Construction and significance of prediction model for chronic obstructive pulmonary disease assessment test based on fusion deep network fused with air data / 中华健康管理学杂志

Objective:To construct a chronic obstructive pulmonary disease (COPD) assessment test (CAT) score prediction model based on a deep network fused with air data, and to explore its significance.Methods:From February 2015 to December 2017, the outdoor environmental monitoring air data near the residential area of the patients with COPD from the Respiratory Outpatient Clinics of Peking University Third Hospital, Peking University People′s Hospital and Beijing Jishuitan Hospital were collected and the daily air pollution exposure of patients was calculated. The daily CAT scores were recorded continuously. The CAT score of the patients in the next week was predicted by fusing the time series algorithm and neural network to establish a model, and the prediction accuracy of the model was compared with that of the long short-term memory model (LSTM), the LSTM-attention model and the autoregressive integrated moving average model (ARIMA).Results:A total of 47 patients with COPD were enrolled and followed up for an average of 381.60 days. The LSTM-convolutional neural networks (CNN)-autoregression (AR) model was constructed by using the collected air data and CAT score, and the root mean square error of the model was 0.85, and the mean absolute error was 0.71. Compared with LSTM, LSTM-attention and ARIMA, the average prediction accuracy was improved by 21.69%.Conclusion:Based on the air data in the environment of COPD patients, the fusion deep network model can predict the CAT score of COPD patients more accurately.

Comparison of symptom and risk assessment methods among patients with chronic obstructive pulmonary disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease (COPD) guidelines classify patients into four groups according to the number of symptoms and the level of future risk of acute exacerbation COPD (AECOPD). This study aimed to compare the results of different methods used in diagnosis of COPD and evaluate the accuracy of the assessment methods in guiding clinical practice.</p><p><b>METHODS</b>A survey was conducted of 194 COPD outpatients between March and September 2012. Demographic characteristics, the number of exacerbations the patient has had within the previous 12 months, COPD assessment test (CAT), Modified British Medical Research Council (mMRC) scale, and results of the lung function tests were recorded.</p><p><b>RESULTS</b>Of the 194 patients assessed, 21 had a CAT score ≥10 and an mMRC grade ≤1, 13 had a CAT score <10 and an mMRC grade ≥2. A predicted forced expiratory volume in one second (FEV1%) of <50% with less than two acute exacerbations was observed in 39 patients, while a predicted FEV1% of ≥50% was noted in 20 patients with two or more acute exacerbations. The sensitivity of a predicted FEV1% <50% in predicting the risk of AECOPD in the future was 80.9%, while that in the real number of AECOPD events recorded was 62.8%, the difference being statistically significant (P = 0.004). The sensitivity of CAT in predicting the severity of symptoms was 90%, while that of mMRC was 83.8%, and the difference was not statistically significant.</p><p><b>CONCLUSIONS</b>The COPD assessment method recommended by the global initiative for chronic obstructive pulmonary disease (GOLD) 2011 is complicated and should be simplified. CAT is more comprehensive and accurate than mMRC. The lung function classification is a better tool for predicting the risk of AECOPD in the future, and the number of AECOPD can be referred to when required.</p>

Underdiagnosis of chronic obstructive pulmonary disease in China: epidemiologic study / 中华健康管理学杂志

Objective To investigate underdiagnosis problem of chronic obstructive pulmonary disease (COPD) in China.Methods Articles published during January 1 st,2000 and December 30th,2011were searched in Wanfang Database and Medline,search words including COPD and epidemiology survey.The papers were then reviewed,and those original contirbutions with sample size ≥ 1000 and strict quality control entered into the final analysis.Results Only 32.90％ (1095/3328) COPD patients had ever been diagnosed to have emphysema,bronchitis or COPD,and only 9.13％ (237/2597) had undergone lung function test.About 65.40％ (2306/3526) COPD patients were presented with at least one of the following symptoms:cough,phlegm and breathlessness.Stage Ⅰ or Ⅱ COPD was found in 74.52％ (1802/2418)patients.Conclusion Underdiagnosis of COPD was quite common in China,and patients with stage Ⅰ or Ⅱ COPD should have deserved early diagosis.

