Objective To evaluate the effect of transtheoretical model(TTM)-based health education on the self-care behaviors of patients with heart failure.Methods One hundred and fifty heart failure patients from January 2012 to June 2013 were randomly assigned to two groups,75 cases in each group.The patients in the experimental group received TTM-based health education;the patients in the control group received conventional health education.All patients were investigated with the Self-Care of Heart Failure Index (SCHFI) at baseline,1 month and 3 months after intervention.Results After intervention,the scores of self-care maintaining,self care management and self care confidence in the experimental group were significantly higher than those in the control group.Conclusions TTM-based health education can effectively improve the self-care behaviors of patients with heart failure.

Spindle cell carcinoma of the breast (SpCC) is a very rare variant of breast cancer characterized as large tumor size,high histological grade and high negative expression of hormone receptors and HER2/neu protein.It has a high tendency for local recurrence and distant metastasis,while the axillary lymph node metastasis is less common occured,which leads to poor outcomes.Given the relatively low incidence,our knowledge about SpCC is limited.The main unsolved obstacles are the early dection and diagnosis,and the improvement in treatments.Herein,this article reviewed the clinicopathologic characteristic,diagnosis,treatment and prognosis of the spindle cell carcinoma of breast.

ObjectiveTo assess the value of intraoperative radiotherapy (IORT) combined with postoperative concurrent chemoradiotherapy for locally advanced pancreatic cancer. MethodsFrom May 2008 to May 2011, 85 cases of locally advanced pancreatic cancer patients in our hospital were analyzed retrospectively.The treatment group included 40 cases treated by IORT plus drainage combined with postoperative concurrent chemoradiotherapy ( group A), and the control group included 45 undergoing IORT plus drainage ( group B).The clinical manifestation, operation plan etc.were summed up and all cases were followed up regularly to evaluate the survival time.ResultsThe follow-up time was from 6 to 15 months and the follow-up rate is 90％ (77/85).For group A and group B, the mean survival time was 10.17 ±0.58 months VS 8.05 ±0.48 months and the median survival time was 11.40 months VS 8.30 months.The survival analysis showed that group A had a significant survival advantage than group B (P =0.027 ).10 patients died in group A and 12 patients died in group B.The difference had no statistical significance (P =0.805 ).ConclusionIORT plus postoperative concurrent chemoradiotherapy can improve the survival rate of patients with locally advanced pancreatic cancer.

Objective To develop a gas chromatography-mass spectrometric method(GC/MS) for simultaneous determination of environmental estrogens including 4-nonylphenol,bishphenol A,diethylstilbestrol and 17?-ethinylestradiol and endogenic estrogens including 17?-estradiol,17?-estradiol,estriol and estrone in mutton. Methods Mutton samples were extracted using a mixture of acetonitrile-ethyl acetate(3∶2,V/V) and cleaned up by florisil cartridge. Derived with pentafluoropropionic anhydride(PFPA) ,the derivatives were determined by GC-MS. Results The linear range of determination was 0.2-5.0 ?g/kg. The intraday relative standard deviations of the peak area were 1.25%—5.85% and the detection limits ranged from 0.024 to 1.40 ?g/kg,and the rates of recovery ranged from 71.5%—111.0% except for 17?-ethinylestradiol( 55.4%) . Conclusion This method is simple,rapid,accurate and applicable to the determination of trace environmental estrogens in mutton

