In this retrospective case series, the clinical data of four pediatric patients with primary hypoparathyroidism (PHPT) treated with teriparatide at the Endocrinology Department of Capital Center for Children's Health, Capital Medical University, from May 2018 to May 2025, were analyzed. All patients were male and from four unrelated families. The ages at onset were 8 months, 12 years, 3 days, and 8 years plus 9 months, respectively, with time from onset to diagnosis ranging from several days to 1 year. The primary clinical manifestations of PHPT included seizures, tetany, and limb numbness. Seizures were observed in the two younger patients, whereas tetany or limb numbness were noted in the two older patients. Physical examination revealed positive Trousseau's sign or facial nerve signs. Laboratory test results showed hypocalcium, hyperphosphatemia, and decreased parathyroid hormone (PTH). Imaging revealed basal ganglia calcification in one patient and multiple small renal calculi in another. A heterozygous pathogenic variant in the CASR gene was identified by whole-exome sequencing in three patients, confirming a diagnosis of autosomal dominant hypocalcemia type 1 (ADH-1). All four patients had poor responses to conventional therapy (calcium supplements + vitamin D or its derivatives) and were subsequently treated with teriparatide (20 μg/dose, subcutaneously, 1-2 doses daily), with dose frequency adjusted based on serum calcium levels. Following 1 to 6 months of treatment, all patients achieved favorable outcomes, including normalization of serum calcium levels and resolution of clinical symptoms. No known teriparatide-related side effects were observed during treatment. Upon treatment discontinuation, patients smoothly transitioned to conventional therapy. Serum calcium levels were maintained at the lower limit of normal. Three patients experienced resolved clinical symptoms, while one patient experienced occasional tetany and numbness when the medicine was taken irregularly. Teriparatide (rhPTH1-34) effectively corrected hypocalcemia and alleviated clinical symptoms in pediatric PHPT, with a favorable safety profile. Therefore, teriparatide can be considered for children with refractory PHPT who do not respond adequately to conventional therapies.

Modern nutrition research has evolved from early discoveries of essential vitamins to exploring the complex interactions between a much larger range of food-derived compounds (the foodome). The microbiome is a key link between diet and health outcomes through multiple gut-host axes. However, the field lacks a unifying framework to demystify its inherent complexities. This review outlines mechanistic evidence that the 5'-AMP-activated protein kinase (AMPK) is a potential mediator of host-microbe relationships and helps move towards the concept of a gut-AMPK axis. Further, it suggests that a plausible function of a "healthy" gut microbiome is to increase the bioavailability of metabolites capable of modulating AMPK. These insights can facilitate larger efforts to define what constitutes a functional gut microbiome, understand the health effects of the broader foodome, and support organismal resilience and healthy aging.

Global population ageing is increasing the burden of chronic disease, functional decline, and loss of independence. For most organs, decline in function starts during the 5th decade of life. Micronutrient (MN) insufficiencies/deficiencies are common and may accelerate biological ageing. MNs are required to support multiple physiologic processes, including mitochondrial homeostasis. Age-related declines in organ function are tightly linked to mitochondrial dysfunction, oxidative stress, inflammageing, and immunosenescence. Selected MNs (vitamins B, C, D, E, iron, selenium, zinc) are critical cofactors for mitochondrial function, antioxidant defence, immunity, and resolution of inflammation. Inadequate MN intakes require specific repletion strategies beyond diet for correction. Low intake, (patho)physiological changes, and common medications jointly contribute to compromised MN status. Emerging trials suggest that correcting MN deficiency may restore mitochondrial function and thereby promote healthy ageing. Optimizing intake over the lifespan represents another means to support healthy ageing. Nevertheless, MNs do not work individually but as a web, and may behave differently in different individuals. Further, low status of the n-3 polyunsaturated fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) is common in older adults, which favours inflammation and functional decline. EPA+DHA work in combination with MNs on inflammation containment. Routine risk assessment, selected biomarker measurement from midlife onwards, and well-designed trials are needed to complement an insufficient status. MN and EPA+DHA optimization should be integral to healthy ageing strategies.

Systemic sclerosis (SSc), also known as scleroderma, is a rare autoimmune disease characterized by fibroproliferative changes, vascular dysfunction, and small-vessel proliferation. It can affect multiple organ systems, including the gastrointestinal tract, skin, heart, eyes, kidneys, and lungs. We report a case of a 67-year-old woman with systemic sclerosis who tested negative for specific antibodies and simultaneously developed two rare complications: autoimmune atrophic gastritis resulting in megaloblastic anemia and acute retinal artery occlusion. Notably, she presented with megaloblastic anemia despite normal serum vitamin B12 levels, consistent with early deficiency due to parietal cell destruction and reduced intrinsic factor production. This case emphasizes the importance of recognizing uncommon gastrointestinal and ocular manifestations in systemic sclerosis, as timely diagnosis and management are essential to prevent serious complications such as severe anemia and permanent vision loss.

