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.

Objective To investigate the value of medical thoracoscopy in diagnosis of pleural effusion of unknown aetiology in aged people.Methods The patients aged 65 years and over,with exudative pleural effusion of unknown aetiology,were enrolled in this study.And they underwent medical thoracoscopy for diagnosis.Results The 49 patients,33 males and 16 females,aged 65-82years (at average age of 70.5 yeas),were enrolled.The 83.7% (41 cases) of pleural effusion was unilateral,and 16.3% (8 cases) was bilateral.The 28.6% (14 cases) of them suffered from tuberculosis,16.3 % (8 cases) malignant tumor.The pathology results of 16 cases showed nonspecific inflammation and normal pleural tissue.The other 10 patients showed a normal pleuracy or abnormal pleuracy undergoing a failure biopsy.Considering the clinical data of the 27 cases,8 cases (16.3 %)had infectious disease,18 cases (38.8%) remained unknown.Diagnostic accuracy of medical thoracoscopy was 61.2%.Complications of these patients undergoing medical thoracoscopy were fever (n=8,16.3%) and subcutaneous emphysema (n=7,14.3%).Conclusions Medical thoracoscopy is a standard option for diagnosing pleural effusion.It could be easily managed by physicians.The complications appear more often in aged people.

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 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.

Objective:To evaluate the application value of electrical impedance tomography(EIT)imaging combining bedside bronchoscopy sputum suction by observing the changes of pulmonary ventilation, tidal volume and dynamic pulmonary compliance after bedside bronchoscopy sputum suction in elderly stroke-associated pneumonia(SAP).Methods:A randomized controlled study was conducted.Patients with SAP admitted to the respiratory intensive care unit of Henan Provincial People's Hospital from January 2017 to December 2018 were enrolled as research objects.They were divided into the control group versus observation group with the only difference in receiving bedside bronchoscope sputum suction replacing control's receiving conventional sputum suction.Impedance imaging region of interest 4(ROI4)values collected by using EIT at admission and 1, 3, 5 days after fiberoptic bronchoscope sputum suction were compared between the two groups.Meanwhile, the tidal volume, dynamic lung compliance, the duration of mechanical ventilation and hospitalization time in intensive care unit were recorded in the two groups.Results:A total of 78 patients meeting an inclusion and exclusion criterion were enrolled, with 37 cases in the control group and 41 cases in the observation group.Compared with control group, the bronchoscope sputum suction group showed the significantly increased regional gas distribution values(2.24±0.77% vs.0.49±0.65%, 7.05±0.77% vs.2.49±0.87%, 12.34±1.47% vs.5.57±0.50%, t=10.85, 24.56 and 26.54, respectively, all P<0.001)at 1, 3, 5 days after fiberoptic bronchoscope sputum suction.The tidal volume and dynamic lung compliance were significantly higher in the observation group than in the control group at 1, 3, 5 days after fiberoptic bronchoscope sputum suction.The duration of mechanical ventilation and hospitalization time in the intensive care unit were shorter in the observation group than in the control group(12.22±0.88 d vs.14.65±0.92 d, 18.41±1.12 d vs.21.14±1.06 d, t=11.91 and 11.01, both P< 0.001). Conclusions:For patients with SAP, an intermittent bedside fiberoptic bronchoscope sputum suction can effectively improve the pulmonary ventilation in the dorsal area, optimize pulmonary respiratory dynamics, facilitate the early withdrawal of the mechanic ventilation, and shorten the hospitalization time in the intensive care unit.

Objective To explore the effect of a mobile-phone based two-way referral system on the timing of myocardial reperfusion and on a prognosis of patients with ST segment elevation myocardial infarction(STEMI). Methods Patients with STEMI were divided into an intervention group whose first admission clinics were equipped with a telemedicine system at the first medical contact(FMC) ,and a control group without a telemedicine system at FMC. The rate of heart failure and cardiac death during hospitalization ,every time point of transporting process ,the value of left ventricular ejection fractions(LVEF)measured at 24 h ,and length of hospital stay were collected and compared. Results In comparison of intervention versus control group ,the timing of myocardial reperfusion at every time point was shorter ( P ＜ 0.05 ) ,the value of LVEF within 24 h was significantly lower[(46.8 ± 3.9)%]vs[(50.3 ± 5.1)%](t＝ 2.32 ,P＜ 0.05) ,the cardiac mortality was lower(4% vs 7%) ,without statistical significance(χ2＝0.19 ,P＝0.66) ,and the length of hospital stay were lower[(6.35 ± 3.68)d]vs[(8.64 ± 5.19)d]without statistical significance (t＝ 2.75 ,P＝0.01). Conclusions A mobile-phone based telemedicine can significantly shorten the time delay of myocardial reperfusion in patients with STEMI ,improve heart function in acute stage ,and reduce the length of hospital stay.

