Objective To investigate the status of self-management of elderly patients with chronic heart failure (CHF) in Xinjiang Region,and to explore the effects of different demographic factors on self-management.Methods A total of 704 patients with chronic heart failure were randomly selected from Urumqi,Kashgar,Khotan,Changji,Shihezi,Yili Hazakh in Xinjiang Uygur Autonomous Region via convenience sampling method and were investigated using heart failure self-management scale.Results The total score of self-management of chronic heart failure elderly patients was(47.6±11.1) and scoring rate was 59.5％.There were statistically significant differences(P＜0.01) in self-management score among patients with different ethnicity,religion,self-care ability,per capita income.The influencing factors of self-management were self-care ability,NYHA class and per capita monthly income(P＜0.05).Conclusion The overall level of self-management of elderly patients with chronic heart failure in Xinjiang Region is low,and self-management is affected by self-care ability,NYHA class and per capita monthly income.Tailored culture-based education should be provided to improve patients' self-management.

Objective To investigate the status of self-management in community-dwelling elderly patients with chronic heart failure in Pudong district and analyze demographic influence factors.Methods A total of 328 patients with chronic heart failure were randomly selected from 4 Shanghai Pudong community centers based on cluster sampling method and were investigated via heart failure self management scale.Results The total score of self-management of chronic heart failure patients was (51 .3 ±8.3),within which the scores of medication management,dietary management,psychological and social management and symptom management were (1 4.5 ±2.7),(9.1 ±2.0),(1 2.2 ±3.1 )and (1 5.5 ±3.9).Gender,religion and self-care ability were the main influencing factors of self-management,which accounted for 9% of variation.Conclusions The self-management of community-dwelling elderly patients with chronic heart failure is medium level.The self-management ability of chronic heart failure patients are affected by many factors.Targeted nursing should be performed to improve patients′self-management.

Objective: To investigate the clinical effect of a novel disposable ring versus that of the suture device in circumcision for redundant prepuce and phimosis. METHODS: We randomly assigned 470 male patients with redundant prepuce or phimosis to receive circumcision with a novel disposable ring (the DR group, n = 235) or the suture device (the SD group, n = 235) and compared the operation time, intraoperative blood loss, pain scores, wound healing time, and postoperative complications and penile appearance between the two groups of patients. RESULTS: All the operations were completed smoothly. Compared with the SD group, the DR group showed significantly shorter operation time (［7.49 ± 1.84］ vs ［3.83 ± 0.42］ min, P <0. 05), less intraoperative blood loss (［3.34 ± 2.59］ vs ［2.41 ± 1.01］ ml, P <0.05), lower intraoperative pain score (0.57 ± 0.76 vs 0.20 ± 0.47, P <0.05) and 6-hour postoperative pain score (3.42 ± 1.12 vs 0.48 ± 0.94, P <0.05), shorter wound healing time (［12.05 ± 2.80］ vs ［7.79 ± 1.65］ d, P <0.05), lower incidence rates of postoperative glans congestion or edema (36.17% ［85/235］ vs 2.56% ［6/235］, P <0.05), dysuria or strenuous urination (34.04% ［80/235］ vs 2.13% ［5/235］, P <0.05) and bleeding or hematoma (5.11% ［12/235］ vs 1.28% ［3/235］, P <0.05), and higher satisfaction with postoperative penile appearance (90.6% ［213/235］ vs 95.8% ［228/235］, P <0.05). There were no statistically significant differences between the SD and DR groups in the pain scores at the sixth night after operation (1.31 ± 0.96 vs 1.34 ± 1.07, P >0.05) or while the staples scraping the underpants or at the ring removal (3.49 ± 1.22 vs 3.36 ± 1.41, P >0.05). No obvious postoperative infection or delayed healing was observed except for 3 cases of wound dehiscence (1 in the DR and 2 in the SD group) and 8 cases of delayed removal of the staples in the SD group. CONCLUSIONS The novel disposable ring, with its advantages of short operation time, less bleeding and pain, good penile appearance, high safety, and simple operation, is obviously superior to the suture device in circumcision and deserves to be applied and popularized clinically. .
Blood Loss, Surgical ; Circumcision, Male ; instrumentation ; Disposable Equipment ; Edema ; etiology ; Humans ; Male ; Operative Time ; Pain Measurement ; Pain, Postoperative ; Penis ; abnormalities ; surgery ; Personal Satisfaction ; Phimosis ; surgery ; Postoperative Complications ; etiology ; Postoperative Period ; Suture Techniques ; instrumentation ; Sutures ; Wound Healing

