Multiple myeloma (MM) is a common hematologic malignancy that originates from precursor conditions such as monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). Identifying its risk factors is crucial for early intervention. The etiology of MM is multifactorial, involving race, familial clustering, gender, age, obesity, cytogenetic abnormalities, and environmental exposures. Among these, cytogenetic abnormalities and modifiable factors play pivotal roles in MM pathogenesis and progression. 1) cytogenetic abnormalities. Primary abnormalities [e.g., hyperdiploidy, t(11;14), t(14;16)] emerge at the MGUS stage, while secondary abnormalities [e.g., 1q+, del(17p)] drive disease progression. The accumulation of 1q+ promotes clonal evolution, and del(17p) is associated with significantly reduced survival. 2) modifiable risk factors. Obesity promotes MM via the acetyl-CoA synthetase 2 (ACSS2)-interferon regulatory factor 4 (IRF4) pathway. Vitamin D deficiency weakens immune surveillance. Exposure to herbicides such as Agent Orange and glyphosate increases MGUS incidence. Insufficient UV exposure, by reducing vitamin D synthesis, elevates MM risk. Gut microbiota dysbiosis (enrichment of nitrogen-cycle bacteria and depletion of short-chain fatty acids producers) induces chromosomal instability through the ammonium ion-solute carrier family 12 member 22 (SLC12A2)-NEK2 axis. Therefore, risk-based screening among high-risk populations (e.g., those who are obese, elderly, or chemically exposed), along with early interventions targeting cytogenetic abnormalities [e.g., B cell lymphoma 2 (Bcl-2) inhibitors for t(11;14), ferroptosis inducers for t(4;14)] and modifiable factors (e.g., vitamin D supplementation, gut microbiota modulation), may effectively delay disease progression and improve prognosis.
Humans ; Multiple Myeloma/epidemiology* ; Risk Factors ; Obesity/complications* ; Chromosome Aberrations ; Monoclonal Gammopathy of Undetermined Significance/etiology* ; Gastrointestinal Microbiome ; Vitamin D Deficiency/complications* ; Precancerous Conditions/genetics*

Objective:To observe and analyze the levels of vitamin D（VD） and their influencing factors in children undergoing adenoidectomy and/or tonsillectomy. Methods:A total of 147 children who received adenoidectomy and/or tonsillectomy in our hospital from November 2018 to March 2019 were selected as the experimental groups, gender and age matched 147 healthy children of the same period were selected as the control group. The differences of VD levels between the two groups were compared, the factors affecting VD levels were investigated, and patients with VD deficiency/insufficiency in the experimental groups were followed up postoperatively. Results:The VD levels of the experimental groups were（19.6±6.6） ng/mL and those of the control groups were （22.5±6.5）ng/mL, which was significantly different （P<0.01）. The experimental groups were divided into inflammation groups and Sleeping disorder breathing（SDB）groups. The VD levels of the two groups were （19.1±6.7）ng/mL and （21.9±6.4）ng/mL, which was significantly different （P<0.05）. Regression analysis showed that VD levels were negatively correlated with age, body mass index （BMI）, adenoid hypertrophy, tonsil hypertrophy and Anti-streptolysin O（ASO）levels （P<0.05）. VD values were remeasured one year postoperatively in 23 of 72 children in the VD deficiency/deficiency groups, and there was a statistically significant difference between preoperative and postoperative VD values[（14.3±3.9）ng/mL and （17.1±5.5） ng/mL, respectively, P<0.05]. There was a significant difference in postoperative VD value between the inflammation groups and the SDB groups[ （15.6±5.9） ng/mL and （20.5±2.1） ng/mL, respectively, P<0.05]. Conclusion:Children who underwent adenoidectomy and/or tonsillectomy had lower VD levels than healthy children.VD levels decreased with increasing age,BMI and ASO values,and associated with the size of adenoid and tonsil. Preoperative VD levels were lower in the inflammation groups, adenoidectomy and/or tonsillectomy improved VD deficiency/insufficiency status, and postoperative elevation of VD levels was more pronounced in the SDB groups.
Humans ; Tonsillectomy ; Adenoidectomy ; Vitamin D/blood* ; Vitamin D Deficiency ; Male ; Female ; Postoperative Period ; Child ; Case-Control Studies ; Child, Preschool