Objective To evaluate the characteristic of left ventricular rotation and twist in healthy adults using ultrasonic velocity vector imaging(VVI),and to discuss its biomechanical mechanism. Methods In 70 healthy adults, the rotational characteristic of left ventricular subendocardium and subepicardium at 3 differently standard shot-axis levels and 18 differently myocardial segments, and the torsional characteristic of left ventricular wall were evaluated via ultrasonic VVI. The maximum rotation angle(Rmax)at different sites of left ventricular wall and the maximum twist angle(Tmax)between left ventricular subendocardium and subepicardium in a completely cardiac cycle were compared respectively. Correlation tests were performed between left ventricular Tmax and the Rmax at different short-axis levels of left ventricular wall.Results ①To be compared with other myocardial segments, Rmax was smallest at antero-septal or anterior wall of the same left ventricular short-axis level(P>0.05).②The mainly rotational directions of the basal leveI and the apical level of left ventricular wall in a completely cardiac cycle were adverse.To be compared with basal or apical level of left ventricular wall,Rmax was smallest at papillary muscle level(P<0.05).and there was no statistical significance in Rmax between basal and apical level.There was positive colinearity between left ventricular Tmax and the Rmax of basal or apical level (P<0.01),but zero correlation was found between the Tmax and the Rmax of papillary muscle level.③Rmax of left ventricular subendocardium was bigger than that of subepicardium(P<0.01).Tmax of left ventricular subendocardium was bigger than that of subepicardium[(11.44±4.82)°vs(7.05±3.90)±,P<0.01].Conclusions Twist of left ventricular wall in healthy adults appeared the torsional characteristic of thin-wall cylinder.Elucidation of the biomechanical mechanism of cardiac twist is promising if basing on the principle of biomechanics.

Objective To explore the risk factors and metastasis of non-sentinel lymph node (NSLN) in breast cancer patients with sentinel lymph node metastasis≤2. Methods 88 cases of breast cancer with sentinel lymph node metastasis≤2 were retrospectively analyzed. Factors influencing the status of NSLN were studied. Results 8 cases (9.09%) had NSLN metastasis. Variance analysis showed that tumor stage(P=0.014), histolog-ical grade(P=0.014) and ER statuts(P=0.009) were correlated with NSLN metastasis. Logistic analysis showed that only histological grade was the independent predictor for NSLN metastasis (P=0.016,OR=1.150,95%CI=0.598~7.740).18 cases had micro-metastasis of sentinel lymph node and 70 cases had macro-metastasis of sentinel lymph node. The ratio of false negative SLN was 10.23%. The mean follow-up time was 11 months. There was no case of recurrence, metastasis or death. Conclusions The metastasis rate of NSLN is relatively low in breast cancer patients with small number of positive SLNs. NSLN metastasis is related to tumor stage, histological grade, and ER expression.

Objective To analyze the reasons of hypoglycemia in patients with diabetic ophthialmopathy,and summarize the corresponding nursing measures in order to reduce the incidence of hypoglycemia in patients with diabetic ophthialmopathy. Methods The reasons for hypoglycemia were analyzed for 43 patients with diabetic ophthalmopathiy in our hospital from January 2009 to November 2011. Results Taking the hunger-cure arbitrarily,no regular diet,no corresponding adjustment for the insulin quantity after stopping taking hormone medicine,and also after the diabetic symptoms relieved,besides,less food-intake caused by high pressure of eyes,vomiting and appetite decreasing after the vitreous body dissection,and the paramedic had no enough cognition for the harm caused by hypoglycemia,combination medication with cardiovascular medicine were the primary reasons for the occurence of hypoglycemia in patients with diabetic ophthalmopathy. Conclusions Many reasons can cause hypoglycemia in patients with diabetic ophthalmopathy,We should strengthen management,propaganda and education,observation of medication and disease condition as well as improve the attention of eye health care workers for hypoglycemia in order to reduce the incidence of hypoglycemia.

BACKGROUND:Acute myocardial infarction with acute onset is dangerous, but the aided diagnosis for hyperacute disease mainly depends on electrocardiogram. The advantages of tissue Doppler strain imaging were utilized to help early diagnosis of acute myocardial infarction.
OBJECTIVE:To observe left ventricular transmural peak radial strain and strain time-to-peak of subendocardiac muscle, midmyocardium and subepicardiac muscle using tissue Doppler strain imaging in dogs before and after acute myocardial infarction, and to assess its mechanical characteristics.
METHODS:A total of 16 Beagle dog models of acute myocardial ischemia were established by ligating left anterior descending coronary artery. The two-dimensional apical short-axis views of the left ventricle in five complete cardiac cycles were acquired and stored in TDI-Q workstation before and after acute myocardial ischemia. Transmural peak radial strain and strain time-to-peak of segment, subendocardiac muscle, midmyocardium and subepicardiac muscle at infarct region and baseline were observed.
RESULTS AND CONCLUSION:Peak radial strains at infarct and subendocardiac muscle, midmyocardium and subepicardiac muscle were decreased compared with the baseline (P<0.05). Peak strain gradient disappeared in each layer of infarct myocardium. Strain time-to-peak of the whole segment and infarct myocardium at different layers was significantly postponed (P<0.05). There was a positive correlation of peak radial strain between subendocardium and segment as wel as between medium and segment at baseline (r=0.617, P<0.01;r=0.556, P<0.01). This relationship disappeared at infarct region (r=0.338, P>0.05;r=0.218, P>0.05). Results indicated that after acute myocardial infarction, peak strain gradient disappeared at different layers at infarct region. Acute myocardial ischemia induces peak radial strain decrease at subendocardium, medium, subepicardium and strain time-to-peak at infarct region was significantly postponed, which reflected abnormal cardiac structure and dysfunction, resulted in uncoordinated cardiac motion and asynchronous heart movement. This may be an important mechanical mechanism triggering heart failure.

