Objective To evaluate the efficacy and safety of tulobuterol patch in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) in the elderly. Methods Totally 165 elderly patients with moderate to severe AECOPD were divided into trial group and control group randomly.83 patients of trial group were treated with tulobuterol patch,2 mg once a day,and fluticasone inhalation 250 μg twice a day; 82 patients of control group were treated with inhalation of salmeterol/fluticasone 250 μg/50 μg twice a day.Basic therapy was the same in two groups. Results After 10-14 days' treatment,forced expiratory volume in one second(FEV1),peak expiratory flow (PEF),6-min walking distance and symptom scores were ( 1.30 ± 0.31 ) L,(245.3 ± 56.1 ) L/min,(263.0±53.2)m,(33.2±12.1)scores in trial group,and (1.21±0.23)L,(213.9±58.4) L/min,(230.0±45.6)m,(37.8± 14.5) scores in control group,respectively.The lung function,6 minute walk distancc and symptom score were improved (t=2.120,3.521,4.279,2.212,all P＜0.05).The frequencies of rescue medication,waking-up suffocating at night and the days of hospital stay were deceased significantly in trial group as compared with control group[(2.5 ± 0.6) time/d,( 1.8 ± 0.5)time/week,(12.9±1.6)dvs.(2.90.8) time/d,(2.2±0.7) time/week,(14.1±1.8) d,t=3.610,4.219,4.524,all P＜0.05].The incidence of adverse reactions was not significant difference between two groups[8 cases(9.6％)vs.7 cases(8.5％),P＞0.05] and the adverse reactions were mild.Conclusions Tulobuterol patch is a newly formulated,effective and safe medication for the treatment of acute exacerbation of AECOPD.

BACKGROUND:The glial scar is a major obstacle to the regeneration of the central nervous system, which plays a physical and chemical barrier role to central nervous system regeneration. How to effectively inhibit glial scar formation and promote axonal regeneration has great significance.
OBJECTIVE:To explore the effect of the immune response in the formation of the glial scar after spinal cord injury.
METHODS:A computer-based online search was performed in the PubMed database and the CNKI database for the articles on the mechanisms of spinal cord injury, immune cel s and spinal cord injury as wel as the glial scar formation after spinal cord injury from January 1990 to January 2013. The key words were “spinal cord injury, immunity, glia scar”in Chinese and English. The languages of the articles were limited in Chinese and English. Final y, 72 articles were included for the further analysis according the inclusion criteria.
RESULTS AND CONCLUSION: After spinal cord injury, the effect of autoimmune response in which stil been much debated. Studies showed that spinal cord injury can cause suppression of cel ular immunity and non-specific immune function, causing immune function decreasing. Monitoring immune indicators and improving immune function have great significance in promoting the ful rehabilitation of patients with spinal cord injury. Glial scar is the most important factor to prevent the repairing after spinal cord injury. Immune and inflammatory response is the main reason to secondary spinal cord injury. Degree of repair after spinal cord injury mainly depends on the protection of the residual neurons in order to keep them off secondary damage. However, autoimmune T cel s can protect the residual neurons, the specific effect of T lymphocytes in glial scar formation after spinal cord injury is stil unclear, and further exploration is needed.

Objective To explore the characteristics of cognitive function in patients with leukoaraiosis(LA)at different extent.Methods The cognitive function of 66 patients with different extent of LA and 49 healthy controls were measured using the MoCA scale,and the relationship between the cognitive function and the extent of LA was evaluated.Results The LA was more severe,the cognitive function of patients was more poor.The cognitive function of patients with type Ⅳ LA significantly decreased than the patients with type Ⅰ LA and the controls,especially in the language,memory,visuoconstructional and executive functions(P<0.05).While the function of naming,attention,abstraction and orientation showed no significant difference between the patients with LA and the controls(P>0.05).Conclusion Moderate and severe LA may cause impairment of cognitive function.