Objective To detect the molecular regulatory mechanism of co-treatment with LA and PCA on P38 MAPK signaling Pathway in the Neurons of Wilson's Disease Model-TX mice.Methods The neurons of TX suckling mice were isolated and cultured by primary method,and were divided into control group,model group,ALA group,PCA group and combined group.Flow cytometry was used to analyze the expression of ROS and JC-1.Western blot was used to detect the expression of P38 MAPK,Cyt C,Caspase 9 and Caspase 3.Results Flow cytometry results showed that MFI of ROS was 59.29±1.22,53.19±1.34 and 52.46±1.23 in ALA,PCA and co-treatment.ALA,PCA and co-treatment could significantly reduce the release of ROS and enhance the fluorescence intensity of JC-1 (P＜0.01).Compared with ALA group and PCA group,combined group could reduce the release of ROS and significantly enhance the fluorescence intensity of JC-1.Western blot indicated that the expression levels of P38 MAPK,Cyt C,Caspase 9,Caspase 3 in the neurons of model group had a remarkable increase compared with control group.Compared with the model group,the three treatment groups could decrease the expression levels of P38 MAPK,Cyt C,Caspase 9 and Caspase 3 in the neurons of TX suckling mice (P＜0.01).Meanwhile,the protein levels of P38 MAPK,Cyt C,Caspase 9 and Caspase 3 had a significant decrease compared with ALA group and PCA group.Conclusion he present findings suggest that co-treatment with LA and PCA can increase the copper excretion,reduce copper-induced mitochondria damage and attenuate the neurotoxicity,which in turn decrease neuronal apoptosis and improve neurological impairment of WD.

Objective:To systematically analyze the influence of early removal of urinary catheters on urinary complications in middle-aged and elderly patients after transurethral resection of the prostate.Methods:Randomized controlled trials or clinical controlled trials on early removal of urinary catheters in patients after transurethral resection of the prostate were retrieved from PubMed, Embase, the Cochrane Library, the Web of Science, CNKI, Wanfang Data, VIP database and CBM.RevMan 5.3 was used to analyzed the data.Results:Nine randomized controlled trials and one controlled clinical trial involving a total of 1529 patients were included.The results of meta-analysis showed that there was a significant difference between catheter removal within three days after surgery and removal 4-7days after surgery in the incidence of urinary tract infections[ OR=0.34, 95% CI(0.20-0.58), P<0.01], but there was no significant difference in secondary hemorrhage[ OR=0.86, 95% CI(0.44-1.66), P>0.05].There was no significant difference in the incidence of re-catheterization or secondary hemorrhage between ≤24 hours and 2-3 days after surgery[ OR=1.32, 95% CI(0.57-3.06), P>0.05; OR=3.18, 95% CI(0.32-31.56), P>0.05]. Conclusions:Early postoperative catheter removal(within 3 days)has a clear advantage in reducing the incidence of urinary tract infections, and urinary catheter removal within 24 hours does not increase the incidence of re-catheterization or secondary hemorrhage compared with removal after 24 hours.

Objective:To explore the relationship between drug resistance occurrence and the distribution pattern of polymorphic loci in individuals with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) treated with highly active anti-retroviral therapy (HAART).Methods:HAART-failed HIV/AIDS patients who successfully amplified the gene sequences of the pol region between June 2015 and December 2021 from 16 prefecture-level administrative regions in Yunnan Province were included.The resistant sequences were classified using the human immunodeficiency virus (HIV) basic local alignment search tool (BLAST) and validated through MEGA 6.0, and the obtained sequences were submitted to the Stanford University HIV Drug Resistance Database to identify drug resistance loci. The distribution of polymorphic loci was analyzed across patients exhibiting varying degrees of drug resistance, different treatment regimens and distinct HIV-1 subtypes.Changes of the frequencies of polymorphic loci in patients with different degrees of drug resistance were analyzed using trend chi-square test. Statistical comparisons and further paired comparisons were performed using chi-square test.Results:Gene sequences were amplified from 1 453 patients, and the resistance testing results showed 954 sensitive, 224 potentially or low resistant, 189 moderately resistant, and 86 highly resistant patients. The frequencies of mutations I15V, L19I, D60E in the HIV-1 protease region (PR region) and E36A, T39D, S48T mutations in the HIV-1 reverse transcriptase region (RT region) showed a decreasing trend as the degree of HIV-1 resistance escalated ( χ2trend=19.86, 9.16, 13.66, 37.64, 18.44 and 40.86, respectively, all P<0.01). Conversely, the mutations V77I in the PR region and K122E in the RT region showed an ascending trend ( χ2trend=12.19 and 10.03, respectively, both P<0.01). Distinct treatment groups, namely zidovudine (AZT)+ lamivudine (3TC)+ lopinavir/ritonavir (LPV/r), AZT+ 3TC+ efavirenz (EFV), AZT+ 3TC+ nevirapine (NVP), and tenofovir (TDF)+ 3TC+ EFV, were examined. Statistically significant differences in the frequencies of mutations E35D, M36I, and D60E in the PR region, as well as S48T, K122E, and R211K in the RT region, were observed among these treatment groups ( χ2=22.46, 9.32, 14.46, 26.85, 18.92 and 24.26, respectively, all P<0.05). In paired comparisons, AZT+ 3TC+ LPV/r group displayed higher frequencies of E35D, M36I, and D60E mutations, the AZT+ 3TC+ EFV group showed a higher frequency of S48T mutation, the AZT+ 3TC+ NVP group showed a higher frequency of K122E mutation, and the TDF+ 3TC+ EFV group exhibited a higher frequency of R211K mutation, all with statistically significant differences (all P<0.008). The differences in the frequencies of T12S, I15V, L19I, M36I, V77I, L89M in the PR region and E53D, I135V, S162C, R211K, K277R in the RT region among circulating recombinant form (CRF)08_BC, CRF07_BC and CRF01_AE subtype group were statistically significant ( χ2=693.60, 712.51, 798.11, 434.85, 386.91, 657.78, 932.58, 409.21, 344.39, 469.44 and 260.48, respectively, all P<0.001). In paired comparisons, the frequencies of T12S, I15V, L19I, E53D, I135V, S162C and R211K in CRF08_BC subtype, the frequencies of V77I and K277R in CRF07_BC subtype, and the frequencies of M36I and L89M in CRF01_AE subtype were higher than those in the other two groups, and the differences were all statistically significant (all P<0.017). Conclusions:The polymorphic loci resulting from HIV-1 HAART failure show different distribution patterns across various degrees of drug resistance, treatment regimens and HIV-1 subtypes.These loci demonstrate both specific and shared characteristics. It is necessary to enhance the surveillance of select polymorphic loci.