Background and purpose:Whether axillary sentinel lymph node biopsy (ASLNB) could replace axillary lymph node dissection (ALND) in patients who converted after neoadjuvant chemotherapy (NAC) from cN+ to ycN0 is still contentious, and the previous study only evaluated the pathological status of ALN without internal mammary lymph node (IMLN) condition. This study is to evaluate roles of ASLNB and internal mammary sentinel lymph node biopsy (IM-SLNB) in breast cancer patients after NAC.Methods:From Jan. 2012 to Dec. 2014, 60 breast cancer cT1-4N0-3M0patients who were scheduled for neoadjuvant chemotherapy (NAC) and agreed to accept surgery after NAC from our department were enrolled into the retrospective study. Patients with cN0 before NAC and ycN0 after NAC underwent ASLNB (group A). Patients with cN+ received NAC and ycN0 after NAC (group B) were treated with ASLNB and ALND. Only patients whose clinical nodal status remained positive (ycN+) after NAC underwent ALND without ASLNB (group C). All the patients received radiotracer injection and patients in group A and group B received blue dye injection additionally. Meanwhile, IM-SLNB would be performed for all patients with IM-SLN visualization.Results:The number of patients enrolled in group A, group B and group C was 6, 45 and 9 cases respectively. The accuracy rate of ASLNB in group A was 100% (6/6). Only one patient was axillary sentinel lymph node (ASLN) positive performed ALND. With combination of blue dye and radiolabeled colloid, the accuracy rate of ASLNB in group B was 100% (48/48) and the false negative rate (FNR) was 17.9% (5/28). The FNR in patients with 1, 2 and>2 SLNs examined was 27.3% (3/11), 20.0% (2/10) and 0% (0/7). All of the ALNs were positive in group C. The visualization rate of IM-SLN was 63.3% (38/60). The detection rate of IM-SLNB was 97.4% (37/38) and the metastasis rate was 8.1% (3/37). The incidence of complications was 5.3% (2/38).Conclusion:ASLNB can be performed either before or after preoperative chemotherapy for patients with cN0 disease. Among women with cN+ converted to ycN0 who had 3 or more SLNs examined, the FNR could return to be less than 10%. Those patients whose nodes are still ycN+ should perform ALND. IM-SLNB should be performed routinely in all breast cancer patients after NAC, for it might help to make clear of the nodal staging and the pathological status of IM-SLN and provide the accurate indication of radiation to the internal mammary area in case of under-stage and under-/over-treatment, expecting to develop the deifnition of pathological complete response (pCR).

