Bone metabolism characteristics and gender differences in patients with COPD: a cross-sectional study.

BACKGROUND: Gender differences in bone metabolism of people with chronic obstructive pulmonary disease (COPD) remain unclear. We aim to explore the characteristics of bone metabolism and its clinical significance for patients with COPD. METHODS: A total of 564 cases (282 COPD cases and 282 controls) were preselected. Clinical and analytical characteristics of these cases were assessed. After excluding patients with other conditions known to disturb calcium metabolism, 333 patients (152 COPD cases and 181 controls) were identified. The medical records, indexes of bone turnover markers, serum calcium and phosphorus of the 333 patients were collected and their correlation was analyzed. RESULTS: The 152 cases with COPD were 82.61 ± 7.745 years, 78.3% males, and the 181 age- and sex-matched control cases were 79.73 ± 11.742 years, 72.4% males. Levels of total procollagen type I amino-terminal propeptide (tPINP), osteocalcin (OC), serum calcium and phosphate were significantly lower (P < 0.001) while the level of parathormone (PTH) was significantly higher (P = 0.004) in COPD than in controls. The 25-hydroxycholecalciferol (25(OH)D3) was below the lower limit of normal value (LLN) in both groups, which was significantly lower in COPD males than in control males (P = 0.026). In COPD group, PTH level was significantly higher in females (P = 0.006), and serum P was lower in males (P = 0.006). The adjusted linear regression analysis showed that the levels of tPINP, OC and serum Ca were decreasing greatly in COPD group [ß (95%CI) - 8.958 (- 15.255 to - 2.662), P = 0.005; - 4.584 (- 6.627 to - 2.542), P < 0.001; - 0.065 (- 0.100 to - 0.031), P < 0.001]. Besides, smoke exposure, gender (male) were also related to hypocalcemia [ß (95%CI) - 0.025 (- 0.045 to - 0.005), P = 0.017; - 0.041 (- 0.083 to - 0.001), P = 0.047], and 25(OH)D3 was correlated with serum calcium, phosphorus, and PTH [ß (95%CI) 15.392(7.032-23.753), P < 0.001; - 7.287 (- 13.450 to - 1.124), P = 0.021; - 0.103(- 0.145 to - 0.061), P < 0.001], and female was more likely to have secondary hyperparathyroidism [ß (95%CI) 12.141 (4.047-20.235), P = 0.002]. CONCLUSION: COPD patients have remarkably low bone turnover (indicated by OC) and impaired bone formation (low tPINP), and they are also more prone to low calcium. Smoking and male may play roles in the formation of hypocalcemia, and the secondary hyperparathyroidism is more significant in COPD women. There may be gender differences in bone metabolism abnormalities and their mechanisms of COPD. The conclusion above still need further research and demonstration.

Efficacy and safety of ceritinib in anaplastic lymphoma kinase-rearranged non-small cell lung cancer: A systematic review and meta-analysis.

WHAT IS KNOWN AND OBJECTIVE: Ceritinib is a new, oral, potent and selective second-generation anaplastic lymphoma kinase (ALK) inhibitor approved by the Food and Drug Administration of the United States in April 2014. It is active in crizotinib-resistant patients, especially in patients with non-small cell lung cancer (NSCLC) and brain metastasis. The aim of this study was to analyse the effects and side effects of ceritinib in ALK-rearranged NSCLC. METHODS: We searched articles published from January 1980 to March 2019 in PubMed, EMBASE, Cochrane Library and Web of Science. The pooled estimate and 95% CI were calculated with DerSimonian-Laird method and the random effect model. RESULTS AND DISCUSSION: From 15 articles, 2,598 patients were included in the meta-analysis. Eleven studies reported the ORR, and the DCR was presented in 10 studies. The ORR and DCR of ceritinib were 0.48 (95% CI, 0.39-0.57) and 0.76 (95% CI, 0.69-0.82), respectively. The PFS and OS were presented in nine and three eligible studies, respectively. The PFS and OS of ceritinib were 7.26 months (95% CI, 5.10-9.43) and 18.73 months (95% CI; 14.59-22.87). These results suggested that ceritinib can effectively treat patients with ALK-rearranged NSCLC. Diarrhoea, nausea and vomiting were the three most common AEs and occurred in 69% (95% CI 51.7-87.1%), 66% (95% CI 47.0-85.8%) and 51% (95% CI 35.9-66.8%) of patients, respectively. Considering serious gastrointestinal AEs, antiemetic and antidiarrhoeal drugs should be considered to improve a patient's tolerance to ceritinib. WHAT IS NEW AND CONCLUSION: Ceritinib is effective in the treatment of patients with ALK-rearranged NSCLC with crizotinib resistance. The DCR was up to 76%, and PFS was extended to 7.6 months. The AEs were acceptable.

