human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Summary On September 29 , 2011 , acknowledged experts in the field of vitamin D , mainly European , were brought together in order to discuss the recent scientific advances in relation to vitamin D : the current requirements and associations with various health outcomes . In this article , the discussion s result ing from the meeting are summarized . Introduction Several groups at risk for developing vitamin D insufficiency have been identified . Accordingly , review s indicate that a significant percentage of the population worldwide have serum 25-hydroxyvitamin D levels below 50 nmol/l . In addition to the role of vitamin D in bone health , recent studies suggest that it may play a pivotal role in other systems , e.g. , the cardiovascular system , pancreas , muscle , immune system and brain . Most evidence , however , is obtained from observational studies and yet inconclusive . Methods To exchange and broaden knowledge on the requirements for vitamin D and its effect on various health outcomes , a workshop entitled “ Vitamin D Expert Meeting : Do we get enough ? ” , was organized . Results Despite low vitamin D levels worldwide , consensus on the definition of deficiency is not yet reached . In order to define cut-off points for vitamin D whilst taking into account extraskeletal health effects , r and omized controlled trials in these fields are warranted . The experts do emphasize that there is evidence to suggest an important role for vitamin D in the maintenance of optimal bone health at all ages and that vitamin D supplementation , in most studies co-administered with calcium , reduces fracture risk in the senior population . Conclusion To reach a serum 25-hydroxyvitamin D level of 50 nmol/l older adults aged ≥65 years are therefore recommended to meet a mean daily vitamin D intake of 20 μg ( 800 IU ) , which is best achieved with a supplement A double-blind comparative study of 1 alpha-OHD3 and placebo was performed on 37 patients with osteoporotic hip fracture without clinical osteomalacia .  1 alpha-OHD3 , in a dose of 1 microgram/day together with 2.5 g CaCO3 , did not heal osteoporosis as judged from determinations of bone mineral density and histomorphometric analyses during four months of treatment . However , 1 alpha-OHD3 seemed to have an effect on fracture healing as concluded from the posttreatment alkaline phosphatase level . Hypercalcemia was common , occurring in six out of 19 patients treated with 1 alpha-OHD3 . It is concluded that treatment of osteoporosis with 1 alpha-OHD3 and calcium is ineffective and potentially dangerous because it frequently causes hypercalcemia BACKGROUND Elevated circulating concentrations of proinflammatory cytokines may contribute to the pathogenesis of congestive heart failure ( CHF ) . In vitro studies suggest that vitamin D suppresses proinflammatory cytokines and increases antiinflammatory cytokines . OBJECTIVE We evaluated the effect of vitamin D supplementation on the survival rate and different biochemical variables in patients with CHF . DESIGN One hundred twenty-three patients r and omly received either 50 mug vitamin D(3)/d plus 500 mg Ca/d [ D(+ ) group ] or placebo plus 500 mg Ca/d [ D(- ) group ] for 9 mo . Biochemical variables were assessed at baseline and after 9 mo . The survival rate was calculated for a follow-up period of 15 mo . RESULTS Ninety-three patients completed the study . Significant treatment effects were observed on logarithmic-transformed serum concentrations of 25-hydroxyvitamin D ( P = 0.001 ) , parathyroid hormone ( P = 0.007 ) , tumor necrosis factor alpha ( P = 0.006 ) , and interleukin 10 ( P = 0.042 ) . 