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 investigate the value of 3D-TEE,2D-TEE,CTA and X-ray contrast in assessing left atrial appendage (LAA) shape,size and guidance for the choice of occlusion.Methods Forty-three cases of left atrial fibrillation who were referred for LAA closure were performed TEE to measure the opening maximum diameter,and maximum depth of 2D-TEE at 0°,45°,90° and 135°.When LAA showed most clearly,the opening maximum and minimum diameter of LAA were measured by using 3D-ROOM mode,and the results were compared with those measured by CTA and X-ray contrast.Results There was no significant difference for opening maximum diameter of LAA measured by 3D-TEE,2D-TEE and X-ray contrast (all P＞0.05),but that of CTA statistically larger than 3D-TEE,2D-TEE,X-ray contrast (all P＜0.01).There were significant difference between 2D-TEE at 90°,135° and CTA,2D-TEE at 135° and X-ray contrast in assessing maximum depth of LAA (all P＜0.05).Opening maximum diameter of LAA measured by 3D-TEE was significantly correlated with each angle of 2D-TEE,CTA,and X-ray contrast (r=0.70-0.77,0.57,0.58,all P＜0.01),and the opening maximum diameter measured by 2D-TEE also correlated with CTA and X-ray contrast (r =0.57-0.71,0.45-0.51,all P＜0.01).Also the opening maximum diameter measured by 3D-TEE,2D-TEE,CTA and x-ray contrast were correlated with occluder size (r=0.93,0.70-0.77,0.57,0.47,all P＜0.01).Conclusion Compared with 2D-TEE,CTA and X-ray contrast,3D-TEE is more instructive for occluder selection.

Objective To detect left atrial (LA) function and left ventricular (LV)-LA coupling using vector flow mapping (VFM) and two-dimensional tissue tracking (2DTT) echocardiography in patients with diabetes.Methods A total of 51 patients with type 2 diabetes (DM group) and 38 healthy volunteers (control group) were studied.LA and LV strain were assessed by 2DTT.The energy loss (EL) of LA and LV during ventricular systole (ELs),early diastole (ELed),and atrial contraction (ELac) were measured by VFM.Results LVEL in DM group was significantly increased compared to that in control group (P<0.05).LAELs and LAELed in control group were higher than those in DM group (P<0.05);while LAELac decreased in control group (P<0.05).Multivariate regression analysis identified E and LVELed as independent predictors of LAELed;Peak torsion,LA peak systolic strain and LVELac were independent predictors of LAELac.Conclusions The reservoir and conduit function of LA are impaired in patients with DM,while the pump function increases as a compensation.Abnormal LA-LV coupling also appears in patients with DM.

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.

Objective To quantitatively assess the geometry configuration of mitral valve and annulus in the ischemic mitral regurgitation(IMR) and non-ischemic mitral regurgitation(NIMR) by real-time threedimensional transesophageal echocardiography (RT-3D-TEE),and provide a basis for surgical cardiac surgery.Methods 98 patients undergone RT-3D-TEE examination were enrolled in this study,and were divided into three groups:IMR group (n =43),NIMR group (n =33),and no mitral regurgitation group (control group,n =22).Full-volume 3D dynamic images of mitral annulus and valve were obtained.The images were off-line analyzed using Qlab 7.0 MVQ workstation,and the geometry indexes:area of leaflets (A3DE),area of anterior leaflet (A3DE Ant),area of posterior leaflet (A3DE Post),perimeter of annulus (C3D),anterolateral to posteromedial diameter of annulus (DAlPm),anterior to posterior diameter of annulus (DAP),annulus height (H),maximal prolapse height (HProl),maximal tenting height (HTent),volume of leaflet prolapse (Vprol),volume of the leaflets tent (Vtent),Aortic orifice to mitral plane angle (θ),angle of anterior leaflet (θAnt),non-planar angle of leaflets (θNPA),angle of posterior leaflet (θPost)and other mitral valve leaflets and annulus,were derived and statistically analyzed.Results Compared with the control group,significant increases of A3DE,A3DE Ant,DAP and θPost,and decreases of θ and θNPA were demonstrated in IMR group,the differences were statistically significant (P ＜ 0.05).Significant increases of A3DE,A3DE Ant,DAP,HProl,Vprol and θNPA,and decreases of θ,θAnt and θPost were explored in NIMR group,the differences were statistically significant (P ＜0.05).Compared with NIMR group,a reduction of A3DE,A3DE Ant,DAP,HProl and θNPA,and increases of θAnt and θPost were found in IMR group and the differences were statistically significant (P ＜0.05).Conclusions Both IMR group and NIMR group could lead to mitral annulus dilatation,leaflets area increase,and mitral annulus geometry change,the overall mitral annulus tends to flatten were more obvious in the NIMR group than those in IMR group.The prolapse is more prominent in NIMR group than those in IMR Group.The difference of mitral annulus geometry between IMR group and NIMR group indicates that the damage of the mitral leaflets and annulus might be more serious in NIMR group.