Effects of Monthly Intramuscular High-Dose Vitamin D2 on Serum 25-Hydroxyvitamin D and Immune Parameters in Very Elderly Chinese Patients with Vitamin D Deficiency.

PURPOSE: Vitamin D deficiency is highly prevalent among the very elderly and is associated with a wide variety of clinical conditions other than musculoskeletal diseases. This study aims to ascertain the efficacy and safety of high-dose intramuscular vitamin D2 in very elderly Chinese patients with vitamin D deficiency. METHODS: Very elderly (aged 80 years or over) Chinese patients with vitamin D deficiency were recruited to receive monthly intramuscular injections of 600,000 IU vitamin D2 until their serum 25-hydroxyvitamin D (25(OH)D) reached ≥30 ng/mL. The serum levels of 25(OH)D2, 25(OH)D3, iPTH, BTMs, immune parameters, and other biochemical parameters were measured at baseline and one month after each dose. RESULTS: Of the 30 very elderly Chinese patients who had been recruited into the study, 27 (90.0%) had their vitamin D deficiency corrected, and 26 (86.7%) reached vitamin D sufficiency. The mean time (±SD) was 3.1 (±1.3) months for vitamin D deficiency to be corrected, and 6.1 (±0.8) months for vitamin D sufficiency to be reached. The mean (±SD) serum level of 25(OH)D2 increased from 0.69 (±1.51) ng/mL to 29.07 (±5.68) ng/mL, while the mean (±SD) serum level of 25(OH)D3 decreased from 9.82 (±2.75) ng/mL to 5.30 (±3.09) ng/mL (both P < 0.001). The total T cells in serum remained unchanged (P > 0.05), and the CD4 and B cells (CD19+) were increased significantly (both P < 0.05). In addition, no significant change was observed in the serum levels of iPTH and BTMs. CONCLUSION: Monthly intramuscular injection of 600,000 IU vitamin D2 is an effective and safe dosing regimen to reach vitamin D sufficiency and enhances immune function in the very elderly Chinese patients with vitamin D deficiency.

Zoledronate-induced acute anterior uveitis: a three-case report and brief review of literature.

PURPOSE: This three-case report aims to highlight the ocular adverse effects induced by bisphosphonate therapy and to call clinicians' attention. METHODS: Three cases of acute anterior uveitis secondary to the initial dose of zoledronate infusion were reported with focus on their symptoms, treatment regimens, and outcomes. A review of published reports provided a basis for discussion. RESULTS: Three cases of acute anterior uveitis were either bilateral or unilateral. They demonstrated typical manifestations of bisphosphonate-induced acute anterior uveitis such as eye pain, blurred vision, conjunctival and ciliary hyperemia, keratic precipitates, and flare in the anterior chamber. After topical corticosteroid-containing comprehensive treatments, these symptoms resolved completely without any vision loss and long-term sequelae. CONCLUSIONS: Acute anterior uveitis may be part of the acute phase reaction induced by zoledronate. Patients should be informed of its symptoms in advance and be monitored closely during and after administration. Clinicians should have a good awareness of the zoledronate-associated acute anterior uveitis and to treat it in a prompt and appropriate manner.

Transient increase in international normalized ratio (INR) and bleeding risk following Alendronate sodium in elderly patients on warfarin: Two case reports.

INTRODUCTION: Alendronate sodium is used to reduce the risk of bone fracture in aged osteoporosis patients. However, its side effects should be recognized, especially for those aged patients with one or more basic cardiovascular diseases. PATIENT CONCERNS: A 90-year-old and a 75-year-old male patient were admitted to our department. These 2 patients were examined by dual energy X-ray absorptiometry (DXA). DIAGNOSIS: Both patients were diagnosed with osteoporosis, they also had history of atrial fibrillation (AF) and had long term use of warfarin. INTERVENTIONS: Alendronate sodium was prescribed to the two patients at 70 mg once a week. OUTCOMES: The 2 patients had experienced dramatic increase of international normalized ratio (INR) to 4.69∼4.86 within 24 hours and gradual decrease in the next 5 days. Both patients experienced spontaneous ecchymoses and petechiae in the skin at the first 72 hours. CONCLUSION: Alendronate sodium can transiently increase the INR over 50%, induce spontaneous ecchymoses and petechiae in the skin of aged male osteoporosis patients with AF who took warfarin. Clinicians should pay enough attention when using alendronate sodium on these kinds of patients and be aware of the consequent potential bleeding risk.