Application of Imaging Examination Based on Deep Learning in the Diagnosis of Viral Senile Pneumonia.

Medical image classification technology, preferably which is based on the deep learning, is not only a key auxiliary diagnosis and treatment method in clinical medicine but also an important direction of scientific research. With the intensification of social aging, the incidence of viral elderly pneumonia has been on the rise and needs dedication from the research community. Doctors rely on personal theories and experience to use traditional methods to check the computed tomography (CT) images of the lungs of elderly patients one by one, which is likely to cause diagnosis errors. The accuracy of the traditional method certainly meets the clinical needs, but it has higher requirements on the theory and experience of medical staff, and the classification efficiency is low. Constructing an accurate and fast auxiliary system can effectively save medical resources. In response to the above problems, we have proposed a viral pneumonia diagnosis method for lung CT images, which is based on the convolutional neural networks. The main research work is carried out around the following aspects: First, in the lung CT image classification task, the traditional methods are inefficient and effective for doctors. The basic quality requirements of the model are high, or, in the model training, the effective training data are small, and so forth, causing problems such as model overfitting. A lung CT classification model based on the improved Inception-ResNet is proposed. In this model, first the overall architecture of the network model is designed, and then the Contrast-Limited Adaptive Histogram Equalization (CLAHE) algorithm is used to perform the same image enhancement processing on the dataset and data needed in this article, and then the pictures pass through three different network models. A binary classification study was carried out on viral pneumonia and normal lung images, and finally the accuracy, sensitivity, and specificity of the three models were compared. The experimental results show that the accuracy of the three models for the judgment of viral pneumonia is more than 95%. Among these, the model proposed in this article has better classification effect and fit, the highest accuracy rate, and less parameters and can be used for rapid screening of viral senile pneumonia. Objective. To complete the classification of lung CT images of the elderly with viral pneumonia based on the improved Inception-ResNet network architecture. Methods. (1) Find and study domestic and foreign medical literature, understand the diagnosis and treatment methods of viral pneumonia, and study lung CT imaging; compare the pattern classifications of deep learning in lung imaging at home and abroad, and further study the application of convolutional neural networks in the medical field application. (2) Study various models and technologies of convolutional neural networks, summarize them separately, and have in-depth understanding of convolutional neural networks, including architecture, methods, and related system frameworks, experimental environments, and so forth. Results. This paper proposes an optimized Inception-ResNet network architecture for image classification. The control experimental model uses two network models, GoogLeNet and ResNet, and selects the viral pneumonia dataset for training and testing. The experimental results are as follows: the sensitivity and specificity are superior to those in the other two models, which can be used for actual medical screening and diagnosis. Conclusion. The improved Inception-ResNet network model method in this paper performs better in terms of accuracy, sensitivity, and specificity. Every metric is higher than those in the ResNet model and the GoogLeNet model, improving the classification effect. In addition, it can be seen from the experimental results that the model used in this paper has a very good classification effect in the classification of new coronary pneumonia CT image data.

Elderly patients with concurrent hip fracture and lower respiratory tract infection: the pathogens and prognosis over different bedridden periods.

