ObjectiveTo systematically review the quality of evidence-based guidelines (EBGs) on medication therapy for children with vitamin D deficiency, and to compare differences and similarities of the drugs recommended, in order to provide guidance for clinical practice. MethodsDatabases such as the TRIP, PubMed, EMbase, CNKI, VIP, WanFang Data, CBM, National Guideline Clearinghouse and Guidelines International Network were searched to collect EBGs on medication therapy for children with vitamin D deficiency. The methodological quality of the guideline was evaluated according to the AGREE Ⅱ instrument, and the differences between recommendations were compared. ResultsA total of 9 EBGs were included. Among them, 3 guidelines were developed by America, 1 by Europe, 1 by France, 1 by China, 1 by Poland, 1 by Canadian and 1 guideline was by Australia and New Zealand. Seven guidelines were developed specially for children, while others were for people of different ages. According to the AGREE Ⅱ instrument, only "Scope and purpose" and "clarity and presentation" were scored more than 60%. The recommendations of different guidelines were of large different. ConclusionThe quality of included guidelines concerning children with vitamin D deficiency is vary. Although only the America 2011 guideline is of high quality, the strength of recommendation is not high. Thus, the development of national guidelines is urgently needed.
ObjectiveTo investigate the role of 1,25-dihydroxyvitamin D3 in the posterior transforaminal lumbar interbody fusion (TLIF) for patients with osteoporosis and lumbar degenerative disease. MethodsBetween November 2011 and October 2012,44 patients with osteoporosis and lumbar degenerative disease were treated with TLIF and the clinical data were retrospectively analyzed.The patients were divided into 2 groups based on the administration of 1,25-dihydroxyvitamin D3.After TLIF operation,1,25-dihydroxyvitamin D3 was used in 21 patients (trial group),and was not used in 23 patients (control group).There was no significant difference in gender,age,etiology,affected segment,and disease duration between 2 groups (P>0.05).Lumbar interbody fusion was observed by X-ray and thin-section CT scan reconstruction of lumbar spine according to Brantigan assessment system at 6 months after operation and last follow-up.Clinical outcome was evaluated by Oswestry disability index (ODI) before and after operation. ResultsThe patients of 2 groups were followed up 12-27 months (mean,14.5 months).No fixation loosening or breaking occurred during follow-up.ODI scores in both groups were significantly improved at 6 months after operation and last follow-up (P<0.05) when conpared with preoperative value.Although at preoperation there was no significant difference in ODI score between 2 groups (P>0.05),ODI score of trial group was significantly lower than that of control group at 6 months after operation and last follow-up (P<0.05).At 6 months after operation,the interbody fusion rate was 76.19% (16/21) in trial group and 43.48% (10/23) in control group,showing significant difference (χ2=3.60,P=0.03); at last follow-up,the fusion rate was 95.24% (20/21) in trial group and 65.22% (15/23) in control group,showing significant difference (χ2=4.38,P=0.02). Conclusion1,25-dihydroxyvitamin D3 can improve the lumbar interbody fusion rate and general conditions in the patients with osteoporosis and lumbar degenerative disease.
ObjectiveTo explore the therapeutic effect of glucosamine hydrochloride combined with calcium and vitamin D on knee osteoarthritis. MethodsA total of 120 female outpatients with knee osteoarthritis from January 2014 to January 2015 were selected. The patients were randomly divided into study group and control group (60 patients in each group) according to their treatment sequence. The patients in the study group were given oral calcium citrate, alfacalcidol and glucosamine hydrochloride while those in the control group were given glucosamine hydrochloride only. Both groups were investigated and scored by Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire before and three and six months after treatment. ResultsThree and six months after the treatment, WOMAC scores of both groups were lower than those before the treatment with significant differences (P<0.05). Three months after the treatment, WOMAC scores between the two groups didn't differ much (P>0.05), while the difference between the two groups was significant 6 months after the treatment (P<0.05). Three months after the treatment, the difference of total effective rate in the study group (43.3%) and control group (41.7%) was not significant (P>0.05), while the rate in the study group (65.0%) was obviously higher than that in the control group (46.7%) 6 months after the treatment (P<0.05). ConclusionGlucosamine hydrochloride has exact effect on knee osteoarthritis. There are differences in the therapeutic effect on knee osteoarthritis between glucosamine hydrochloride combined with calcium and vitamin D and glucosamine hydrochloride alone after six-month treatment.
