OBJECTIVE:To study the effects of clinical pharmacists' intervention on rational drug use of outpatients with hypertension.METHODS:76 hypertensive patients who had poor medication compliance were provided with faceto face pharmaceutical care once a week(at least 15 min/each time) for a total of four times.Patients' medication compliance and the target-reaching rate of blood pressure were analyzed after 4-week treatment.RESULTS:The rate of compliance increased from 48.99%?22.90%on week one to 83.82%?12.47%on week five(P

OBJECTIVE:To provide reference for rational use of antihypertensive drugs in the clinic. METHODS:One hun-dred and eighteen primary hypertensive inpatients were selected from our hospital during Jan.2014-Oct.2015. The application of anti-hypertensive drugs and medication compliance were summarized and analyzed by reviewing the doctor’s advice and the question-naire survey method. RESULTS:Commonly used antihypertensive drugs of our hospital included diuretic,βreceptor blocker,calci-um antagonist, angiotensin converting enzyme inhibitor, angiotensinⅡreceptor antagonist and aldosterone receptor antagonist. Among 118 patients,fewer patients treated with monotherapy(10 cases,8.47%),and three-drug regimen took up the greatest pro-portion(51 cases,43.22%). The number of patients receiving antihypertensive drugs in related internal medicine departments(94 cases)was more than in related surgical departments(24 cases). 25 patients used antihypertensive drugs irrationally,mainly from internal medicine department,heart disease department,cerebropathy department,etc. Irrational medication mainly included irratio-nal frequencies(8 cases,32.00%),pharmaceutical frame structure damage(5 cases,20.00%),irrational drug selection(4 cases, 16.00%),etc. The poor medication compliance was found in 16 patients,mainly resulted from complex therapy plan (6 cases, 37.50%),forgetting to take medicine(5 cases,31.25%). CONCLUSIONS:Irrational use of antihypertensive drugs exist in prima-ry hypertensive inpatients of our hospital. Clinical pharmacists should use their own advantage to strengthen communication with medical staff,develop in pharmaceutical care and promote rational drug use in the clinic.

Objective To analyze the influence of diabetes mellitus (DM) on the outcomes of percutaneous transluminal angioplasty (PTA) with stenting of femoropopliteal artery,in patients with atherosclerotic occlusive disease (ASO).Method Clinical data of inpatients who successfully received PTA with stenting procedures of femoropopliteal artery in Xuanwu Hospital from January 2006 to December 2012 were analyzed retrospectively.Patients were stratified into DM and non-DM groups.Results were compared between the two groups including primary patency (PP),assisted patency (AP),limb salvage and survival using Kaplan-Meier life table and Cox regression analyses.Result Totally 291 patients underwent 332 procedures.There were 214 DM and 118 non-DM limbs.Mean follow-up was 34 months.The 5-year PP was 23.2％,AP was 35.3％,limb salvage was 89.2％,and survival was 69.6％.DM was associated with lower 5-year PP,limb salvage,and survival than non-DM.But there were no significant difference in AP between the two groups.Females were associated with decreased PP than males on Cox multivariate analysis.Hypertension and below tibial diseases were associated with lower limb salvage rate and age is the only predictor of survival rate.Conclusions DM is a risk factor for poor outcomes after PTA with stenting procedures.

ObjectiveTo analyze the surgical treatment of visceral artery aneurysm (VAAs).MethodClinical data of 19 patients surgically treated for visceral artery aneurysm in our hospital from Feb 2002 to Jun 2010 were reviewed. There were 7 cases of splenic, 1 of right hepatic, 1 of left gastric,3 of pancreaticoduodenal,2 of gastroduodenal, 1 of superior mesenteric, 1 of middle colic, 1 of left colic and 2 of renal artery aneurysms. Rupture of the aneurysm occurred in 12 patients. Transcatheter arterial embolization was performed in 13 cases, other 6 cases received open surgical treatment.ResultsFour patients suffered from recurrent bleeding after first embolization, 2 of those received surgery to stop bleeding, another 2 were successfully managed by second embolization.Bleeding were rapidly controlled in 8 ruptured patients associated with shock. Duodenum incomplete obstruction developed in 1 patient after pancreaticoduodenal artery embolization, another 2 patients suffered from partial splenic infarction after splenic artery operation. 18 cases were followed-up from 2 to 103 months without aneurysm recurrence.ConclusionsEndovascular embolization and open surgery for VAAs are safe and effective, endovascular intervention and embolization is especially life saving for ruptured pseudo-aneurysm cases.