Reference intervals of ß-C-terminal telopeptide of type I collagen, procollagen type I N-terminal propeptide and osteocalcin for very elderly Chinese men.

AIM: The present study was intended to establish the reference intervals of ß-C-terminal telopeptide of type I collagen, procollagen type I N-terminal propeptide and osteocalcin for very elderly (aged 80 years or more) Chinese men. METHODS: A total of 1316 very elderly Chinese men were recruited into the study, and subjected to a survey of clinical characteristics, measurements of bone mineral density and assays of bone turnover markers. The relationships between underlying diseases and bone turnover markers were investigated, and the reference intervals of ß-C-terminal telopeptide of type I collagen, procollagen type I N-terminal propeptide and osteocalcin for very elderly Chinese men were established through defining the central 95% range of all observations. RESULTS: We found that type 2 diabetes mellitus, chronic obstructive pulmonary disease and abnormal bone mass were associated with serum bone turnover markers (P < 0.01), and thereby identified 208 men without type 2 diabetes mellitus, chronic obstructive pulmonary disease and/or abnormal bone mass as healthy participants from 1316 very elderly Chinese men. The reference intervals for very elderly Chinese men were 0.13-0.63 ng/mL for ß-C-terminal telopeptide of type I collagen, 18-94 ng/mL for procollagen type I N-terminal propeptide and 9-28 ng/mL for osteocalcin, respectively. The three turnover markers were moderately correlated to each other (P < 0.001), and all negatively associated with the bone mineral density of three sites (P < 0.05). CONCLUSIONS: We have established the reference intervals of ß-C-terminal telopeptide of type I collagen, procollagen type I N-terminal propeptide and osteocalcin for very elderly Chinese men. Geriatr Gerontol Int 2017; 17: 773-778.

Effects of endocrine therapy on the prognosis of elderly patients after surgery for papillary thyroid carcinoma.

Papillary thyroid carcinoma (PTC) is a common thyroid malignancy. Elderly patients have more severe disease and more complications following postoperative endocrine therapy to control thyroid-stimulating hormone (TSH) levels. We aimed to identify optimal postoperative serum TSH levels in elderly patients to prevent recurrence and metastasis and minimize complications. This retrospective cohort study collected data of 87 consecutive elderly patients (age >75) who underwent surgery for PTC with postoperative levothyroxine therapy (50-150 µg/d) between January 2006 and June 2008 and were followed until 2013. After 24 patients with TSH fluctuations and incomplete data were excluded, 73 patients were grouped based on postoperative TSH levels: Group A, 0.3-0.5 mIU/mL; Group B, 0.1-0.3 mIU/mL; and Group C <0.1 mIU/mL (n = 24, 25, 24, respectively). Subjects' baseline, preoperative data, postoperative complications and 1-, 3- and 5-year follow-up data were compared between groups. No significant differences in gender, age (median age of 80 years old), surgery type or clinical characteristics were found between groups (all p value >0.05). Postoperatively, all subjects had normal ECG and neck ultrasound, no osteoporosis, and no differences in survival rate or metastasis. Five-year follow-up revealed significant differences in development of arrhythmias, osteoporosis, insomnia and anxiety between Groups B (0.1-0.3 mIU/mL) and C (<0.1 mIU/mL) compared to Group A (0.3-0.5 mIU/mL). Postoperative incidence of PTC recurrence and metastasis remained stable in elderly patients undergoing thyroid surgery and endocrine therapy but complications increased significantly with increasing TSH levels. Controlling TSH to lower limits of normal may help prevent PTC recurrence and metastasis and reduce complications in this high-risk population.

Factors associated with low femoral neck bone mineral density in very elderly Chinese males.