Objectives: This study aimed to compare the severity of COVID-19, inflammatory parameters and clinical outcomes among patients with normal and subnormal levels of Vitamin D. Methodology: This is a retrospective cohort study of 135 patients admitted in a tertiary hospital for COVID-19. Patients were grouped according to their Vitamin D level. Primary outcome measure was the composite of all-cause mortality and morbidity. Other outcome measures determined were the comparison among the groups on the severity of COVID-19 infection, changes in inflammatory parameters, length of hospital stay and duration of respiratory support. Results: There was a significant trend of higher ICU admission (p=0.024), mortality (p=0.006) and poor clinical outcome (p=0.009) among the Vitamin D deficient group. No significant difference was found for most of the inflammatory parameters, duration of hospital stay and respiratory support. Overall, patients with deficient, but not insufficient Vitamin D level had 6 times higher odds of composite poor outcome than those with normal Vitamin D (crude OR=5.18, p=0.003; adjusted OR=6.3, p=0.043). Conclusion The inverse relationship between Vitamin D level and poor composite outcome observed in our study suggests that low Vitamin D may be a risk factor for poor prognosis among patients admitted for COVID-19.
Vitamin D ; Vitamin D Deficiency ; COVID-19

Background: Apart from its role in bone health, recent developments have shown that vitamin D also has anti-inflammatory properties, and therefore may have a role in inflammatory bowel disease (IBD) in children. Objectives: To determine the effect of vitamin D supplementation on the disease activity of pediatric patients with IBD. Design: Random-effects meta-analysis Data Sources: : Studies were searched at Cochrane Library, PubMed, EBSCO Host, ScienceDirect, Google Scholar, and Wiley Online. Review Methods: Experimental studies measuring the effect of vitamin D on the disease activity of pediatric patients with IBD were included. The proportion of disease activity, measured as remission rate or inactivity using Pediatric Crohn’s Disease Activity Index (PCDAI) or Pediatric Ulcerative Colitis Activity Index (PUCAI), and the mean and standard deviation of mean serum vitamin D [25(OH)D] level, change in 25(OH)D, and different inflammatory markers [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] were extracted or estimated and recorded in an abstraction form. Standardized mean difference and odds ratio were used as summary effect measures and estimated using Stata/Multiprocessor. Results: The serum 25(OH)D (SMD = 1.75, z = 2.33, p = 0.001) and change in 25(OH)D (SMD = 3.37, z = 2.34, p = 0.019) was significantly higher among those who received a high dose of vitamin D. However, a significantly high heterogeneity was estimated (I2 >50%). For the disease activity of IBD, the standard mean difference of mean ESR (SMD = –1.10, z = 5.35, p = 0.001) was significantly lower with high-dose vitamin D. The likelihood of remission rate using the Pediatric Crohn’s Disease Activity Index (PCDAI) or Pediatric Ulcerative Colitis Activity Index (PUCAI), and standardized mean difference of CRP were not significantly different among those who received high-dose and low-dose vitamin D. Conclusion Cognizant of the functions of vitamin D in enhancing intestinal flora balance, regulating immunologic response, and improving intestinal mucosal barrier, vitamin D can be recommended as a supplementary treatment for IBD among the pediatric population. Nevertheless, there is still insufficient evidence for the cut-off level of adequate levels of serum 25(OH)D among pediatric patients with IBD, thus necessitating further studies.
Vitamin D Deficiency