Objective To explore the effects of microRNA(miRNA)- 30c knockdown on proliferation,diffe-rentiation of P19 cells. Methods miRNA - 30c knockdown plasmid(miRNA - 30c knockdown group)or no - load vector(negative control group)was transfected into P19 cells by lipo2000 and stable cell lines were selected by Blastici-din;Dual luciferase reporter gene system was used to confirm miRNA - 30c knockdown. Cell counting kit - 8(CCK - 8) assay was adopted to detect cell proliferation activity. An inverted microscope was used to observe morphological chan-ges of P19 cell differentiation. Cells were induced to differentiated to myocardiocyte with dimethyl sulfoxide(DMSO). Differentiation marker genes including cTnT,NKX2. 5,GATA4 relative mRNA expression levels were detected with real - time quantitative polymerase chain reaction,respectively. Results Observation of green fluorescent protein ex-pression under a fluorescence microscope indicated similar transfection efficiencies,and miRNA - 30c knockdown re-leased the activity of target gene Gli2. As a result,miRNA - 30c knockdown vector was constructed successfully(P ﹤0. 001). During differentiation of mouse P19 cells into myocardial cells,the beating cell clusters in miRNA - 30c knockdown cells were much lower than those in the control cells,and cTnT,NKX2. 5,GATA4 in miRNA - 30c knock-down cells showed significantly lower expression than those in the control cells( all P ﹤ 0. 05). Conclusions miRNA - 30c inhibits the P19 cell proliferation and differentiation. This study gives us a new insight of heart develop-ment and we need more efforts on exploring the deep function of heart diseases.

Objective To investigate the status of community nurses′ cultural competence and analyze its influence factor, so as to provide evidence for enhancing. Methods A total of 537 nurses were selected from Shanghai community center and were asked to complete cultural competence scale for culture nursing awareness, knowledge and skills. Results The total score of cultural competence in Shanghai community nurses was (124. 29 ± 28. 97);the cultural awareness dimension score was (34. 69 ± 8. 47);cultural knowledge dimension score was (33. 43 ± 8. 39); and cultural skill dimension score was (56. 17 ± 14. 45). There were significant difference of cultural competence in age, department and English level (P<0. 05). Logistic regression analysis showed that English level and age were the influencing factors for the cultural competence. Conclusions The conditions of Shanghai community nurses′cultural competence are not satisfactory. The improvement of cultural competence level is a gradual process, so nursing managers and nursing educators should make scientific training and education plan to improve cultural competence of community nurses.

Objective To build a model of self-management behavior for senile patients with chronic heart failure (CHF) based on Bandura's self-efficacy theory and Clark's chronic disease self-regulation model aged CHF patients and to provide scientific evidence for formulating self-management interventions and plans for senile CHF patients. Methods Totally 881 CHF patients were investigated in 30 hospitals from 6 districts of Shanghai from December 2014 to March 2016. The statistical software AMOS 21.0 was used to conduct the path analysis, include various influencing factors, and build systematically an equation model demonstrating the internal mechanism of self-management behaviors. Results The score of self-management of aged CHF patients was (50.2±9.8). Self-concept, per capita income, heart function grading, avoidance as response, self-care ability, quality of life, resignation as response and education level were included into the multiple regression equation of self-management, and these variables accounted for 20.8% of the total variation. The structural equation model demonstrating the influencing factors of self-management for senile CHF patients fit better, and all path coefficients reached a significant level, suggesting that self-efficacy had only indirect effect on the self-management of senile CHF patients, while self-concept, per capita income, heart function grading, avoidance as response, self-care ability, quality of life, resignation as response and education level had both direct and indirect effect on their self-management. Conclusions The self-management of senile CHF patients remains at a medium and low level on the whole, and symptom management is the worst. This study has constructed a model demonstrating the internal mechanism of self-management behaviors in senile CHF patients, suggesting that medical staff should take targeted and systematic interventions according to the general condition of patients and their self-efficacy and self-concept to help improve their self-management level.

Bosworth fracture and dislocation is relatively rare, accounting for about 1% of ankle fractures. It is characterized by the proximal fibula fracture embedded in the posterolateral distal tibia. Due to an insufficient understanding of this fracture, it is easy to cause missed diagnosis and misdiagnosis in clinical practice. Due to the insertion of the fracture, it is challenging to perform closed reduction, and improper treatment is easy to cause complications. Surgical treatment is recommended for this type of fracture. In order to improve the understanding of orthopedic surgeons about Bosworth fracture and dislocation, this paper reports the diagnosis and treatment of 2 cases of Bosworth fracture and dislocation, and reviews the literature on Bosworth fracture's mechanism, diagnosis, classification, complications, and treatment options in recent years.
Humans ; Ankle Fractures/surgery* ; Joint Dislocations/surgery* ; Fracture Fixation, Internal ; Fibula ; Tibia