Objective To observe left ventricular transmural peak radial strain and strain time-to-peak of peri-infarct different layers myocardium using tissue Doppler strain imaging, to assess its mechanical pattern during acute myocardial ischemia.Methods Left anterior descending coronary artery (LAD) were ligated in experimental open-chest Beagle dog models (n = 9),the two-dimensional apical short-axis views of left ventricle in three complete cardiac cycles were acquired and stored in TDI-Q workstation at baseline(the control group of peri-infarc myocardium) and during acute myocardial ischemia respectively.Sampling volume was uesd to measure the peak radial strain and the strain time-to-peak consesquently on the derived M -mode tissue Doppler velocity images at peri-infarct myocardium before and after ischemic segments and different layers(subendocardium, medium, subepicardium).Statistical analies was performed using student's t- test or Pearson's correlations.Results Peak radial strain decreased at peri-infarct subendoeardium (P<0.05) with no significant difference between those at baseline and at peri-infarct medium (P >0.05), the peak radial strain increasd at peri-infarct subepieardium (P < 0.05) ,and the strain time-to-peak at different layers of peri-infarct myoeardium was significantly postponed (P< 0.05).There was a good correlationship of peak radial strain between subendocardium and segment as well as between the medium and segment (r = 0.617, P<0.01 ; r = 0.556, P<0.01).This correlationship disappeared at peri-infarct myocardial segment (r = 0.287, P > 0.05, r = 0.243, P > 0.05).Conclusions The left ventricular transmural mechanical remodeling at peri-infarct myocardium is the integrant of result of mechanical interactions between ischemic and nonischemic myocardium,which might be one of the trigger the structural and fundational remodeling processes involving in the pathophysiological foundation of ischemie cardiomyopathy.

Objective To investigate the effects of miR-335-5p on the proliferation and apoptosis of osteoblasts which were exposed to high glucose condition, and explore its possible molecular mechanisms. Methods MC3T3-E1 osteoblasts were divided into four groups:control group(5. 5 mmol/L glucose), high glucose group(HG group, 22. 0 mmol/L glucose), agomir-335-5p group(transfected with agomir-335-5p and exposed to 22. 0 mmol/L glucose) , and agomir negative control group( agomir NC group, transfected with agomir negative control and exposed to 22. 0 mmol/L glucose), cultured for 7 days. Cell proliferaton, cell apoptosis, expressions of miR-335-5p and dickkopfhomolog1(DKK1)mRNA,proteinlevelsofDKK1andcysteinylaspartate-specificproteinase-3(caspase-3) were detected using MTT, flow cytometry, quantitative realtime PCR and western blot, respectively. Results Compared with control group, the expression of miR-335-5p mRNA and cell proliferation in HG group were significantly decreased(P<0. 05), while cell apoptosis and the protein levels of DKK1 and caspase-3 were increased significantly(P<0. 05), the expression of DKK1 mRNA did not change (P>0. 05). The miR-335-5p mRNA expression and cell proliferation in agomir-335-5p group were higher than those in HG group and agomir NC group(P<0. 05). However, Cell apoptosis and the protein levels of DKK1 and caspase-3 in agomir-335-5p group were lower than those in HG group(P<0. 05). Conclusion High glucose inhibits the proliferation and induce the apoptosis of MC3T3-E1 osteoblast through decreasing the expression of miR-335-5p and subsequently increasing the DKK1 expression.