OBJECTIVES: To study the correlation between 25-hydroxyvitamin D [25-(OH)D] and nephroblastoma in children and its value in assessing the prognosis of the disease. METHODS: A total of 50 children with nephroblastoma who were admitted from January 2018 to December 2022 were included as the nephroblastoma group, and according to the postoperative pathological type, they were divided into a good prognosis group with 38 children and a poor prognosis group with 12 children. A total of 50 healthy children who underwent physical examination during the same period of time served as the healthy control group. The above groups were compared in terms of serum creatinine and 25-(OH)D level. A Spearman correlation analysis was used to investigate the correlation between serum 25-(OH)D level and therapeutic effect reaction. A multivariate logistic regression analysis was used to identify the risk factors affecting the prognosis of nephroblastoma in children. RESULTS: The nephroblastoma group had significantly lower levels of serum creatinine and 25-(OH)D than the healthy control group (P<0.05). Compared with the good prognosis group, the poor prognosis group had a significantly larger tumor diameter, a significantly higher proportion of children with stage III-IV tumors, a significantly higher rate of tumor metastasis, and significantly lower serum levels of creatinine and 25-(OH)D (P<0.05). The Spearman correlation analysis showed that serum 25-(OH)D level was negatively correlated with therapeutic effect reaction (r_s=-0.685, P<0.001). The multivariate logistic regression analysis showed that tumor diameter ≥10 cm, stage III-IV tumors, presence of tumor metastasis, and 25-(OH)D <19 ng/mL were closely associated with the poor prognosis of nephroblastoma in children (P<0.05). Serum 25-(OH)D level had an area under the curve of 0.805 (95%CI: 0.706-0.903, P<0.001) in evaluating the prognosis of nephroblastoma in children, with a Youden index of 0.512, a sensitivity of 0.938, and a specificity of 0.575 at the optimal cut-off value of 1.764 ng/mL. CONCLUSIONS There is a significant correlation between 25-(OH)D level and the prognosis of nephroblastoma in children, and 25-(OH)D can be used for prognosis prediction.
Humans ; Child ; Creatinine ; Vitamin D Deficiency/complications* ; Vitamin D ; Calcifediol ; Prognosis ; Wilms Tumor ; Kidney Neoplasms/complications*

OBJECTIVES: To study the mechanism of retinoic acid receptor α (RARα) signal change to regulate neurexin 1 (NRXN1) in the visual cortex and participate in the autistic-like behavior in rats with vitamin A deficiency (VAD). METHODS: The models of vitamin A normal (VAN) and VAD pregnant rats were established, and some VAD maternal and offspring rats were given vitamin A supplement (VAS) in the early postnatal period. Behavioral tests were performed on 20 offspring rats in each group at the age of 6 weeks. The three-chamber test and the open-field test were used to observe social behavior and repetitive stereotyped behavior. High-performance liquid chromatography was used to measure the serum level of retinol in the offspring rats in each group. Electrophysiological experiments were used to measure the long-term potentiation (LTP) level of the visual cortex in the offspring rats. Quantitative real-time PCR and Western blot were used to measure the expression levels of RARα, NRXN1, and N-methyl-D-aspartate receptor 1 (NMDAR1). Chromatin co-immunoprecipitation was used to measure the enrichment of RARα transcription factor in the promoter region of the NRXN1 gene. RESULTS: The offspring rats in the VAD group had autistic-like behaviors such as impaired social interactions and repetitive stereotypical behaviors, and VAS started immediately after birth improved most of the behavioral deficits in offspring rats. The offspring rats in the VAD group had a significantly lower serum level of retinol than those in the VAN and VAS groups (P<0.05). Compared with the offspring rats in the VAN and VAS groups, the offspring rats in the VAD group had significant reductions in the mRNA and protein expression levels of NMDAR1, RARα, and NRXN1 and the LTP level of the visual cortex (P<0.05). The offspring rats in the VAD group had a significant reduction in the enrichment of RARα transcription factor in the promoter region of the NRXN1 gene in the visual cortex compared with those in the VAN and VAS groups (P<0.05). CONCLUSIONS RARα affects the synaptic plasticity of the visual cortex in VAD rats by regulating NRXN1, thereby participating in the formation of autistic-like behaviors in VAD rats.
Animals ; Autistic Disorder ; Female ; Pregnancy ; Rats ; Rats, Sprague-Dawley ; Receptors, N-Methyl-D-Aspartate ; Retinoic Acid Receptor alpha ; Visual Cortex ; Vitamin A ; Vitamin A Deficiency

