Objective To observe the effects ofTiaozhi-Tongluo decoction combined with atorvastatin tablets on type 2 diabetes mellitus and lipid metabolism in patients with hyperlipidemia.Methods All patients were recruited into a control group and an observation group. Patients in both groups were performed diet control, reasonable exercise, and routine oral sulfonylureas and biguanides to make glucose level in a normal range. The control group was treated with atorvastatin tablets, 20 mg/d. While the observation group was treated with atorvastatin tablets plusTiaozhi-Tongluo decoction. After both groups were treated for 6 months, the blood glucose and blood lipid level were detected for the evaluation of clinical curative effect.Results The total effective rates in the observation group and the control group were 87.5%(56/64)and 73.0%(46/63), respectively, the difference was statistically significant (χ2=4.213,P=0.040). The serum levels of total cholesterol (4.31 ± 1.11 mmol/Lvs.5.62 ± 1.34 mmol/L,t=6.004) and triglyceride (1.73 ± 0.53 mmol/Lvs. 2.57 ± 1.01 mmol/L,t=5.855) in the observation group were significant lower than those in the control group. The levels of fasting plasma glucose (6.31 ± 1.64 mmol/Lvs.7.21 ± 1.71 mmol/L,t=3.027) , 2-h postchallenge plasma glucose (8.81 ± 1.39 mmol/Lvs.9.69 ± 1.55 mmol/L,t=3.370), and glycosylated hemoglobin (6.79% ± 1.61%vs.7.96% ± 1.72%,t=3.958) in the observation group after treatment were significantly decreased than the control group (P<0.01).ConclusionTiaozhi-Tongluodecoction combined with atorvastatin can reduce serum total cholesterol and triacylglycerol, and it is superior to atorvastatin alone in reducing lipidemia in type 2 diabetes mellitus patients with hyperlipidemia.

OBJECTIVE:To evaluate the application of narcotic analgesics in the inpatients of our hospital,and to provide ref-erence for rational drug use in clinic. METHODS:The application of narcotic analgesics in the inpatients of our hospital during 2013-2016 was analyzed statistically in respects of consumption sum,DDDs,DDC and B/A. RESULTS:There were 13 kinds of narcotic analgesics in the inpatients of our hospital. Top 3 narcotic analgesics in the list of consumption sum were Fentany transder-mal patches (8.4 mg),Oxycodone hydrochloride prolonged-release tablets (20 mg) and Fentany transdermal patches (4.2 mg) in our hospital during 2013-2016. Top 2 drugs in the list of DDDs were Fentany transdermal patches(4.2 mg)and Fentany transder-mal patches (8.4 mg). DDC of Oxycodone hydrochloride prolonged-release tablets (10,20 mg) ranged 350-370 yuan,taking up first or second place. B/A of Oxycodone hydrochloride prolonged-release tablets(10,20 mg)was<0.50,those of Bucinnazine hy-drochloride injection and Compound platycodon tablets were >1.50;those of other drugs mostly ranged 0.50-1.50. CONCLU-SIONS:The consumption trend of narcotic analgesics varies rarely in our hospital during 2013-2016,and the clinical use of narcot-ic analgesics is basically rational. Morphine sustained-release tablet and Fentany transdermal patch have become the first choice for pain treatment.