Objective:To explore the predictive value of HACOR score [heart rate (H), acidosis (A), consciousness (C), oxygenation (O), and respiratory rate (R)] on the clinical outcome of non-invasive positive pressure ventilation in patients with pulmonary encephalopathy due to chronic obstructive pulmonary disease (COPD).Methods:A prospective study was conducted. The patients with COPD combined with pulmonary encephalopathy who were admitted to Henan Provincial People's Hospital from January 1, 2017 to June 1, 2021 and initially received non-invasive positive pressure ventilation were enrolled. Besides non-invasive positive pressure ventilation, standard medical treatments were delivered to these patients according to guidelines. The need for endotracheal intubation was judged as failure of non-invasive ventilation treatment. Early failure was defined as the need for endotracheal intubation within 48 hours of treatment, and late failure was defined as the need for endotracheal intubation 48 hours and later. The HACOR score at different time points after non-invasive ventilation, the length of intensive care unit (ICU) stay, the total length of hospital stay, and the clinical outcome were recorded. The above indexes of patients with non-invasive ventilation were compared between successful and failed groups. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive effect of HACOR score on the failure of non-invasive positive pressure ventilation in the treatment of COPD with pulmonary encephalopathy.Results:A total of 630 patients were evaluated, and 51 patients were enrolled, including 42 males (82.35%) and 9 females (17.65%), with a median age of 70.0 (62.0, 78.0) years old. Among the 51 patients, 36 patients (70.59%) were successfully treated with non-invasive ventilation and discharged from the hospital eventually, and 15 patients (29.41%) failed and switched to invasive ventilation, of which 10 patients (19.61%) were defined early failure, 5 patients (9.80%) were late failure. The length of ICU and the total length of hospital stay of the non-invasive ventilation successful group were significantly longer than those of the non-invasive ventilation failure group [length of ICU stay (days): 13.0 (10.0, 16.0) vs. 5.0 (3.0, 8.0), total length of hospital stay (days): 23.0 (12.0, 28.0) vs. 12.0 (9.0, 15.0), both P < 0.01]. The HACOR score of patients at 1-2 hours in the non-invasive ventilation failure group was significantly higher than that in the successful group [10.47 (6.00, 16.00) vs. 6.00 (3.25, 8.00), P < 0.05]. However, there was no significant difference in HACOR score before non-invasive ventilation and at 3-6 hours between the two groups. The ROC curve showed that the area under the ROC curve (AUC) of 1-2 hour HACOR score after non-invasive ventilation for predicting non-invasive ventilation failure in COPD patients with pulmonary encephalopathy was 0.686, and the 95% confidence interval (95% CI) was 0.504-0.868. When the best cut-off value was 10.50, the sensitivity was 60.03%, the specificity was 86.10%, positive predictive value was 91.23%, and negative predictive value was 47.21%. Conclusions:Non-invasive positive pressure ventilation could prevent 70.59% of COPD patients with pulmonary encephalopathy from intubation. HACOR score was valuable to predict non-invasive positive pressure ventilation failure in pulmonary encephalopathy patients due to COPD.