25-Hydroxyvitamin D increased by 26.8 ng/mL in the D(+ ) group but increased only by 3.6 ng/mL in the D(- ) group . Compared with baseline , parathyroid hormone was significantly lower and the antiinflammatory cytokine interleukin 10 was significantly higher in the D(+ ) group after 9 mo . The proinflammatory cytokine tumor necrosis factor alpha increased in the D(- ) group but remained constant in the D(+ ) group . The survival rate did not differ significantly between the study groups during the follow-up period . CONCLUSIONS Vitamin D(3 ) reduces the inflammatory milieu in CHF patients and might serve as a new antiinflammatory agent for the future treatment of the disease . Our data provide evidence for the involvement of an impaired vitamin D-parathyroid hormone axis in the progression of CHF INTRODUCTION Vitamin D ( 25-hydroxyvitamin D , 25(OH)D ) deficiency , hypovitaminosis D , is highly prevalent in chronic kidney disease patients and is potentially involved with complications in the hemodialysis ( HD ) population . The aim of this study was to evaluate the impact of cholecalciferol supplementation on biomarkers of mineral metabolism , inflammation , and cardiac function in a group of HD patients presenting with hypovitaminosis D and low intact parathyroid hormone ( iPTH ) levels . MATERIAL AND METHODS HD patients with iPTH levels of < 300 pg/mL , not receiving vitamin D therapy , and presenting with 25(OH)D levels of < 30 ng/mL were enrolled in this prospect i ve study . Oral cholecalciferol was prescribed once a week in the first 12 weeks ( 50,000 IU ) and in the last 12 weeks ( 20,000 IU ) of the study . High-sensitivity C-reactive protein , interleukin-6 , and serum albumin were used as inflammatory markers .  Echocardiograms were performed on a midweek interdialytic day at baseline and after 6 months of cholecalciferol supplementation . RESULTS In all , 30 patients were included in the final analysis . We observed a significant increase in serum 25(OH)D levels after 3 months ( 46.2 ± 14.4 ng/mL vs. 18.1 ± 6.6 ng/mL ; P < .001 ) and after 6 months ( 40.4 ± 10.4 ng/mL vs. 18.1 ± 6.6 ng/mL ; P < .001 ) of cholecalciferol supplementation . There were no significant changes in alkaline phosphatase , iPTH , phosphorus , and serum albumin levels , but there was a slight but significant increase in calcium levels after 6 months of cholecalciferol supplementation ( 9.4 ± 0.6 mg/dL vs. 9.0 ± 0.6 mg/dL ; P = .02 ) . Additionally , we observed a significant reduction in high-sensitivity C-reactive protein levels after 3 months ( median : 0.62 [ 0.05 to 29.6 ] mg/L vs. 0.32 [ 0.02 to 3.13 ] mg/L ; P = .02 ) and after 6 months ( median : 0.62 [ 0.05 to 29.6 ] mg/L vs. 0.50 [ 0.02 to 5.66 ] mg/L ; P = .04 ) of cholecalciferol supplementation , as well as a significant reduction in interleukin-6 levels ( median : 6.44 pg/mL vs. 3.83 pg/mL ; P = .018 ) after 6 months of supplementation . Left ventricular mass index was significantly reduced at the end of supplementation ( 159 ± 55 g/m(2 ) vs. 175 ± 63 g/m(2 ) ; P = .03 ) . CONCLUSIONS Cholecalciferol supplementation in HD patients was found to be safe and efficient to correct hypovitaminosis D and established little impact on mineral metabolism markers . Additionally , we observed a reduction in important surrogate markers of cardiovascular risk , namely systemic inflammation and left ventricular hypertrophy , suggesting an anti-inflammatory action and possibly an improvement of cardiac dysfunction The purpose of this study was to ( 1 ) quantify the healing process of the human osteoporotic proximal humerus fracture ( PHF ) expressed in terms of callus formation over the fracture region using BMD scanning , and ( 2 ) quantify the impact of medical intervention with vitamin D3 and calcium on the healing process of the human osteoporotic fracture . The conservatively treated PHF was chosen in order to follow the genuine fracture healing without influence of osteosynthetic material s or casts . Thirty women ( mean age = 78 years ; range = 58–88 ) with a PHF , osteoporosis or osteopenia ( based on a hip scan , WHO criteria ) , and not taking any drugs related to bone formation , including calcium or vitamin D supplementation  , were r and omly assigned to either oral 800 IU