Vitamin D is of vital importance for bone health and also regulates inflammatory cytokines. It is possible that physical activity could influence serum 25-hidroxyvitamin D concentrations (25(OH)D), and it has been suggested that exercise can increase serum 25(OH)D concentration. We hypothesized that regular exercise enables the body to absorb and use vitamin D more effectively, leading to lower concentrations of inflammatory cytokines. This is a cross-sectional population-based study, conducted with 712 adults aged 20 to 59 years living in the urban area of Viçosa, Minas Gerais, Brazil. Sociodemographic, anthropometric, behavioral and biochemical variables were collected. Multiple linear regression models (crude and adjusted) were used to determine associations between 25(OH)D concentration and inflammatory biomarkers. In the multiple linear regression models, it can be observed that for each unit increase in the concentration of 25(OH)D, there was an average decrease in the inflammatory biomarkers. Physical activity concentrations was considered an effect modifier of the association between serum 25(OH)D concentrations and some cytokines, and participants whose PAL was greater than 150 minutes tended to have lower concentrations of IL-6, IL-10, TNF-α and IL-12p70 when plasma 25(OH)D concentration was increased. In conclusion, higher 25(OH)D concentrations were associated with lower concentrations of inflammatory biomarkers in Brazilian adults. Furthermore, physical activity served as a significant effect modifier of this association, enhancing the reduction of pro-inflammatory cytokines.

Fish are exposed to residues of anticoagulant rodenticides in the environment, likely due to secondary poisoning or direct consumption of fragments of bait. The mode of action in which they affect fish is similar to mammals: inhibition of vitamin K epoxide reductase leads to a vitamin K deficiency, and consequently, to a coagulation disorder. However, distinct species- and compound-specific differences in the sensitivity and toxicity occur and data for the comparison of the effects on fish are still lacking. We exposed ca. 1-year old (body weight ∼180 g) rainbow trout (Oncorhynchus mykiss) in a preliminary 15 day-experiment and ca. 1.5-year old rainbow trout (body weight ∼360 g) in a 30 d-experiment to a single dose of bromadiolone-spiked feed. The onset of overt signs in individual trout took 12-14 d. Prolonged prothrombin time and hemorrhages were observed in some fish exposed to ≥ 10 mg/kg body weight bromadiolone. While at the end of the experiment no effect on vitamin K and undercarboxylated osteocalcin levels occurred, concentration of vitamin K epoxide reductase subunit 1-like 1 was reduced in rainbow trout exposed to ≥ 0.4 mg/kg body weight bromadiolone in the 30 d-experiment (p < 0.001). The experiment showed that high oral doses of bromadiolone can cause coagulopathy in fish, but the acute poisoning scenario tested in our study indicated no severe risk for fish at hepatic bromadiolone concentrations that have been detected to date in wild freshwater fish. However, to assess the risk of bromadiolone, further research is needed to investigate possible effects caused by multiple exposure to bromadiolone and its mixture toxicity in combination with other anticoagulant rodenticides, both of which are more realistic exposure scenarios for fish in the environment.

In this randomized, double-blind, placebo-controlled trial, 72 healthy vegan adults (aged 19-57 years) received a multinutrient supplement consisting of a vitamin and mineral supplement (providing 26 µg vitamin D) and an omega-3 supplement administered in either a single dose (EPA 98.7 mg, DHA 171.0 mg, additional vitamin D 36 µg, vitamin E 3.7 mg) or a double dose (EPA 197.4 mg, DHA 342.0 mg, additional vitamin D 72 µg, vitamin E 7.4 mg) or placebo capsules for 4 months. Nutrient biomarkers were assessed at baseline and at the end of the intervention after 4 months. An analysis of covariance was employed to test for between-group differences (p < 0.05) and adjusted for multiple testing using the Bonferroni-Holm method. Compared to the control group, which showed on average a significant decline in both the omega-3-index and 25-hydroxyvitamin D, participants in both intervention groups demonstrated significant increase in these parameters (p < 0.001). Although the double dose group exhibited numerically greater increases in omega-3 index and vitamin D compared to the simple dose group, the differences between these dosing regimens were not statistically significant. As expected, vitamin E levels remained unchanged, reflecting its inclusion solely for antioxidative protection in the omega-3 supplement rather than as a critical nutrient in vegan diets. In conclusion, supplementation significantly improved omega-3 and vitamin D status in healthy vegans, with no significant benefit from doubling the dose. Although clinical endpoints were not evaluated, improved nutrient status may have potential implications for health. The study has been registered at the German Clinical Trials Register (DRKS00028151).

Immune checkpoint inhibitor (ICI)-based combination therapies are standard treatments for advanced hepatocellular carcinoma (HCC). However, the efficacy of sequential ICI regimens remains unclear. We report the case of a 59-year-old woman with advanced HCC with peritoneal dissemination who showed rapid tumor regression after nivolumab plus ipilimumab as a third ICI-based regimen, following confirmed progression on durvalumab plus tremelimumab and atezolizumab plus bevacizumab. After two cycles, tumor markers markedly decreased, and radiological evaluation demonstrated a partial response by Response Evaluation Criteria in Solid Tumors (RECIST) and a complete response by modified RECIST (mRECIST). By late May 20XX+2, the patient had completed four cycles of nivolumab plus ipilimumab without any additional adverse events. The marked biochemical response was maintained, with alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II levels further decreasing to 173.6 ng/mL and 76 mAU/mL, respectively. The patient is currently scheduled for a follow-up radiological evaluation to confirm the durability of the response. This case suggests that nivolumab combined with ipilimumab may retain efficacy even after multiple prior ICI failures.