Objective to investigate the relationship between the size of ostium secondary atrial septal defect (ASD) and the pulmonary arterial pressure (PAP) in children less than 5 years of age. Methods During the period from April 2000 to January 2011, a total of 189 child patients less than 5 years of age with ostium secondary ASD were admitted to General Hospital of Shenyang Military Command. Under general anaesthesia with ketamine cardiac catheterization was performed, PAP was measured, and percutaneous occlusion of ASD was carried out in all patients. The clinical indexes, including sex, age, body height, body weight, body surface area, diameter of ASD defect, heart- to- thorax ratio, the systolic, diastolic and mean pressure of the pulmonary artery, etc. were determined. The patients were followed up for one year and postoperative cardiac ultrasonography was performed to check the results. The patients were divided into groups according to the defect size. Results The 189 patients consisted of 77 males and 112 females with a male-to-female ratio of 1 ∶ 1.5. The mean age was (4.1 ± 0.9) years old, ranging from 2 to 5 years old. The mean weight was (17.2 ± 3.6) kg, ranging from 10.0 to 30.0 kg. The mean height was (104.9 ± 9.2) cm, ranging from 77 to 135 cm. The mean body surface area (BSA) was (0.71 ± 0.10) m2, ranging from 0.46 to 1.02 m2. The mean size of ASD was (12.6 ± 4.8) mm, ranging from 5 to 29 mm. The mean size of ASD, which was modified by BSA, was (18.0 ± 7.0) mm/m2, ranging from 5.3 to 38.9 mm/m2. The mean systolic PAP was (41.1 ± 8.9) mmHg with a range of 15 - 67 mmHg. The mean diastolic PAP was (16.8 ± 6.5) mmHg with a range of 3 - 45 mmHg. The mean PAP was (24.9 ± 6.7) mmHg with a range of 12 - 48 mmHg. One hundred and fifty- nine patients (89.4%) had pulmonary arterial hypertension (PAH) which was determined by right heart catheterization, but no patient showed PAH when the pulmonary arterial pressure was measured by echocardiography before the procedure as well as 1, 3, 6, 12 months after the procedure. No definite correlation existed between the size of ASD and the pulmonary artery pressure (P > 0.05). Conclusion Pulmonary artery pressure measured by right heart catheterization has no definite correlation with the size of ASD in children less than 5 years of age. Pulmonary artery pressure obtained from right heart catheterization is higher than that determined by cardiac ultrasonography, which may be caused by the effect of ketamine when general anaesthesia is used in performing right heart catheterization.

Objective To evaluate clinical effectiveness of transcatheter closure of atrial septal defects ( ASD) with severe pulmonary arterial hyperyension ( sPAH) by fenestrated Amplatzer septal occluders ( ASO) . Methods From September 2002 to April 2013, 17 patients of ASD with sPAH received transcatheter ASD closure using fenestrated occluders. Aged from 18 - 72 years, the diameters of ASDs were 18 - 33 mm. The systolic pulmonary arterial hypertension measured by transthoracic echocardiogram were 80 - 112 (96. 9 ± 8. 9) mmHg. The follow-up study included electrocardiography, chest radiography and echocardiography. All the patients were followed up for 1. 5 - 12 ( mean 6. 4 ± 0. 7) years. Results Systolic pulmonary arterial pressure (sPAP) of 60 - 108 (88. 7 ± 11. 7) mmHg and mean pulmonary artery pressure ( mPAP) of 29. 3 - 60 (51. 0 ± 8. 1) mmHg were measured by cardiac catheterization before ASD closure. Qp/ Qs was 1. 50 - 2. 44 (1. 8 ± 0. 31) and the pulmonary vascular resistance was 3. 1 - 9. 7 (5. 6 ± 1. 5) wood units (wu) . Immediately after the implantation of fenestrated occluders, sPAP decreased to 56 - 99 (70 ± 11. 5) mmHg and mPAP to 27 - 51. 7 (41. 1 ± 7. 1) mmHg. On the 3 d, 3 m and 6 m follow-up exam, RVEDd decreased ( P ﹤ 0. 05), while LVEDd, LVEDV and LVEF increased significantly (P ﹤ 0. 05) . sPAP decreased significantly after transcatheter closure at 3 m and 6 m as compared to pre-closure levels (both P ﹤ 0. 05) . The mean sPAP in long term follow up was (60. 2 ± 13. 3) mmHg which had significant decrease compared to pre-closure level ( P ﹤ 0. 01), but no significant difference found when compared to 6 m follow up (P ﹥ 0. 05). Conclusions ASD closure with fenestrated ASO is a satisfactory approach for ASD with severe PAH.

