treatment group compared that in the tibolone alone group. CONCLUSION: Tibolone alone, and in combination with active vitamin D, effectively increased the BMD at all skeletal sites in postmenopausal women. Combination treatment for osteoporosis is emerging as a promising modality in Korean postmenopausal women.