Objective To investigate the effects of 1, 25-( OH) 2D3 on the expression of matrix metalloprotease-9 ( MMP-9) and nuclear factor κB ( NF-κB) activity in a murine model of chronic asthma. Methods BALB/ c mice were sensitized and challenged with ovalbumin to establish chronic asthmatic model. The animals were randomly divided into a control group, an asthma group and a VD group. Lung sections from the mice were stained by HE and Masson’s trichrome, respectively. Morphometric analysis of the stained sections was performed using computerized image analysis system. Nuclear translocation of NF-κB p65 was examined using Western blot. The level of IκBαwas detected with real-time quantitative PCR ( RTPCR) and Western blot. In addition, the expression of MMP-9 in both activity and mRNA level was detected by gelatin zymograph and RT-PCR, respectively. Results Prominent airway remodeling developed in the asthma group, including the inflammatory cell infiltration, subepithelial collagen deposition and increased airway smooth muscle mass. In contrast, 1, 25-( OH) 2D3 attenuated these established structural changes of the airways. Stimulation with OVA induced a 7. 87-fold increase in the MMP-9 activity compared with that in the control group, and 1, 25-( OH) 2D3 treatment only induced a 3. 46-fold increase in the MMP-9 activity compared with that in the control group ( P lt;0. 05) . The mRNA level of MMP-9 in the VD group ( 3.16 ± 0.09) was decreased compared with the asthma group ( 5.74 ±0.13) ( P lt;0.05) , but itwas still higher than that in the control group ( 0.57 ±0.08) ( P lt;0.05) . 1, 25-( OH) 2D3 reduced the nuclear translocation of NF-κB p65 while up-regulated the IκBα level in lung tissue of chronic asthma. Conclusions 1, 25- ( OH) 2D3 can inhibit the NF-κB activity and down-regulate the expression of MMP-9 in lung tissue of chronic asthma, thus alleviating the established chronic asthma-induced airway remodeling.
Objective To summarize the changes of serum vitamin D level in patients with primary hyperparathyroidism (pHPT), the correlation between vitamin D and clinical manifestations, and feasible pathogenesis of pHPT. Method The literatures related to vitamin D and pHPT in recent years were reviewed. Results The level of vitamin D was decreased in patients with pHPT. Vitamin D level was negatively correlated with the weight of parathyroid adenoma, parathyroid hormone and blood calcium level, and positively correlated with bone mineral density. Conclusions Vitamin D nutritional status affects the severity of symptoms, main biochemical indexes and main clinical complications of patients with pHPT. There are various reasons accounted for the decline of vitamin D level, and the specific pathogenesis needs to be further explored. For patients with pHPT, vitamin D should be supplemented carefully and appropriately before surgical operation.