vitamin D3 plus 1 g calcium or placebo , in a double-blind prospect i ve study . We measured biochemical , radiographic , and bone mineral density effect parameters to evaluate the impact on the healing process . Scanning procedures of the fractured shoulder included use of a fixation device to obtain the highest possible precision . Double scans of the fractured shoulder revealed a coefficient of variation ( CV ) on BMD measurements that improved from 2.8 % immediately after fracture occurrence to 1.7 % at 12 weeks ( P = 0.003 ) approaching the 1.2 % levels observed over the healthy shoulder . BMD was similar in the two groups at baseline ( active 0.534 g/cm2 vs. placebo 0.518 g/cm2 ) , and both increased over the 12-week observation period , with peak levels in week 6 . By week 6 BMD levels were higher in the active group ( 0.623 g/cm2 ) compared with the placebo group ( 0.570 g/cm2 , P = 0.006 ) . Thirty seven percent of the patients presented with vitamin D levels below 30 nmol/l , indicative of mild vitamin D insufficiency . In conclusion , we have demonstrated that it is possible to quantify callus formation of the PHF with sufficiently high precision to demonstrate the positive influence of vitamin D3 and calcium over the first 6 weeks after fracture . Whether this results in more stable fractures , extends to other fracture types , or applies to other osteogenic bone agents such as bisphosphonates remains to be examined Background / objectives : Vitamin D has anti-inflammatory and immune-regulating properties . We aim ed to determine if high-dose cholecalciferol supplementation for 1 year in subjects with early chronic kidney disease ( CKD ) improved circulating markers of inflammation and immunity . Subjects/ methods : In this double-blind , r and omized , placebo-controlled trial , 46 subjects with early CKD ( stages 2 and 3 ) were supplemented with oral cholecalciferol ( 50 000 IU weekly for 12 weeks followed by 50 000 IU every other week for 40 weeks ) or a matching placebo for 1 year . Serum tumor necrosis factor-α , interleukin-6 , monocyte chemoattractant protein-1 ( MCP-1 ) , interferon gamma-induced protein-10 and neutrophil gelatinase-associated lipocalin were measured at baseline , 12 weeks and 1 year . Serum cathelicidin ( LL-37 ) was measured at baseline and 12 weeks . An in vitro experiment was performed to investigate the effect of 1,25-dihydroxyvitamin D3 ( 1,25(OH)2D3 ) treatment on MCP-1 secretion in THP-1 monocytes activated with lipopolysaccharide ( LPS ) and Pseudomonas aeruginosa . Results : By 12 weeks , serum MCP-1 decreased in the cholecalciferol group ( 66.2±2.5 to 60.8±2.6 pg/ml , group-by-time interaction P=0.02 ) but was not different from baseline at 1 year . Other markers of inflammation and immunity did not change . In vitro , LPS- and Pseudomonas-activated monocytes treated with 1,25(OH)2D3 had significantly less MCP-1 secretion compared with untreated cells . Conclusions : High-dose cholecalciferol  decreased serum MCP-1 concentrations by 12 weeks in patients with early CKD , although the decrease was not maintained for the remainder of the year . In vitro results confirm an MCP-1-lowering effect of vitamin D. Future studies should determine if vitamin D-mediated reductions in MCP-1 concentrations reflect improved clinical outcomes CONTEXT Several trials have reported an increased risk of fractures and falls after intermittent high-dose vitamin D. Treatment with loading doses of vitamin D may increase 1,25(OH)(2 ) vitamin D catabolism through changes in calcium/phosphate homeostasis and fibroblast growth factor-23 ( FGF-23 ) . OBJECTIVE The aim was to determine the effects of high-dose vitamin D on circulating concentrations of 1,25(OH)(2 ) vitamin D and FGF-23 in patients with osteoporosis and vitamin D insufficiency . DESIGN , SETTING , PATIENTS , AND INTERVENTION We carried out a prospect i ve study of 45 subjects with vitamin D deficiency/insufficiency treated with a bolus dose of 30 