Les effets extra-osseux de la vitamine D : faits, questions et controverses

La vitamine D a été longtemps considérée comme une hormone utile pour réguler le métabolisme phosphocalcique et la minéralisation osseuse. Depuis dix ans, la progression des connaissances fondamentales et cliniques sur son influence pluritissulaire est vertigineuse. Les auteurs passent en revue les effets biologique et clinique de la vitamine D en particulier sur le système immunitaire, les maladies auto-immunes, les infections, le cancer, le syndrome métabolique, le risque de chute, les fonctions cognitives et le fonctionnement musculaire

Extraskeletal effects of vitamin D: Facts, uncertainties, and controversies

Vitamin D was long viewed as a hormone acting chiefly to regulate calcium-phosphate metabolism and bone mineralization. Over the last decade, however, basic science and clinical researchers have produced a bewildering amount of information on the extraskeletal effects of vitamin D. This article is a review of the clinical and biological actions of vitamin D including effects on the immune system, auto-immune diseases, infections, cancer, metabolic syndrome, fall risk, cognitive function, and muscle function

Motherhood, Moral Authority and the Charismatic Matriarch in the Aftermath of Lethal Violence

Images of maternal suffering are an evocative and powerful means of communication in a world where the private grief of victims has increasingly become subject to commodification and public consumption. This article looks at the influence of bereaved mothers as symbols of respect, peace and dignity in the aftermath of violence, and as a result their persuasive presence in family activism. Drawing upon two case studies, this article explores the importance of victims’ stories in public life and, in particular, the presence of the charismatic matriarch in creating communities of solidarity, raising awareness of harms that have previously gone unheard and prompting policy change. It considers the ‘canonical’ story of the mother in public life and concludes by arguing that more attention should be paid to victims’ stories and their influence on policy-making, politics and eventually in becoming public grievances

Early risk factors for hyperactivity-impulsivity and inattention trajectories from age 17 months to 8 years.

CONTEXT: Attention-deficit/hyperactivity disorder is an etiologically heterogeneous neurodevelopmental condition with long-term negative outcomes. However, the early developmental course of hyperactivity-impulsivity and inattention symptoms and their association with previous environmental risk factors are still poorly understood OBJECTIVES: To describe the developmental trajectories of hyperactivity-impulsivity and inattention symptoms and to identify their prenatal, perinatal, and postnatal risk factors. DESIGN: Birth cohort from the general population. SETTING: Quebec Longitudinal Study of Child Development. PARTICIPANTS: The sample consisted of 2057 individuals, followed up from age 5 months to 8 years. MAIN OUTCOME MEASURES: Prenatal, perinatal, and postnatal risk factors assessed at age 5 months were considered predictors of group membership in high hyperactivity-impulsivity and inattention trajectories from age 17 months to 8 years. RESULTS: The frequency of hyperactivity-impulsivity symptoms tended to slightly decrease with age, whereas the frequency of inattention symptoms substantially increased up to age 6 years. However, trajectories of hyperactivity-impulsivity and inattention symptoms were significantly associated with each other. Risk factors for high trajectories of both types of symptoms were premature birth (adjusted odds ratio [aOR], 1.93; 95% CI, 1.07-3.50), low birth weight (2.11; 1.12-3.98), prenatal tobacco exposure (1.41; 1.03-1.93), nonintact family (1.85; 1.26-2.70), young maternal age at birth of the target child (1.78; 1.17-2.69), paternal history of antisocial behavior (1.78; 1.28-2.47), and maternal depression (1.35; 1.18-1.54). CONCLUSIONS: A large range of early risk factors, including prenatal, perinatal social, and parental psychopathology variables, act independently to heighten the likelihood of having persistently high levels of hyperactivity-impulsivity and inattention symptoms from infancy to middle childhood. Early interventions should be experimented with to provide effective tools for attention-deficit/hyperactivity disorder prevention

Gamma oscillations in V1 are correlated with GABA(A) receptor density: A multi-modal MEG and Flumazenil-PET study.

High-frequency oscillations in the gamma-band reflect rhythmic synchronization of spike timing in active neural networks. The modulation of gamma oscillations is a widely established mechanism in a variety of neurobiological processes, yet its neurochemical basis is not fully understood. Modeling, in-vitro and in-vivo animal studies suggest that gamma oscillation properties depend on GABAergic inhibition. In humans, search for evidence linking total GABA concentration to gamma oscillations has led to promising -but also to partly diverging- observations. Here, we provide the first evidence of a direct relationship between the density of GABA(A) receptors and gamma oscillatory gamma responses in human primary visual cortex (V1). By combining Flumazenil-PET (to measure resting-levels of GABA(A) receptor density) and MEG (to measure visually-induced gamma oscillations), we found that GABA(A) receptor densities correlated positively with the frequency and negatively with amplitude of visually-induced gamma oscillations in V1. Our findings demonstrate that gamma-band response profiles of primary visual cortex across healthy individuals are shaped by GABA(A)-receptor-mediated inhibitory neurotransmission. These results bridge the gap with in-vitro and animal studies and may have future clinical implications given that altered GABAergic function, including dysregulation of GABA(A) receptors, has been related to psychiatric disorders including schizophrenia and depression

