Underdiagnosis and underreporting of vertebral fractures on chest radiographs in men aged over 50 years or postmenopausal women with and without type 2 diabetes mellitus: a retrospective cohort study.

BACKGROUND: Osteoporotic vertebral fractures are often clinically silent and unrecognized. The present study aimed to determine whether routine chest radiographs could be a potential screening tool for identifying missed vertebral fractures in men aged over 50 years or postmenopausal women, especially those with type 2 diabetes mellitus (T2DM). In this study, we aimed to determine the prevalence of undetected vertebral fractures in elderly Chinese patients with and without T2DM. METHODS: Clinical data and chest radiographs of 567 individuals with T2DM (T2DM group) and 583 without diabetes (nondiabetic group) at a tertiary hospital in central south China were extracted from the records. Vertebral fractures were specifically looked for on chest radiographs and classified using the Genant semi-quantitative scale. Prevalence was compared between the two groups. RESULTS: Mean age and sex composition were comparable between the two groups. Mean weight and body mass index were significantly lower in the T2DM group. In both groups, fractures mostly involved the T11-12 and L1 vertebrae. Moderate/severe fractures were identified in 33.3% individuals in the T2DM group (31.4% men and 36.0% women) versus 23.2% individuals (20.9% men and 25.5% women) in the nondiabetic group. CONCLUSIONS: Routine chest radiographs could be a useful screening tool for identifying asymptomatic vertebral fractures. Trial registration The study was designed as an observational retrospective study, therefore a trial registration was not necessary.

Association between hypomagnesemia and severity of primary hyperparathyroidism: a retrospective study.

BACKGROUND: The occurrence of hypomagnesemia in patients with primary hyperparathyroidism (PHPT) has been noted previously; however, the association of hypomagnesemia and severity of primary hyperparathyroidism remains unknown. The present study aimed to evaluate the association of hypomagnesemia with biochemical and clinical manifestations in patients with PHPT. METHODS: This was a retrospective study conducted at a tertiary hospital. We obtained data from 307 patients with PHPT from January 2010 through August 2020. Data on demographics, history, laboratory findings, bone densitometry findings, and clinical presentation and complications were collected and were compared in normal magnesium group vs hypomagnesemia group. RESULTS: Among the 307 patients with PHPT included in our study, 77 patients (33/102 [32.4%] males and 44/205 [21.5%] females) had hypomagnesemia. Mean hemoglobin levels in the hypomagnesemia group were significantly lower than those in the normal magnesium group in both males and females. In contrast, patients with hypomagnesemia had a higher mean serum calcium and parathyroid hormone than individuals with normal magnesium. The typical symptoms of PHPT, such as nephrolithiasis, bone pain/fractures, polyuria, or polydipsia, were more common in the hypomagnesemia group. In addition, patients with hypomagnesemia had a higher prevalence of osteoporosis, anemia, and hypercalcemic crisis. Even after adjusting for potential confounders, including age, sex, body mass index, estimated glomerular filtration rate, and parathyroid hormone levels, these associations remained essentially unchanged. CONCLUSION: Biochemical and clinical evidence indicates that patients with PHPT with hypomagnesemia have more severe hyperparathyroidism than those without hypomagnesemia. In addition, PHPT patients with hypomagnesemia had a higher prevalence of osteoporosis, anemia, and hypercalcemic crisis.

Inhibition of immune checkpoints prevents injury-induced heterotopic ossification.

Heterotopic ossification (HO), true bone formation in soft tissue, is closely associated with abnormal injury/immune responses. We hypothesized that a key underlying mechanism of HO might be injury-induced dysregulation of immune checkpoint proteins (ICs). We found that the earliest stages of HO are characterized by enhanced infiltration of polarized macrophages into sites of minor injuries in an animal model of HO. The non-specific immune suppressants, Rapamycin and Ebselen, prevented HO providing evidence of the central role of the immune responses. We examined the expression pattern of ICs and found that they are dysregulated in HO lesions. More importantly, loss of function of inhibitory ICs (including PD1, PD-L1, and CD152) markedly inhibited HO, whereas loss of function of stimulatory ICs (including CD40L and OX-40L) facilitated HO. These findings suggest that IC inhibitors may provide a therapeutic approach to prevent or limit the extent of HO.

Dissolution rate enhancement of new co-crystals of ezetimibe with maleic acid and isonicotinamide.

Ezetimibe (EZT) is a selective cholesterol absorption inhibitor with poor aqueous solubility (0.012mg/ml 23oC) and low oral bioavailability (about 35-65% for a once 10mg dose). The present study illustrates the preparation and characterization of two new co-crystals of ezetimibe using maleic acid and isonicotinamide as the coformers by solid grinding method. The co-crystal structures were characterized by X-ray powder diffraction (PXRD), differential scanning calorimetry (DSC), infrared spectroscopy (IR) techniques. Crystallinity and surface morphological characteristics of these prepared co-crystals were observed by scanning electron microscope (SEM). Dissolution rate tests demonstrated that both of the new co-crystals showed significant improvement in sodium lauryl sulfate -sodium acetate buffer solution (PH=4.5) at 15min and 20min. This study enriched the types of EZT co-crystals and identified that pharmaceutical co-crystal engineering technique play an important role in the dissolution rate enhancement of ezetimibe.

Effect of lit-moxa stimulation of Guanyuan (CV 4) acupoint on levels of lactic acid and superoxide dismutase in skeletal muscle of rats.

OBJECTIVE: To observe the effect of lit-moxa stimu- lating acupoint Guanyuan (CV 4) on lactic acid and super-oxide dismutase (SOD) in skeletal muscle after exercise exhaustion. METHODS: Twenty-eight adult male Sprague-Dawley rats were randomly divided into normal control group, exhausted control group, exercise group and moxibustion group using exercise training and mild heating with lit-moxa stick as treatment methods. The exhausted control group, moxibustion group and exercise group received an exhaustive swimming after 20 days of intervention. Swimming exhausted times were recorded. Lactic acid and SOD concentration in soleus muscle were detected and compared between every two groups. RESULTS: The swimming exhausted times of the moxibustion group and the exercise group were significantly increased compare to the exhausted control group (P < 0.05). The lactic acid of the exhausted control group was significantly increased comparing with the normal control group (P < 0.05), and the lactic acid of the moxibustion group and the exercise group were significantly lower than that of the exhausted control group (P < 0.05). The SOD level of the exhausted control group was significantly decreased comparing with the normal control group (P < 0.05), and the SOD level of the moxibustion group and the exercise group were significantly higher than that of the exhausted control group (both, P < 0.05). There was no statistical difference between the moxibustion group and the exercise group. CONCLUSION: With lit moxa stick, heat stimulating acupoint of Guanyuan (CV 4) decreased the levels of lactic acid and SOD in rat's skeletal muscle.