Objective To study the effect of hyperbaric oxygen on cognitive dysfunction in patients with leukoaraiosis (LA). Methods 48 cases of moderate or severe LA with cognitive dysfunction were divided into 2 groups: the experimental group accepted hyperbaric oxygen (HBO) besides routine therapy, while the control group accepted routine therapy only. Both groups were assessed with Montreal cognition assessment (MoCA). Results The scores of MoCA in patients in the experimental group improved after treatment（P<0.05）, and was more than that of the control group（P<0.05）. Conclusion HBO can improve the cognitive function in patients with LA.

Objective To compare the associated anastomotic complication of cervical esophagogastric anastomosis between stapled and hand-sewn anastomosis in minimally invasive esophagectomy (MIE). Methods Clinical data of 203 patients with esophageal cancer receiving combined thoracoscopic and laparoscopic esophagectomy with anastomosis in the neck in our hospital from January 2010 to November 2013 were retrospectively analyzed. All the patients were divided into stapled group (104 patients) and hand-sewn group (99 patients). The incidence of anastomotic leakage and anastomotic stricture between these two groups were compared. Results There were no significant differences between two groups in gender, age, body mass index, total protein, albumin, and neoadjuvant chemotherapy (all P>0.05). There was no significant difference between the two groups in the incidence of anastomotic leakage[6/104(5.77%) vs. 3/99(3.03%), P>0.05], while the difference in the incidence of anastomotic stricture was significant [10/104(9.62%) vs. 2/99(2.02%), P<0.05]. The time of anastomosis, dieting and hospital stay was (15.5±5.0) min, (5.0±2.8) d and (18.3±5.9) d in stapled group, which was significantly shorter than (28.0±4.5) min, (5.9±1.2) d and (21.8±4.2) d in hand-sewn group (all P<0.05). Conclusion In the minimally invasive esophagectomy, stapled cervical esophagogastric anastomosis is simple and precise , but it is associated with increased risk of anastomotic stricture, therefore the type of anastomosis should be chosen based on the conditions of the patient.

Objective To compare the associated anastomotic complication of cervical esophagogastric anastomosis between stapled and hand-sewn anastomosis in minimally invasive esophagectomy (MIE). Methods Clinical data of 203 patients with esophageal cancer receiving combined thoracoscopic and laparoscopic esophagectomy with anastomosis in the neck in our hospital from January 2010 to November 2013 were retrospectively analyzed. All the patients were divided into stapled group (104 patients) and hand-sewn group (99 patients). The incidence of anastomotic leakage and anastomotic stricture between these two groups were compared. Results There were no significant differences between two groups in gender, age, body mass index, total protein, albumin, and neoadjuvant chemotherapy (all P>0.05). There was no significant difference between the two groups in the incidence of anastomotic leakage[6/104(5.77%) vs. 3/99(3.03%), P>0.05], while the difference in the incidence of anastomotic stricture was significant [10/104(9.62%) vs. 2/99(2.02%), P<0.05]. The time of anastomosis, dieting and hospital stay was (15.5±5.0) min, (5.0±2.8) d and (18.3±5.9) d in stapled group, which was significantly shorter than (28.0±4.5) min, (5.9±1.2) d and (21.8±4.2) d in hand-sewn group (all P<0.05). Conclusion In the minimally invasive esophagectomy, stapled cervical esophagogastric anastomosis is simple and precise , but it is associated with increased risk of anastomotic stricture, therefore the type of anastomosis should be chosen based on the conditions of the patient.

