Browsing by Subject "Vitamin D"
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Item Association of Vitamin D Serum Concentration with Infection Outcomes for Children after Surgery(2016-01-19) Aboul-Fettouh, Nader; Williams, Timothy; Ploski, Roxana; Griffin, Allison; Szmuk, PeterVitamin D insufficiency and deficiency has been associated with various disease states and lower health outcomes. In the adult population, higher vitamin D levels correlated with decreased odds of in-hospital morbidity and mortality. However, no study examined the role of Vit D on the perioperative and post-operative outcomes in the pediatric patient population. We hypothesized that vitamin D deficient pediatric patients will have a higher incidence of composite infectious complications. As a secondary outcome we will analyze whether there is a relationship between the patient's vitamin D levels and hospital length of stay. With IRB approval we performed an EPIC search for all Children's Health patients from 2011 to 2015 where at least one 25-hydroxyvitamin D level was determined within the perioperative period (1 month pre- and post-surgery). Patients were included if they were less than 18 years of age and had underwent non-cardiac surgery. Patients were excluded if they did not receive general anesthesia, stayed less than one night in the hospital, had an American Society of Anesthesiologists Physical Status greater than 4, or underwent emergent surgery. Pertinent information including details of the surgery and relevant past medical history were collected for each patient to help analyze the data set and account for confounding factors. In order to have access to a larger number of patients, this project was performed in collaboration with Cleveland Clinic (Cleveland, OH). The EPIC search provided us with 1600 patient charts from CMC or Children's Health-Plano, and 850 were included into the study after being screened using the criteria noted previously. After analyzing the data, The incidence of infection were 5.5%, 5.8%, 4.9%, 5.8%, and 11.7% for patients with vitamin D level ≤13, 14-19, 20-25, 26-34, and ≥35 ng/ml, respectively. The odds of having infection did not differ significantly among the five vitamin D groups. Secondly, no difference was found in the length of hospital stay among the five vitamin D groups (P = 0.55). Vitamin D levels do not seem to be associated with infection or length of hospital stay in pediatric surgical patients. Other baseline and surgical factors have probably a stronger influence on in-hospital infection and length of hospital stay than vitamin D levels.Item Bile Acids and Nuclear Receptors: Their Roles in Nutrition and Cancer(2012-08-15) Schmidt, Daniel R.; Mangelsdorf, David J.The bile acid receptor, also known as farnesoid X receptor (FXR), is essential for feedback regulation of bile acid synthesis. Bile acids are required for the proper absorption of dietary lipids, including fat-soluble vitamins; however, some bacterial metabolites of bile acids have been shown to promote intestinal tumorigenesis in rodent models. Since high fat diet is considered a major risk factor for colorectal cancer (CRC), and is associated with increased bile acid concentrations in the colon, it has been proposed that bile acids contribute to the pathogenesis of CRC. This study was undertaken to investigate the mechanism of tumor promotion by bile acids and determine whether FXR is involved in this process. The effects of bile acids and FXR on intestinal tumorigenesis were studied in mouse models of CRC and in colon cancer cell lines. In addition, the effects of FXR on bile acid-induced intestinal proliferation were investigated. To gain insight into the function of FXR in the large intestine, transcriptional profiling experiments were performed in mouse colon treated with natural and synthetic FXR agonists. Finally, a variety of mouse models were used to understand how fat-soluble vitamins affect bile acid synthesis at a molecular level. These studies found that FXR plays a role in protecting against colorectal cancer. Akr1b7 was identified as a novel FXR target gene and was shown to detoxify bacterial bile acid metabolites, suggesting that FXR may play a role in protecting intestinal mucosa by inducing bile acid detoxification. The proliferative effects of bile acids in vivo were found to be independent of FXR, and instead involved activation of PI3K/AKT signaling. Finally, vitamins A and D were found to activate nuclear receptors in the intestine and repress bile acid synthesis. These results underscore the role of nuclear receptors and their ligands in maintaining intestinal homeostasis and in protecting against the tumor- promoting effects of bile acids.Item Disorders of steroid and thyroid hormone receptors(1989-03-02) Wilson, Jean D.Item Disorders of vitamin D excess(1992-07-02) Breslau, Neil A.Item [News](1977-11-23) Williams, AnnItem [News](1979-09-14) Williams, AnnItem [Southwestern News](2001-10-24) Echeverria, IoneItem Standard Calcium Supplementation May Increase Kidney Stone Risk: A Study in Women with Postmenopausal Osteoporosis(2014-02-04) Menegaz, Colleen; Adams-Huet, Beverley; Li, Xilong; Rubin, CraigINTRODUCTION: The US prevalence of kidney stones has increased from 2.6% in 1972 to 8.4% in 2010.The majority of stones contain calcium (Ca) with hypercalciuria (hCa) highly associated with stone formation. Postmenopausal osteoporosis (pmo) is a common problem affecting 30% of postmenopausal women in the US. Supplementation with Ca and vitamin D (D) is recommended for most older women. PURPOSE: To determine the percentage of patients (pts) who become hypercalciuric while receiving Ca and D supplementation for pmo and to identify biochemical predictors for higher risk of developing hCa. METHODS: 84 ambulatory women aged ≥55 yrs in a RT comparing alendronate (ALN) and sustained-release sodium fluoride (SRF) for the tx of pmo received standard Ca and D supplements. 24-hr urinary Ca (uCa) and deoxypyridinoline and serum D, PTH and bone-specific alk. phos. were measured at 0 and 12 mos. We determined the percentage of pts who became hypercalciuric (uCa >250 mg/24h) during tx. to identify predictors of hCa. Changes in biochemical variables were assessed with mixed model repeated measures analysis. Logistic regression analysis was used to assess predictors of elevated uCa and construct receiver operating characteristic (ROC) curves. RESULTS: 42 pts were randomized to ALN and 42 to SRF. 67 pts completed ≥ one yr. 90% (27/30) of the ALN group and 92% (33/36) of the SRF group had normal uCa excretion at baseline. Patients with normal uCa at baseline experienced significant increases in uCa in the first year (ALN p=0.01, SRF p<0.0001). However, baseline hypercalciurics experienced no significant increase in uCa from baseline after Ca and D supplementation. In all, 13% (4/30) of ALN pts became hypercalciuric (p= 0.41) vs. 28% (10/36) in the SRF group (p=0.002). The best-fit multi-variable model determined baseline uCa (p=0.02) and D (p=0.03) were strong predictors of hCa at 12 mo. and produced a favorable ROC curve (0.90). Baseline uCa was a consistently strong predictor of hCa and a simple logistic regression analysis generated a ROC curve (0.84) which determined that 180 mg/d uCa at baseline was a strong predictive cut-point for detection of pts at higher risk of hCa with treatment. CONCLUSION: 21% of patients became hypercalciuric on recommended doses of Ca and D. Current Ca and D supplementation practice may have significant public health consequences by contributing to the growing incidence of nephrolithiasis. Practice guidelines should consider assessing baseline 24-hr uCa in all pts and 12 mo. 24-hr uCa in pts with baseline uCa ≥of 180 mg/24h.Item Vitamin D metabolism: biochemical, physiological, and clinical considerations(1974-12-05) Pak, Charles Y. C.