OBJECTIVE: This study was designed to identify factors associated with the femoral neck bone mineral density (FNBMD) of the very elderly (aged 80 or more) Chinese males. METHODS: A total of 1177 very elderly Chinese males were recruited into the study, and subjected to FNBMD, biochemical parameters, bone turnover markers, and serum sex steroids assays. Univariate and multivariate regression analyses were performed to identify factors independently related to FNBMD. RESULTS: It was demonstrated that age (ß=-0.003, P=0.035), concomitant chronic obstructive pulmonary disease (COPD, ß=-0.027, P=0.009), serum ß-C-telopeptide of type 1 collagen (ß-CTX, ß=-0.097, P<0.001), and parathyroid hormone (PTH, ß=-0.001, P=0.004) were negatively correlated with the FNBMD, while body mass index (BMI, ß=0.009, P<0.001), and serum estradiol (ß=0.001, P=0.038) were positively related to FNBMD in very elderly Chinese males. CONCLUSION: An integrated intervention should be implemented to increase the BMD of the very elderly males, with special attention to preventing and curing COPD, reducing serum ß-CTX and PTH levels, as well as keeping a proper BMI and serum estradiol level.

Targeting SMAD3 for inhibiting prostate cancer metastasis.

Although SMAD3 signaling has been suggested to play a role in the metastasis of various cancers, its possible involvement as well as the underlying mechanism in the pathogenesis in prostate cancer remains unclear. Here, we found that the MMP9 level, an indicator of the invasiveness of cancer cells, negatively correlates with the activity of phosphorylated SMAD3 levels in the prostate cancer patients. Moreover, the phosphorylated SMAD3 also appeared to regulate the MMP9 level in a prostate cancer cell line, PC3. Augmented phosphorylated SMAD3 inhibited MMP9 and invasiveness of PC3 cells, while inhibition of phosphorylated SMAD3 activated MMP9 and promoted PC3 cell invasiveness. Furthermore, forced MMP9 inhibition abolished the effect of phosphorylated SMAD3 on the invasiveness of PC3 cells, while forced MMP9 activation abolished the effect of phosphorylated SMAD3 on the invasiveness of PC3 cells. Taken together, our data suggest the possibility of the existence of a unique signaling cascade in which SMAD3 signaling regulates MMP9 during cancer metastasis.

High salt intake and stroke: meta-analysis of the epidemiologic evidence.

Research on the potential impact of high salt intake on health has grown rapidly over the last decades. Recent studies have suggested that high salt intake could also be associated with adverse effects on cardiovascular system. The review evaluated the current level of epidemiologic evidence on the association between the level of habitual salt intake and stroke outcome. We also suggest further research direction. There were 21 independent samples from 12 studies, with 225,693 participants (follow-up, 3-19 years) and 8135 stroke events. High salt intake was associated with risk of stroke event (pooled odd ratio [OR], 1.34; 95% confidence interval [CI], 1.19-1.51), stroke death (1.40; 1.21-1.63) and stroke onset (1.11; 1.00-1.24), ischemic stroke death (2.15; 1.57-2.95), not associated with risk of ischemic stroke onset (1.07, 0.95-1.2), with no significant evidence of publication bias. High salt intake is associated with significantly increased risk of stroke event. Further research should be directed toward clarifying and quantifying these possible effects and generating testable hypotheses on plausible biologic mechanisms.

Meta-analysis of association between particulate matter and stroke attack.

AIMS: We conducted systematic review as well as meta-analyses on the association between particulate matter and daily stroke attack from a number of epidemiologic studies. METHODS: Twelve quantitative studies about the associations between particulate matter and stroke attack met the inclusive criteria. We evaluated the odds ratio (OR) of stroke attack associated with per 10 µg/m(3) increase of the concentration of PM(10) (particulate matter with aerodynamic diameter ≤ 10 µm) or PM(2.5) (particulate matter with aerodynamic diameter ≤ 2.5 µm) as effect scale, and a sensitivity analysis for the results was conducted. RESULTS: In the time-series design, PM(10) exposure wasn't related to an increased risk of daily stroke attack [OR per 10 µg/m(3) = 1.002, 95% confidence interval (CI): 0.999~1.005], PM(2.5) exposure were related to an increased risk of daily stroke attack (OR per 10 µg/m(3) = 1.006, 95%CI: 1.002~1.010]; but in the case-crossover studies, PM(10) exposure was related to increase in risk of daily stroke attack (OR per 10 µg/m(3) = 1.028, 95%CI: 1.001~1.057). PM(2.5) exposure was not significant association with daily stroke attack (OR per 10 µg/m(3) = 1.016, 95%CI: 0.937~1.097). Sensitivity analysis showed that the results for PM(10) , PM(2.5) and daily stroke attack were robust in the time-series design. CONCLUSIONS: We found some evidence for an effect of air pollutants on stroke attack risk.