Objective To investigate the risk factors and early diagnosis of the severe thrombocytopenia complicating transcatheter ccclusion of patent ductus arteriosus ( PDA ) . Methods Between February, 2011 and May, 2015, 80 patients with patent ductus arteriosus underwent percutaneous intervention occlusion were studied. Results Average age were ( 17. 5 ± 17. 1 ) years, 63 were females (78. 8%), mean weight were (35. 6 ± 20. 2)kg (from 6. 0 to 75. 0 kg), mean body surface area (BSA) were (1. 09 ±0. 44) m2(from 0. 32 to 1. 91 m2). A bolus of heparin calcium (80 U/kg) was administered by intravenous injection. The mean diameters of patent ductus arteriosus were 4 mm (from 2 to 18 mm), and the mean diameters of occluders were 12 mm (from 6 to 30 mm). 14 patients were found to have severe thrombocytopenia (PLT count﹤100 × 109/L). The reduction rate of platelet in 12 of 14 patients was more than 19%. The diameters of all occluders were equal to or more than 14 mm, the mean diameters of patent ductus arteriosus were 10 mm ( from 6 to 18 mm) and the mean diameters of occluders were 18 mm ( from 14 to 30 mm). All the 14 patients started to present progressive decrease in PLT count since the second day post procedure. Taking the selected occluder diameter greater than 14 mm as cut-off points in diagnosis of severe thrombocytopenia, the sensitivity was 100%, specificity was 68%, the positive predictive value was 40%, and the negative predictive value was 100%. Combined with the postprocedural second day complete blood count analysis and the platelet count decreased by 10% as cut-off points in diagnosis of severe thrombocytopenia patients, the sensitivity was 93%, specificity was 67%, the positive predictive value was 65%, the negative predictive value was 93% . If taking the platelet count decreased by 7% on second day as cut-off points in diagnosis of severe thrombocytopenia patients, the sensitivity was 100%, specificity was 57%, the positive predictive value was 61%, the negative predictive value was 100% . Logistic regression analysis discovered that risk factors of severe thrombocytopenia after PDA are procedural platelet count and occluder diameter. Conclusions The risk factors of severe thrombocytopenia complicating transcatheter ccclusion of patent ductus arteriosus were the procedural reduction of platelet count and big occluder diameter. Patients with PDA who were inplanted with occluders equal to or bigger than 14 mm should retest the numbers of platelet on the second day after procedure and retest on third day if the numbers reduce on the second day, which may help in the prediction of severe thrombocytopenia.

Objective To evaluate the effectiveness of peer support interventions on exclusive breastfeeding among primiparous women. Methods Randomized controlled trials (RCTs) that reportedthe effectiveness of peer support interventions on exclusive breastfeeding among primiparous women were retrieved in several electronic databases. Data were analyzed using RevMan 5.3 software after quality assessment and data extraction. Results A total of 9 RCTs which included 1435 patients were incorporated in this meta-analysis. The meta-analysis revealed that peer support interventions could increase the rate of exclusive breastfeeding(OR=2.84, 95％CI2.22-3.64, P<0.01), increase duration of exclusive breastfeeding(WMD=43.66, 95％CI28.04-59.27, P<0.01). Subgroup analysis showed that peer support increased the rate of exclusive breastfeeding atone month(OR=1.84,95％CI1.24-2.73, P<0.01), three months(OR=2.28, 95％CI1.67-3.12, P<0.01)and six months(OR=3.42,95％CI2.46-4.76, P<0.01) of postpartum. Conclusions Peer support interventions could increase exclusive breastfeeding rate and duration of exclusive breastfeeding. It is worth being popularized.

Objective: To explore the influence of body mass index (BMI) on postoperative complications and survival in patients with esophageal squamous cell carcinoma (ESCC) using propensity score matched (PSM) methods. Methods: We retrospectively analyzed clinical data of 533 patients with ESCC who were admitted for thoracic surgery in Shandong Provincial Hospital, between January 2011 and December 2012. After conducting PSM methods to balance the covariates, the incidence of postoperative complications and sur-vival rate were compared between the two groups. The effects of BMI on postoperative complications and survival were analyzed with multivariate Logistic regression and Cox proportional hazard analyses, respectively. Survival analysis was performed using Kaplan-Mei-er curves and Log-rank test. Results: After adjusting the PSM and confounding variables, the two groups were well matched (146 pa-tients each) without significant differences in baseline characteristics. The incidence of wound infection and respiratory system compli-cations in the H-BMI group (BMI≥25 kg/m2) were significantly higher than those in the N-BMI group (18.5-25 kg/m2) (P<0.05). H-BMI was an independent risk factor for wound infection and respiratory system complications. In the present study, no significant differ-ence was observed in the 3-year overall survival between H-BMI and N-BMI patients (54.1% vs. 47.8%, P=0.212). Patients with H-BMI had significantly better 5-year overall survival than those with N-BMI (39% vs. 25%, P=0.016). The subgroup analysis showed that pa-tients with H-BMI had a better overall survival than those with N-BMI in stages Ⅰ-Ⅱ (47.3% vs. 29.0%, P=0.032). However, this difference was not significant when patients were stratified into stages Ⅲ and Ⅳ (24.5% vs. 16.7%, P=0.393). Conclusions: H-BMI appears not to decrease the overall survival of patients with ESCC. Therefore, ESCC in patients with H-BMI can receive surgical treatment safely, but proper intraoperative management and close postoperative monitoring should be performed.