Objective To evaluate the efficiency and safety of infrainguinal arterial bypass in diabetic ischemia of the lower extremities. Method Eighty-two consecutive patients undergoing lower extremity arterial reconstruction from 2002 to 2005 were divided into diabetes group (DM) and nondiabetes group ( NDM ) . Graft patency, limb salvage, and perioperative complications were compared between the two groups. Results There were 82 patients receiving 86 grafts, 44 grafts (51. 2% ) in patients with diabetes (DM group) and 42 (48. 8% ) in nondiabetic patients (NDM group). Average age of the DM group was (68?10) years, vs. (63?12) years of NDM group (P=0.025). In-hospital perioperative mortality was 3. 7% ( DM group 4. 8% vs. NDM 2. 5% ,P = 1. 000). Cumulative primary and secondary graft patency in 4 year was 44% in DM group and 64% in NDM group, P =0. 112 and 69% in DM group, 66% in NDM group, P = 0. 083) , respectively. The 4 year overall limb salvage rate was not statistically defferent ( DM group, 68%; NDM group, 66%; P =0.114). Conclusions Diabetes mellitus does not influence perioperative mortality, graft patency, or limb salvage rates after lower extremity arterial bypass.

Objective To explore the safety and feasibility of calf arterial stent angioplasty to treat severe lower limb ischemia. Methods Clinical data of 13 patients in our hospital during recent 3 years were retrospectively analysed and all these patients were followed up after discharge.Of these patients there were 10 males and 3 females; mean age was (73 ±7) years; mean disease course was (8 ±4) months.Severe claudication was reported in 5 patients,rest pain in 4 patients,toe ulcer in 2 patients,gangrene in 2 patients.Stent was placed in the tibioperoneal trunk artery in 5 patients ; in the proximal part of peroneal artery in 3 patients; in the tibioperoneal trunk and proximal peroneal artery in 2 patients; in the anterior tibial artery in 2 patients; in the posterior tibial artery in one patient.Simultaneous endovascular treatment of femoral/popliteal arterial disease was done in 11 patients. Results All the procedures were successful and the treated arteries kept patent on discharge of patients.Claudication distance increased to be above 500 meter in 5 patients; rest pain relieved in 4 patients ; toes ulcer reduced in 2 patients,feet gangrene kept dry till discharge in 2 patients.Postoperative ABI increased in all patients.Patients were followed-up of mean (6.9 ± 2.2) months.One patient with previous toe gangrene underwent amputation due to recurrent pain while the stent in anterior tibial artery kept patent after 6 months discharge.In the other patient gangrene toe had fallen off and the wound healed.Two patients with toe ulcer had a total recovery and patients with previous rest pain had no recurrent symptoms. Conclusions Below knee arterial stent angioplasty is a safe and effective method in the treatment of severe lower limb ischemia.

Objective To investigate the effect and safety of autologons bone margow-mononuclear cell (BM-MNC)transplantation after the bone marrow stimulation in patients with thromboangiitis obliterans (TAO).Methods The bone marrows of 12 patients were stimulated by an injection of the recombinant human granuloeyte-macmphage colony-stimulatory factor(GCSF)for 3-5 days.150-200 ml bone marrow was drown from the iliac spine and the autologous BM-MNC were obtained in each patients.Fifteen lower limbs of 12 patients received implantation of the autologous BM-MNC by an intramuscular iniecdon.A series of subjective indexes(including improvement of pain and cold sensation)and objeetive indexes [including increase of ankle braehial index(ABI),transcutaneons oxygen pressure(TcPO2)and improvement of foot skin ulcer] were used to evaluate the effects.Results The outcomes were evaluated after 2 months of transplantation.The pain-relief rate and the cold feeling improvement rate were 86.7%(13/15)and 93.3%(14/15)respectively.The ABI were 0.38 ±0.05 vs.0.61 ±0.14(P<0.05)before transplantation and 2 months after transplantation respectively.increased in 66.7%(10/15)limbs.The TcPO2 of the ischemic legs increased from(27.47±2.85)mm Hg to(43.53 ±8.38)mm Hg(t=-7.03,P<0.05)after the transplantation,and the improvement rate of TcPO2 was 93.3%(14/15).Skin ulcers in improved in 8/9 limbs.Twelve patients were followed up for all average period of 10 months.The patients'symptoms improved in 80.0%(12/15)limbs,as to the objective index the ABI was0.57±0.13,TcPO2 was(42.07 ±7.81)mm Hg,which improved significandy compared to before treatment(t=-5.33,-7.80,Ps<0.05).skin ulcer healing rate was 66.7%(6/9).The ischemic symptoms in 2 patients were not relieved.There WBS no mortality and high level amputation in all subjects.The complications,such as proliferative retinopathy,malitpmnt tumor,myocardial infarction,stroke or hemangioma were not found in any patients.Conclusion In patients with TAO,intramuscular transplantation of autologous BM-MNC after the bone marrow stimulation has advantages of less bone marrow aspiration,more mononuclear cell content and relatively high safety.It may be a new and effective method to alleviate symptoms and accelerate the healing of skin ulcer.