Objective To systematically review the effect of vitamin D (VitD) supplementation on cognitive function in people with cognitive impairment and non-cognitive disorders. MethodsThe PubMed, Web of Science, Cochrane Library, EMbase, CBM, CNKI, WanFang Data and VIP databases were searched to collect randomized controlled trials (RCTs) about the effect of VitD supplementation on cognitive function of patients with cognitive impairment or non-cognitive disorders from inception to March, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 19 articles including 8 684 cases were included. The results of meta-analysis showed that mini-mental state examination (MMSE) score (MD=1.70, 95%CI 1.20 to 2.21, P<0.01), Montreal cognitive assessment (MoCA) score (MD=1.51, 95%CI 1.00 to 2.02, P<0.01), Wechsler Adult Intelligence Scale-Revised (WAIS-RC) score (MD=9.12, 95%CI 7.77 to 10.47, P<0.01) and working memory (SMD=1.87, 95%CI 1.07 to 2.67, P<0.01) in the VitD group of patients with cognitive impairment were all better than those in the control group. However, the overall cognitive function and working memory of the non-cognitive impairment population were not significantly different compared with the control group. In terms of language fluency and language memory, there was no significant difference between the VitD group and the control group. In terms of the executive functions, at the intervention time of> 6 months, the VitD and control groups were statistically significant (SMD=0.15, 95%CI 0.01 to 0.28, P=0.03). Conclusion Current evidence suggests that VitD supplementation can effectively improve the overall cognitive function and working memory of patients with cognitive impairment, and has a positive effect on executive function at an intervention time of >6 months. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
Primary osteoporosis is a common metabolic disease in China, causing immense disease and economic burden to patients, their families and the society. Prevention is an important strategy to reduce the disease burden of primary osteoporosis. Calcium, as a basic element for maintaining bone health, plays an important role in the prevention of primary osteoporosis. This guideline was initiated by the Chinese Pharmaceutical Society Evidence-based Pharmacy Specialised Committee. The standard methodology for the development of evidence-based clinical practice guidelines of the World Health Organization (WHO) was employed. A multidisciplinary guideline working group was formed. Delphi method was used to select and eventually identified 15 key clinical questions. Systematic evaluation was carried out on each of the key clinical question and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to formed 15 recommendations, providing guidance for standardizing the clinical practice of calcium supplementation in prevention of primary osteoporosis in adults in China.
ObjectiveTo systematically evaluate the effects of vitamin D supplementation on fasting blood glucose, insulin resistance, β cell function in type 2 diabetes mellitus. MethodsDatabases including PubMed, The Cochrane Library (Issue 12, 2015), Web of Science, ScienceDirect Online, VIP, CNKI, WanFang Data, and CBM were searched to collect randomized controlled trials (RCTs) about vitamin D supplementation for type 2 diabetes mellitus from inception to December 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 and Stata12.0 softwares. ResultsA total of 22 RCTs involving 1 756 patients were included. The results of meta-analysis showed that, compared with the control group, the vitamin D supplementation group had a significant improvement in insulin resistance (SMD=–0.68, 95%CI –1.23 to –0.12, P=0.02), but there were no significant differences in levels of FPG, HbA1c and HOMA-β between the two groups (all P value > 0.05). Subgroup analysis showed that, the levels of FPG and HOMA-IR were significantly decreased in the vitamin D supplementation group in Middle Easterners and patients whose follow-up duration was less than three months. ConclusionVitamin D supplementation could improve HOMA-IR but could not improve the levels of FPG, HbA1c and HOMA-β. However, the evidence is weak to recommend vitamin D as a means of improving glycemic control, insulin resistance and β cell function in type 2 diabetes mellitus. Further larger, high quality trials are warranted.
ObjectiveTo systematically review vitamin D nutritional status among children and adolescents in China.MethodsCNKI, CBM, WanFang Data, VIP and PubMed databases were electronically searched to collect cross-sectional studies on vitamin D nutritional status among children and adolescents in China from inception to September, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by using Stata 11.0 software.ResultsA total of 23 cross-sectional studies involving 38 047 total sample size were included.The results of meta-analysis showed that the combined vitamin D deficiency rate was 27.9% (95%CI 21.9% to 33.8%), and the inadequate rate was 31.6% (95%CI 25.7% to 37.6%).Subgroup analysis showed that vitamin D deficiency rate of females was higher than that of males (25.3% vs. 22.5%). The vitamin D deficiency rate of children aged 10 to 18 was higher than those aged 6 to 9 (44.9% vs. 32.9%). The vitamin D deficiency rate of children in the north was higher than that in south (36.1% vs. 14.8%). The vitamin D deficiency rate from 2015 to 2018 was higher than that from 2011 to 2014 (34.9% vs. 17.6%). In addition, the vitamin D deficiency rate ofurban children was higher than that of rural children (29.9% vs. 24.9%).ConclusionsThe incidence of vitamin D deficiency among children and adolescents is high in China. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.