BACKGROUND: Elderly patients who experience hip fractures often become bedridden and are at risk of developing lower respiratory tract infections. The current study was to investigate the etiology and bacterial drug resistance patterns of elderly patients with hip fractures and lower respiratory tract infections on prolonged bedridden time and to determine their prognosis. METHODS: Patients diagnosed with hip fractures admitted from May 2015 to April 2017 were included. The basic characteristics including the patients' gender, age, fracture type, operation mode, bedridden duration, length of hospital stay, prognosis, past medical history, routine bloodwork, C-reactive protein (CRP), procalcitonin (PCT), blood biochemistry, blood gas analysis, glycosylated hemoglobin (HbA1C%), sputum smear, sputum culture, and anti-infection and related therapy were recorded. All patients were classified into three groups based on bed rest duration, including short-term (<1 month), mid-term (1-12 months), and long-term (> 12 months). The correlation between the bedridden time and the patients' basic characteristics, disease history, laboratory examination results, pathogen, anti-infection, and related therapy were evaluated. The risk factors related to the prognosis of the disease were investigated. RESULTS: Prolonged bed rest in patients led to an increase in hospitalization time, mortality rates, and decreased serum albumin levels (P < 0.05). Sputum bacteriological culture results showed that, with bed rest prolongation, the proportion of Pseudomonas aeruginosa and fungal infections increased. Binomial logistic regression of pulmonary infection prognosis, glucocorticoid use during the anti-infective period, prolonged bedridden time, and serum albumin level showed that intravenous use of glucocorticoid during anti-infective treatment, bed rest > 1 year, and low serum albumin level were related to poor prognosis. CONCLUSION: Elderly hip fracture patients with prolonged bedridden time had an increased chance of opportunistic pulmonary infection and decreased nutritional status. Glucocorticoids should be used cautiously.

Application of bone turnover markers and DXA and QCT in an elderly Chinese male population.

BACKGROUND: To investigate the clinical values and relationships of bone turnover markers (BTMs), dual-energy X-ray absorptiometry (DXA), and quantitative computed tomodensitometry (QCT) in the screening of osteoporosis (OP) in elderly Chinese males. METHODS: General data, including age, height, and weight, the results of BTM measurements, and the findings of DXA and QCT in 357 male patients aged ≥50 years who visited the outpatient or inpatient Department of Geriatrics, Beijing Jishuitan Hospital from June 2017 to May 2019 were retrospectively analyzed. RESULTS: The OP detection rates based on T-scores of DXA L1-4, DXA total hip, and spine QCT were 3.4% (12/357), 13.2% (47/357), and 40.3% (144/357), respectively. QCT had a significantly higher OP detection rate than did DXA (P<0.001). There were 24 cases of fragility fractures, which were significantly correlated with the DXA total hip BMD and its T-score, with risk cut-off values of 0.607 g/cm2 and -2.950, respectively. The measured levels of the 5 BTMs were as follows: total procollagen type I amino-terminal propeptide (tPINP), 39.23±20.82 ng/mL; ß-isomerized C-terminal telopeptides (ß-CTX), 0.38±0.21 ng/mL; osteocalcin (OC), 13.50±8.80 ng/mL; 25-hydroxycholecalciferol (25(OH)D3), 12.90±7.46 ng/mL; and parathormone (PTH), 54.50±25.35 pg/mL. The elevation of tPINP, ß-CTX, and OC were negatively correlated with aging and positively correlated with decreased BMD (all P<0.05). OC and 25(OH)D3 values were significantly lower than their normal range. Among the 43 patients with normal bone mass on both DXA and QCT examinations, 34 presented with abnormal BTMs, including elevated tPINP in 2 cases, elevated ß-CTX in 2 cases, and OC decreased in 31 cases. CONCLUSIONS: In the Chinese elderly male population, spine QCT has a higher detection rate of OP than DXA, whereas hip DXA is more advantageous in predicting the risk of fragility fracture. tPINP, ß-CTX, and OC can be used as reliable indicators for the dynamic observation of bone content changes and may screen for early bone metabolism abnormalities when BMD examinations still show negative results.