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Summary On September 29 , 2011 , acknowledged experts in the field of vitamin D , mainly European , were brought together in order to discuss the recent scientific advances in relation to vitamin D : the current requirements and associations with various health outcomes . In this article , the discussion s result ing from the meeting are summarized . Introduction Several groups at risk for developing vitamin D insufficiency have been identified . Accordingly , review s indicate that a significant percentage of the population worldwide have serum 25-hydroxyvitamin D levels below 50 nmol/l . In addition to the role of vitamin D in bone health , recent studies suggest that it may play a pivotal role in other systems , e.g. , the cardiovascular system , pancreas , muscle , immune system and brain . Most evidence , however , is obtained from observational studies and yet inconclusive . Methods To exchange and broaden knowledge on the requirements for vitamin D and its effect on various health outcomes , a workshop entitled “ Vitamin D Expert Meeting : Do we get enough ? ” , was organized . Results Despite low vitamin D levels worldwide , consensus on the definition of deficiency is not yet reached . In order to define cut-off points for vitamin D whilst taking into account extraskeletal health effects , r and omized controlled trials in these fields are warranted . The experts do emphasize that there is evidence to suggest an important role for vitamin D in the maintenance of optimal bone health at all ages and that vitamin D supplementation , in most studies co-administered with calcium , reduces fracture risk in the senior population . Conclusion To reach a serum 25-hydroxyvitamin D level of 50 nmol/l older adults aged ≥65 years are therefore recommended to meet a mean daily vitamin D intake of 20 μg ( 800 IU ) , which is best achieved with a supplement A double-blind comparative study of 1 alpha-OHD3 and placebo was performed on 37 patients with osteoporotic hip fracture without clinical osteomalacia .  1 alpha-OHD3 , in a dose of 1 microgram/day together with 2.5 g CaCO3 , did not heal osteoporosis as judged from determinations of bone mineral density and histomorphometric analyses during four months of treatment . However , 1 alpha-OHD3 seemed to have an effect on fracture healing as concluded from the posttreatment alkaline phosphatase level . Hypercalcemia was common , occurring in six out of 19 patients treated with 1 alpha-OHD3 . It is concluded that treatment of osteoporosis with 1 alpha-OHD3 and calcium is ineffective and potentially dangerous because it frequently causes hypercalcemia BACKGROUND Elevated circulating concentrations of proinflammatory cytokines may contribute to the pathogenesis of congestive heart failure ( CHF ) . In vitro studies suggest that vitamin D suppresses proinflammatory cytokines and increases antiinflammatory cytokines . OBJECTIVE We evaluated the effect of vitamin D supplementation on the survival rate and different biochemical variables in patients with CHF . DESIGN One hundred twenty-three patients r and omly received either 50 mug vitamin D(3)/d plus 500 mg Ca/d [ D(+ ) group ] or placebo plus 500 mg Ca/d [ D(- ) group ] for 9 mo . Biochemical variables were assessed at baseline and after 9 mo . The survival rate was calculated for a follow-up period of 15 mo . RESULTS Ninety-three patients completed the study . Significant treatment effects were observed on logarithmic-transformed serum concentrations of 25-hydroxyvitamin D ( P = 0.001 ) , parathyroid hormone ( P = 0.007 ) , tumor necrosis factor alpha ( P = 0.006 ) , and interleukin 10 ( P = 0.042 ) . 