Objective To investigate the abnormal expression of proto-oncogene YES-associated protein (YAP) in gastric cancer tissues in the elderly and its correlation with poor prognosis.Methods Clinical data of 80 elderly patients with gastric cancer treated in our hospital from March 2011 to October 2014 were statistically analyzed.Results The positive expression rate of YAP was significantly higher in gastric carcinoma than in adjacent tissues [71.3％ (57/80) vs.13.8％ (11/80),P＜0.05].The positive expression of YAP were significantly associated gastric tumor size,tumor stage,invasion depth and lymph node metastasis (all P＜0.05),but had no correlation with tumor differentiation (P＞0.05).The 5-year survival rate was significantly lower in patients with YAP-positive expression than in patients with YAP-negative expression (P ＜ 0.05),but the differences in 1-year,3-year survival rates were not significant between the two groups (all P＞0.05)The YAP expression,tumor stage,lymph node metastasis were significantly associated with the prognosis of gastric cancer in patients (all P＜0.05).Conclusions YAP-positive expression rate is significantly higher in gastric cancer tissues than in adjacent tissues in the elderly,which indicates poor prognosis of patients with gastric cancer.

AIM: To determine astragaloside Ⅳ in Qixiu Granule (Radix Astragali seu Hedysari, Radix Salviae Miltiorrhizae, Radix Paeoniae Rubra, etc.) by HPLC ELSD. METHODS: HPLC ELSD was used in the quantitative analysis by using Alltima C 18 chromatography column and acetonitril water (34∶66) as a mobile phase. The flow rate of mobile phase was 1mL?min -1 . The tube temperature of the detector was 100?C. The flow rate of pure air was 2.7L?min -1 . RESULTS: The regressione quation was Y=-4.40?105+2.07?105X, r=0.9992 (3.73～13.59?g). The average recovery of astragaloside Ⅳ was 100.73%, RSD was 3.97%. CONCLUSION: The method is simple, reliable, accurate and can be regard as the quantity control method of Qixiu Granule.

Objective To evaluate the safety and feasibility of laparoscopy in combination with fast track colorectal surgery (FTCS) in the treatment of colorectal cancer in the elderly.Methods A total of 123 patients were randomly divided into 3 groups:the laparoscopy plus FTCS group (n=41),the laparoscopy group (n=41) and the laparotomy group (n=41).Parameters for measuring surgical quality,recovery and postoperative complications were analysed.Results No significant differences were found in age,gender,tumor location,anesthesia ASA classification,American Joint Committee on Cancer (AJCC) Tumor Node Metastasis (TNM) staging,Eastern Cooperative Oncology Group (ECOG) score or complications between the three groups (P＞0.05 for all).There were no differences in blood loss,operative time,time required to resume defecation or number of lymph nodes dissected between the laparoscopy plus FTCS group and the laparoscopy or laparotomy group (P＞0.05 for all),but time taken to initiate postoperative ambulation,time taken to resume flatulence,time taken to start intake of liquid food and length of hospital stay were shorter in the laparoscopy plus FTCS group than in the other groups (P ＜ 0.05 for all).The incidence of postoperative complications was 12.2％ or 5/41 in the laparoscopy plus FTCS group,which was lower than in the laparoscopy group (34.1％ or 14/41) and in the laparotomy group (68.3％ or 28/41) (x2 =5.549 and 28.826,P=0.018 and 0.01,respectively),a statistically significant difference was also found between the latter two groups (x2 =9.567,P =0.002).Conclusions Laparoscopy in combination with FTCS is safe and effective in the treatment of colorectal cancer in the elderly.

Objective To explore the diagnosis and surgical treatment of ileosigmoid fistulas (ISF) complicated by Crohn's disease (CD).Methods 13 CD patients with ISF were collected.Patients' clinical data,diagnostic methods,surgical procedures and outcomes were reviewed.Results Suspected or definite diagnosis was suggested by preoperative imaging in 12 patients.All 13 patients received surgery.Ileal lesions were all removed,while sigmiod fistula were repaired in 11 patients and partially resected in 2 patients.11 patients had a temporary ileostomy.All the patients recovered well,with 3 cases suffering from postoperative complications.Conclusions The diagnosis of ISF can be established preoperatively,and treatment should be individualized to patient' condition.