Objective To investigate the therapeutic effect of severe thrombocytopenia in patients underwent transcatheter patent ductus arteriosus occlusion.Methods Clinical data of 80 pure patent ductus arteriosus patients who underwent interventional occlusion between February 2011 and November 2014 in General Hospital of Shenyang Military Region were retrospective analyzed.A bolus of heparin calcium (80 U/kg) was administered by intravenous injection during the procedure.Blood test was conducted in all patients before and after the procedure.The patients with both platelet reduction rate ≥ 5％ and platelet count ＜ 100 × 109/L(severe thrombocytopenia) were treated by following strategies:bed rest,avoidance of activities,intensive control of blood pressure through sodium nitroprusside administration,and inhibition of presumed immunological reaction by glucocorticoids and human immunoglobulin administration.Follow-up ended in May 2015.Results (1) A total of 54 cases (67.5％) were diagnosed as thrombocytopenia in second days after the procedure.The reduction rate of platelet in 41 out of 54 patients was equal or more than 5％ on the second day,and the diameter of occludes were equal or more than 14 mm in 35 out of these 54 patients.Severe thrombocytopenia occurred in 14 patients and the occluder diameter was ≥ 14 mm in these 14 patients.Severe thrombocytopenia did not occur in patients with occlude diameter ＜ 14 mm or with reduction rate of platelet ＜5％.(2) A total of 14 severe thrombocytopenia patients were treated.No bleeding events occurred in hospital and during the whole follow-up period.The the lowest value of platelet count of patients was seen on the 4.5 (3.8,6.0) days post the procedure.The lowest numbers were 16.5 (7.5,37.3) × 109/L.The platelet count of patients restored to more than 30 × 109/L on the 8.0 (4.8,9.5) days and restore to more than 100 × 109/L on the 12.0 (9.8,39.3) days post procedure.The average hospitalization day of the patients were 15.5 (11.8,21.5) days.The platelet counts of severe thrombocytopenia patients were normal during the end of follow up (median 3.8 (1.0,4.9)years).Conclusion The patients with very severe thrombocytopenia after transcatheter occlusion of patent ductus arteriosus are associated with a benign outcome in case of timely and proper treatment.

Objective: To investigate the safety and efficacy of transcatheter closure of ruptured sinus of Valsava aneurysm(RSVA). Methods: A total of 33 RSVA patients underwent transcatheter closure from January 2006 to March 2017 in our hospital were included in this retrospective study. The RSVA was diagnosed by echocardiography.Different type of occluders were applied for transcatheter closure based on the aortography results. All the patients were followed up after the procedure. Results: The patients were (37.6±12.1) years old,and the male patients accounted for 78.8%(26 cases).RSVA from right coronary sinus was found in 25 patients,and draining chamber was right atrium in 13 cases, right ventricle in 12 cases. RSVA from noncoronary sinus was diagnosed in 8 patients,and the draining chamber was right atrium. Aortography defined the narrowest diameter at the rupture site was (6.4±1.7)mm. The ratio of Qp/Qs was 2.2±0.5,and the mean pressure of pulmonary artery was 24.0(21.2,33.7)mmHg(1 mmHg=0.133 kPa). One patient developed serious occluder related aortic regurgitation and underwent surgery, transcatheter closure was successfully performed in 32 patients. The success rate of transcatheter closure was 97.0%. Two types of device were used in the study including small-waist double-disk ventricular septal defect(VSD) occluders in 20 cases and patent ductus arteriosus(PDA) occluders in 12 cases. During a median follow-up of 73.5(28.3,89.5) months, there were no infective endocarditis, residual shunt, thrombosis, device displacement,serious aortic regurgitation, serious arrhythmia or death.At the last follow-up, the left atrial diameter((37.4±6.5) mm vs. (41.5±5.3)mm,P<0.01),right atrial diameter((42.4±3.0) mm vs. (48.5±6.0)mm,P<0.01), right ventricular diameter((22.2±3.8) mm vs. (27.7±7.2)mm,P<0.01) and left ventricular end-diastolic diameter((51.3±4.9) mm vs.(55.0±4.3)mm,P<0.01)measured by echocardiography were all smaller than pre-procedural level. Conclusion Transcatheter closure of RVSA is a safe and effective strategy and associated with a good long-term outcome.