25-Hydroxyvitamin D increased by 26.8 ng/mL in the D(+ ) group but increased only by 3.6 ng/mL in the D(- ) group . Compared with baseline , parathyroid hormone was significantly lower and the antiinflammatory cytokine interleukin 10 was significantly higher in the D(+ ) group after 9 mo . The proinflammatory cytokine tumor necrosis factor alpha increased in the D(- ) group but remained constant in the D(+ ) group . The survival rate did not differ significantly between the study groups during the follow-up period . CONCLUSIONS Vitamin D(3 ) reduces the inflammatory milieu in CHF patients and might serve as a new antiinflammatory agent for the future treatment of the disease . Our data provide evidence for the involvement of an impaired vitamin D-parathyroid hormone axis in the progression of CHF INTRODUCTION Vitamin D ( 25-hydroxyvitamin D , 25(OH)D ) deficiency , hypovitaminosis D , is highly prevalent in chronic kidney disease patients and is potentially involved with complications in the hemodialysis ( HD ) population . The aim of this study was to evaluate the impact of cholecalciferol supplementation on biomarkers of mineral metabolism , inflammation , and cardiac function in a group of HD patients presenting with hypovitaminosis D and low intact parathyroid hormone ( iPTH ) levels . MATERIAL AND METHODS HD patients with iPTH levels of < 300 pg/mL , not receiving vitamin D therapy , and presenting with 25(OH)D levels of < 30 ng/mL were enrolled in this prospect i ve study . Oral cholecalciferol was prescribed once a week in the first 12 weeks ( 50,000 IU ) and in the last 12 weeks ( 20,000 IU ) of the study . High-sensitivity C-reactive protein , interleukin-6 , and serum albumin were used as inflammatory markers .  Echocardiograms were performed on a midweek interdialytic day at baseline and after 6 months of cholecalciferol supplementation . RESULTS In all , 30 patients were included in the final analysis . We observed a significant increase in serum 25(OH)D levels after 3 months ( 46.2 ± 14.4 ng/mL vs. 18.1 ± 6.6 ng/mL ; P < .001 ) and after 6 months ( 40.4 ± 10.4 ng/mL vs. 18.1 ± 6.6 ng/mL ; P < .001 ) of cholecalciferol supplementation . There were no significant changes in alkaline phosphatase , iPTH , phosphorus , and serum albumin levels , but there was a slight but significant increase in calcium levels after 6 months of cholecalciferol supplementation ( 9.4 ± 0.6 mg/dL vs. 9.0 ± 0.6 mg/dL ; P = .02 ) . Additionally , we observed a significant reduction in high-sensitivity C-reactive protein levels after 3 months ( median : 0.62 [ 0.05 to 29.6 ] mg/L vs. 0.32 [ 0.02 to 3.13 ] mg/L ; P = .02 ) and after 6 months ( median : 0.62 [ 0.05 to 29.6 ] mg/L vs. 0.50 [ 0.02 to 5.66 ] mg/L ; P = .04 ) of cholecalciferol supplementation , as well as a significant reduction in interleukin-6 levels ( median : 6.44 pg/mL vs. 3.83 pg/mL ; P = .018 ) after 6 months of supplementation . Left ventricular mass index was significantly reduced at the end of supplementation ( 159 ± 55 g/m(2 ) vs. 175 ± 63 g/m(2 ) ; P = .03 ) . CONCLUSIONS Cholecalciferol supplementation in HD patients was found to be safe and efficient to correct hypovitaminosis D and established little impact on mineral metabolism markers . Additionally , we observed a reduction in important surrogate markers of cardiovascular risk , namely systemic inflammation and left ventricular hypertrophy , suggesting an anti-inflammatory action and possibly an improvement of cardiac dysfunction The purpose of this study was to ( 1 ) quantify the healing process of the human osteoporotic proximal humerus fracture ( PHF ) expressed in terms of callus formation over the fracture region using BMD scanning , and ( 2 ) quantify the impact of medical intervention with vitamin D3 and calcium on the healing process of the human osteoporotic fracture . The conservatively treated PHF was chosen in order to follow the genuine fracture healing without influence of osteosynthetic material s or casts . Thirty women ( mean age = 78 years ; range = 58–88 ) with a PHF , osteoporosis or osteopenia ( based on a hip scan , WHO criteria ) , and not taking any drugs related to bone formation , including calcium or vitamin D supplementation  , were r and omly assigned to either oral 800 IU vitamin D3 