Humans ; Vitamin D/therapeutic use* ; Vitamin D Deficiency/therapy*

Objective: To explore current vitamin D status and influential factors of vitamin D deficiency and insufficiency among children under 7 years of age in 11 provinces, autonomous regions or municipalities of China. Methods: According to the "province-city-hospital" sampling technical route, a total of 1 531 healthy children under 7 years of age were sampled from 11 provinces, autonomous regions or municipalities in China by the cluster random sampling method from November 2020 to November 2021. The demographic information, family conditions, behavior and living habits and feeding behaviors were collected using unified questionnaire. Serum 25-hydroxyvitamin D(25(OH)D) levels were measured by liquid chromatography-tandem mass spectrometry. Serum 25(OH)D<30 nmol/L was considered deficient and 30-50 nmol/L was considered insufficient. With 25(OH)D≤50 nmol/L as the dependent variable, multivariate Logistic regression was applied to analyze the association between vitamin D deficiency and insufficiency and potential influential factors. Results: The prevalence of vitamin D deficiency and insufficiency among children under 7 years of age in 11 provinces, autonomous regions or municipalities of China was 14.0% (215/1 531), 3.8% (25/664) and 21.9% (190/867) in 0-<3 and 3-<7 of age years, respectively. Compared to children aged 0-<3 years, children aged 3-<7 years had a 2.6-fold increased risk of vitamin D deficiency and insufficiency (OR=3.60, 95%CI 1.93-6.72, P<0.001). Frequent sunlight exposure (OR=0.46, 95%CI 0.29-0.73, P=0.001), vitamin D supplementation (sometimes, OR=0.33, 95%CI 0.21-0.51, P<0.001; daily, OR=0.20, 95%CI 0.11-0.36, P<0.001) and infant formula intake(4-7 times per weeks, OR=0.43, 95%CI 0.28-0.68, P<0.001) were protective factors for vitamin D deficiency and insufficiency. Conclusion: Vitamin D deficiency and insufficiency are common among children under 7 years of age in 11 provinces, autonomous regions or municipalities of China, which is affected by age, sunlight exposure, vitamin D supplementation and infant formula intake.
Child ; China/epidemiology* ; Cross-Sectional Studies ; Humans ; Infant ; Vitamin D ; Vitamin D Deficiency/epidemiology* ; Vitamins

Adult ; Body Mass Index ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/epidemiology* ; Humans ; Obesity/epidemiology* ; Vitamin D ; Vitamin D Deficiency ; Vitamins ; Waist Circumference

Introduction: Derangement in calcium homeostasis is common in nephrotic syndrome (NS). It is postulated that low serum total calcium and vitamin D levels are due to loss of protein-bound calcium and vitamin D. It is unclear if free calcium and free vitamin D levels are truly low. The guideline is lacking with regards to calcium and vitamin D supplementation in NS. This study aims to examine calcium and vitamin D homeostasis and bone turnover in NS to guide practice in calcium and vitamin D levels supplementation. Methodology: This is a prospective pilot study of ten patients diagnosed with NS, and eight healthy controls. Calcium, vitamin D, and bone turnover-related analytes were assessed at baseline, partial and complete remission in NS patients and in healthy controls. Results: NS patients had low free and total serum calcium, low total 25(OH)D, normal total 1,25(OH)D levels and lack of parathyroid hormone response. With remission of disease, serum calcium and vitamin D metabolites improved. However, nephrotic patients who do not attain complete disease remission continue to have low 25(OH)D level. Conclusion In this study, the vitamin D and calcium derangement observed at nephrotic syndrome presentation trended towards normalisation in remission. This suggested calcium and vitamin D replacement may not be indicated in early-phase nephrotic syndrome but may be considered in prolonged nephrotic syndrome.
Vitamin D Deficiency