Objective: To compare the clinical effect of a novel disposable circumcision device Ring with that of conventional circumcision in the treatment of redundant prepuce and phimosis. METHODS: Totally, 750 patients with redundant prepuce or phimosis underwent Ring circumcision (group A, n = 450) or conventional circumcision (group B, n = 300). We recorded the operation time, intraoperative blood loss, Visual Analogue Scale (VAS) intraoperative pain scores, postoperative complications, wound healing time, and patients' satisfaction with postoperative penile appearance, followed by comparison of the collected data between the two groups of patients. RESULTS: All the operations were successfully completed. Group A, as compared with B, showed significantly shorter operation time (［3.78 ± 0.42］ vs ［26.24 ± 3.99］ min, P <0.05), less intraoperative blood loss (［2.39 ± 1.01］ vs ［10.80 ± 3.57］ ml, P <0.05), lower pain scores intraoperatively (0.14 ± 0.36 vs 2.30 ± 1.46, P <0.05), 6 hours postoperatively (0.32 ± 0.78 vs 3.03 ± 1.56, P <0.05) and at the ring removal (3.35 ± 1.42 vs 2.78 ± 1.43, P <0.05), shorter wound healing time (［7.61 ± 1.60］ vs ［8.57 ± 1.37］ d, P <0.05), higher satisfaction with postoperative penile appearance (97.8% ［440/450］ vs 86% ［258/300］, P <0.05), and lower incidence of postoperative bleeding or hematoma (0.89% ［4/450］ vs 3% ［9/300］, P <0.05). No statistically significant differences were observed between groups A and B in the nocturnal pain score before the ring removal (1.45±1.02 vs 1.38 ± 0.92, P >0.05) or the postoperative incidence rate of edema (0.89% ［4/450］ vs 2.33% ［7/300］, P >0.05). There were no significant postoperative infections or delayed incision healing except for 1 case of wound dehiscence in each group. CONCLUSIONS Ring circumcision, with its advantages of shorter operation time, less blood loss and pain, higher safety, and better postoperative penile appearance, is easily accepted by the patients and deserves wide clinical application.
Blood Loss, Surgical ; statistics & numerical data ; Circumcision, Male ; instrumentation ; Disposable Equipment ; Humans ; Incidence ; Male ; Operative Time ; Pain Measurement ; Patient Satisfaction ; Penis ; abnormalities ; anatomy & histology ; surgery ; Phimosis ; surgery ; Postoperative Complications ; Postoperative Hemorrhage ; Postoperative Period ; Wound Healing

Objective To verify the accuracy of the modified technique for internal mammary sentinel lymph node biopsy ( IM-SLNB) in breast cancer .Methods In the validation study , the radiotracer was injected with the modified technique , and fluorescence tracer was injected into the peritumoral breast tissue .The radioac-tive IM-SLN was identified by preoperative lymphoscintigraphy and γprobe.The radioactive IM-SLN received bi-opsy during operation .The status of the fluorescence tracer was identified by the fluorescence imaging system . Results A total of 162 patients were enrolled from Sep .2013 to Dec.2014.IM-SLNB was performed in 110 pa-tients.The radiotracer and the fluorescence tracer were identified in the same IM-SLN in 94 cases, and the con-cordance rate was 85.5%(Case-base, Spearman coefficient correlation 0.823, P<0.001).Conclusion Dif-ferent tracers injected into the different sites of the intra-parenchyma can reach the same IM-SLN, proving the ac-curacy of the modified technique and the hypothesis of IM-SLN lymphatic drainage pattern ( IM-SLN receives not only the lymphatic drainage from the primary tumor area but the entire breast parenchyma ) .