Investigation on the value of procalcitonin in diagnosing lower respiratory tract infection in adult / 中华检验医学杂志

ObjectiveTo investigate the value of serum procalcitonin (PCT) in diagnosing lower respiratory tract infection (LRTI) in adult.MethodsIn a retrospective study,97 patients were enrolled,who admitted into Peking University People's Hospital with suspected LRTI from July to December 2008.During analysis,the subjects are categorized into groups of LRTI with sepsis,hospital-acquired pneumonia(HAP),community-acquired pneumonia(CAP),acute exacerbation of chronic obstructive lung disease (AECOPD),other LRTI and non-infectious diseases.In these cases,the following parameters were assessed regularly,such as white blood cell count,erythrocyte sedimentation rate( ESR),C-reactive protein (CRP),PCT,bacterial culture of both sputum and blood,and Acute Physiology and Chronic Health Evaluation (APACHE)Ⅱ score.PCT levels were determined using antibody-coated tubes as a complete diagnostic-kit (LUMI test Pro-Calcitonin) in a Luminometer.ResultsMean PCT levels in groups of LRTI with sepsis, hospital-acquired pneumonia ( HAP ), community-acquired pneumonia ( CAP ), acute exacerbation of chronic obstructive lung disease( AECOPD),other LRTI,non-infectious diseases were 10.1 (0.7 -37.0),0.3(0.1 -0.8),0.2(0.1 -0.9),0.2(0.1 -0.4),0.3(0.1 -0.5),0.1 (0.1 -0.2) mg/L,respectively.There were statistical differences between these groups (H =19.898,P ＜ 0.01 ).And the PCT levels in groups of LRTI with sepsis,HAP,CAP,AECOPD,other LRTI were higher than group of non-infectious diseases ( U values were 0,18.000,81.000,20.000,all P ＜ 0.01 ).Patients with sepsis exhibited strongly higher PCT levels than patients with other lung diseases ( U values were 11.000,45.000,3.000,4.500,all P ＜ 0.01 ).Pearson correlation analysis of PCT levels with positive bacterial cultures and APACHE Ⅱ score was performed ( r =0.449).ROC analysis revealed that optimal discrimination between LRTI and non-infectious diseases could be performed at the cut-off point of 0.5 mg/L with a sensitivity of 32.6％ and specificity of 100％,while at a suggested cut-off point of 0.235 mg/L with a sensitivity of 53.9％ and specificity of 100％.Conclusions PCT is a more useful parameter for diagnosing lower respiratory tract infections( especially for those with sepsis) than other infectious markers such as CRP,ESR and white blood cell count.The sensitivity of PCT could be elevated with a reduction of the cut-off level.

Impact of continuing medical education on chronic obstructive pulmonary disease knowledge of medical doctors practicing at the grassroots / 中华全科医师杂志

ObjectiveTo understand knowledge level about chronic obstructive pulmonary disease (COPD)of medical doctors practising at district hospitals and community health service and impact of different models of continuing medical education on their knowledge level.MethodsKnowledge of COPD was investigated with a close-book examination in 372 medical doctors working at the grassroots of 10 urban copies of finished examination papers were returned in this investigation.with an average score of 50.1 and pass rate of 42.5%.About 67.7%and 67.5%of medical doctors passed the examination of knowledge on definition,risk factors and non.pharmacological treatment for COPD.respectively,and 19.9%of them passed the examination on pharmacological treatment for COPD.Different modes of continuing medical education made varied impacts on their acquisition of COPD knowledge.with an average score of 67 and pass rate of 73.3%in the intensified education group,respectively,significantly higher than those in general education group and non-education group.ConclusionsClinical knowledge and skills of COPD for medical doctors working at the grassroots in Beijing Was not so satisfactory and education should be strengthened urgently to raise their knowledge on COPD prevention and control.

Awareness of Knowledge of COPD by Doctors in District and Community Hospitals / 中国慢性病预防与控制

Objective To discover the knowledge level about the COPD of doctors in District and Community Hospitals. Methods The knowledge level of COPD was investigated with questionnaire in 400 physicians in 10 districts of Beijing in December 2007. Content included: COPD definition, diagnosis, epidemiology, risk factor, COPD common symptoms, exacerbation manifestation, COPD non-pharmacological treatment (pulmonary rehabilitation, smoking quitting, influenza and pneumococcal vaccination), and COPD pharmacological treatment (bronchodilator therapy, antibiotic therapy, inhaled and systemic corticosteroids therapy). Results There were 372 answered copies of questionnaire collected, the total average score was 50.1?20.6 points, pass rate was 42.5%, while was 55.2?20.6 points and 57.6% in 30~year old group and 55.6?14.2 points & 51.9% in 40~year old group, which were higher than those in 20~year old group and ≥50 year old group (P