plus 1 g calcium or placebo , in a double-blind prospect i ve study . We measured biochemical , radiographic , and bone mineral density effect parameters to evaluate the impact on the healing process . Scanning procedures of the fractured shoulder included use of a fixation device to obtain the highest possible precision . Double scans of the fractured shoulder revealed a coefficient of variation ( CV ) on BMD measurements that improved from 2.8 % immediately after fracture occurrence to 1.7 % at 12 weeks ( P = 0.003 ) approaching the 1.2 % levels observed over the healthy shoulder . BMD was similar in the two groups at baseline ( active 0.534 g/cm2 vs. placebo 0.518 g/cm2 ) , and both increased over the 12-week observation period , with peak levels in week 6 . By week 6 BMD levels were higher in the active group ( 0.623 g/cm2 ) compared with the placebo group ( 0.570 g/cm2 , P = 0.006 ) . Thirty seven percent of the patients presented with vitamin D levels below 30 nmol/l , indicative of mild vitamin D insufficiency . In conclusion , we have demonstrated that it is possible to quantify callus formation of the PHF with sufficiently high precision to demonstrate the positive influence of vitamin D3 and calcium over the first 6 weeks after fracture . Whether this results in more stable fractures , extends to other fracture types , or applies to other osteogenic bone agents such as bisphosphonates remains to be examined Background / objectives : Vitamin D has anti-inflammatory and immune-regulating properties . We aim ed to determine if high-dose cholecalciferol supplementation for 1 year in subjects with early chronic kidney disease ( CKD ) improved circulating markers of inflammation and immunity . Subjects/ methods : In this double-blind , r and omized , placebo-controlled trial , 46 subjects with early CKD ( stages 2 and 3 ) were supplemented with oral cholecalciferol ( 50 000 IU weekly for 12 weeks followed by 50 000 IU every other week for 40 weeks ) or a matching placebo for 1 year . Serum tumor necrosis factor-α , interleukin-6 , monocyte chemoattractant protein-1 ( MCP-1 ) , interferon gamma-induced protein-10 and neutrophil gelatinase-associated lipocalin were measured at baseline , 12 weeks and 1 year . Serum cathelicidin ( LL-37 ) was measured at baseline and 12 weeks . An in vitro experiment was performed to investigate the effect of 1,25-dihydroxyvitamin D3 ( 1,25(OH)2D3 ) treatment on MCP-1 secretion in THP-1 monocytes activated with lipopolysaccharide ( LPS ) and Pseudomonas aeruginosa . Results : By 12 weeks , serum MCP-1 decreased in the cholecalciferol group ( 66.2±2.5 to 60.8±2.6 pg/ml , group-by-time interaction P=0.02 ) but was not different from baseline at 1 year . Other markers of inflammation and immunity did not change . In vitro , LPS- and Pseudomonas-activated monocytes treated with 1,25(OH)2D3 had significantly less MCP-1 secretion compared with untreated cells . Conclusions : High-dose cholecalciferol  decreased serum MCP-1 concentrations by 12 weeks in patients with early CKD , although the decrease was not maintained for the remainder of the year . In vitro results confirm an MCP-1-lowering effect of vitamin D. Future studies should determine if vitamin D-mediated reductions in MCP-1 concentrations reflect improved clinical outcomes CONTEXT Several trials have reported an increased risk of fractures and falls after intermittent high-dose vitamin D. Treatment with loading doses of vitamin D may increase 1,25(OH)(2 ) vitamin D catabolism through changes in calcium/phosphate homeostasis and fibroblast growth factor-23 ( FGF-23 ) . OBJECTIVE The aim was to determine the effects of high-dose vitamin D on circulating concentrations of 1,25(OH)(2 ) vitamin D and FGF-23 in patients with osteoporosis and vitamin D insufficiency . DESIGN , SETTING , PATIENTS , AND INTERVENTION We carried out a prospect i ve study of 45 subjects with vitamin D deficiency/insufficiency treated with a bolus dose of 30 
    Output:
    