Profile of French community-dwelling older adults supplemented with vitamin D: findings and lessons

INTRODUCTION: The vast majority of older French adults exhibit some degree of hypovitaminosis D. The objective of this cross-sectional study was to determine the rate and the reasons for vitamin D prescription among older French adult community dwellers. METHODS: Vitamin D supplementation was systematically assessed among 1876 French community dwellers aged ≥ 65 years. Theoretical indications for vitamin D supplementation were collected, ie, the causes of hypovitaminosis D (older age, male gender, kidney failure, undernutrition, polymorbidity) or its clinical complications (vertebral or non-vertebral fractures, gait disturbances, history of falls, muscle weakness, and cognitive impairment). RESULTS: In total, 13.8% of the subjects (n=258) had vitamin D supplementation. They were more often malnourished (P=0.002), exhibited polymorbidity (P<0.001) and muscle weakness (P<0.001), and had a history of vertebral fractures (P<0.001), non-vertebral fractures (P<0.001), and accidental falls (P<0.001). Vitamin D supplementation was explained by the number of complications of hypovitaminosis D (odds ratio [OR]=1.61, P<0.001) including vertebral fractures (adjusted OR=1.49, P=0.007), non-vertebral fractures (adjusted OR=1.74, P=0.026), accidental falls (adjusted OR=1.44, P=0.015), and muscle weakness (adjusted OR=3.96, P<0.001), but not by the number of causes of hypovitaminosis D (P=0.464). CONCLUSION: Even if vitamin D supplementation is selected well for appropriate patients, the rate of supplementation remains insufficient in France, and probably comes too late, ie, at the stage of complications of hypovitaminosis D. These findings should encourage physicians to supplement vitamin D more often and sooner in their elderly patients

Fracture incidence after 3 years of aromatase inhibitor therapy

BACKGROUND: The purpose of this study was to describe the fracture incidence and bone mineral density (BMD) evolution in a large cohort of post-menopausal women with breast cancer after 3 years of aromatase inhibitor (AI) therapy. PATIENTS AND METHODS: A prospective, longitudinal study in real-life setting. Each woman had an extensive medical assessment, a biological evaluation, a BMD measurement, and systematic spinal X-rays at baseline and after 3 years of AI therapy. Women with osteoporosis at baseline (T-score < -2.5 and/or non-traumatic fracture history) were treated by oral weekly bisphosphonates. RESULTS: Among 497 women (mean age 63.8 ± 9.6 years) included in this study, 389 had a bone evaluation both at baseline and after 3 years of AI therapy: 267 women (mean age 61.2 ± 8.6) with no osteoporosis at baseline and 122 women (mean age 67.2 ± 9.1) with osteoporosis at baseline justifying a weekly oral bisphosphonate treatment. Women without bisphosphonates had a significant decrease in spine BMD (-3.5%, P < 0.01), neck BMD (-2.0%, P < 0.01), and total hip BMD (-2.1%, P < 0.01) over the 3 years but only 15 of them (5.6%) presented an incident vertebral or non-vertebral fracture. In osteoporotic women treated with bisphosphonates, spine and hip BMD were maintained at 3 years but 12 of them (9.8%) had an incident fracture. These fractured women were significantly older (74.1 ± 9.8 versus 66.5 ± 8.8) but also presented BMD loss during treatment suggesting poor adherence to bisphosphonate treatment. CONCLUSION: This real-life study confirmed that AIs induced moderate bone loss and low fracture incidence in post-menopausal women without initial osteoporosis. In women with baseline osteoporosis and AI therapy, oral bisphosphonates maintain BMD but were associated with a persistent fracture risk, particularly in older women

High parathyroid hormone, but not low vitamin D concentrations, expose elderly inpatients to hypertension

AIM: Serum parathyroid hormone (PTH) and 25-hydroxyvitamin D (25OHD) concentrations might contribute to blood pressure (BP) levels. Mixed results in previous literature could be due to the failure to consider both these hormones concurrently, despite their long-known relationship. Our objective was to examine the association of serum intact PTH and 25OHD concentrations with BP levels amongst older inpatients, while accounting for each other. METHODS: The participants were 284 Caucasian older inpatients with no suspicion of primary hyperparathyroidism (mean age 85.87 ± 5.90 years; 65.8% female) admitted to the geriatric acute care unit of Angers University Hospital, France. They were divided into two groups according to the existence of hypertension (i.e. systolic blood pressure [SBP] >140 mmHg, or diastolic blood pressure [DBP] >90 mmHg). Age, sex, numbers of chronic diseases and of drugs taken daily, use of antihypertensive or corticosteroid drugs and of calcium supplements/vitamin D, thyroid-stimulating hormone and albumin concentrations, creatinine clearance, and season tested were used as covariables. RESULTS: Hypertensive participants (n=106) had higher intact PTH concentrations than normotensive patients (P=0.044). There was a positive linear association of BP with intact PTH concentrations (adjusted β=0.08, P=0.015 for SBP; adjusted β=0.05, P=0.044 for DBP), but not with vitamin D. Serum intact PTH concentration, unlike 25OHD, was associated with hypertension (adjusted OR 1.01, P=0.038). CONCLUSIONS: Irrespective of 25OHD, PTH was associated with hypertension by increasing both SBP and DBP