Objective To evaluate the feasibility of endovascular aortic repair (EVAR) under local anesthesia without using any contrast agent for abdominal aortic aneurysm in patients with high allergic risk to contrast agent.Methods Under local anesthesia and with no use of any contrast,percutaneous EVAR was performed in a patient with abdominal aortic aneurysm who carried high allergic risk to contrast agent.Results Percutaneous EVAR was successfully accomplished.Postoperative follow-up MRI examination showed that the abdominal aortic aneurysm was completely isolated with no endoleak.The blood flow was unobstructed in the covered stent,and bilateral renal arteries were well visualized.Conclusion For the treatment of abdominal aortic aneurysm in patients who are highly allergic to contrast agent and who have contraindications to general anesthesia,percutaneous EVAR performed under local anesthesia and using no contrast agent is safe and effective.Strict observation of indications and sufficient preoperative evaluation of clinical conditions is the key to ensure a successful operation.

Objective To investigate the effect and safety of autologous transplantation of peripheral blood mononuclear cells (PBMCs) for the treatment of lower limb ischemia. Methods Eighty-three limbs in 53 patients with lower limb ischemia were treated by autologous transplantation of peripheral blood mononuclear cells from June 2004 to October 2005. Of the patients, there were 71 diabetic ischemic limbs in 44 cases, 6 arteriosclerotic occlusion limbs in 5 cases and 6 thromboangiitis obliterans in 4 cases. Symptoms included a feeling of pain in 80. 7% (67/83) limbs, cold in 72.3% (60/83) limbs and numb in 67.5% (56/83) limbs. Results There was no mortality. The outcome was evaluated after 2 months of transplantation. The pain-relieve rate, improvement rate of cold feeling and numbness was 83. 6% , 91. 7% and 75. 0% , respectively. Ankle / brachial index ( ABI) increased in 39. 8% (33/83) limbs. TcPO2 of the ischemic legs was obviously elevated in 89. 2% (74/83 ) limbs. Ulceration area reduced in 29. 2% limbs. Digital subtraction angiography ( DSA) was performed in 44. 6% (37 limbs of 23 patients) with collateral circulation increased in 72. 9% limbs. 15 limbs (18. 1% ) were amputated including 5 limbs with lowered level of amputation. Conclusion Autologous transplantation of peripheral blood mononuclear cells is a simple, safe, and effective method to treat patients with lower limb ischemia in which arterial reconstruction is impossible.

Objective To discuss the methods, advantages and indications of multipoint puncturing in performing endovascular therapy for complex lower extremity arterial occlusive diseases. Methods During the period from Oct. 2011 to Oct. 2013, a total of 46 patients with complex lower extremity arterial occlusive diseases were treated with endovascular therapy by using multipoint puncturing technique. The puncturing type, the advantages of multipoint puncturing technique and the success rate of this technique were analyzed. Results The multipoint puncturing was divided into three types: type Ⅰ : puncturing from the opposite direction to deal with the same target vessel; type Ⅱ: direct puncturing of the target vessel; and type Ⅲ:using the same puncturing direction to deal with different target vessels. The success rate of endovascular treatment was 80.4%. Conclusion Multipoint puncturing technique helps improve endovascular treatment success rate for lower extremity arterial occlusive diseases. Full understanding of the advantages of multipoint puncturing technique, perfect preoperative planning, precise puncturing technique and proper interventional equipments are helpful to ensure a successful treatment.