Hypothyroidism (HT) can arise as a complication of radiotherapy for breast cancer. Despite having a significant impact on patients′ quality of life, HT had always been overlooked by radiotherapists in the past. In recent years, many studies highlighting the protection of the thyroid in the process of radiotherapy for breast cancer have been conducted, achieving valuable conclusion. These studies can serve as a guide for radiotherapists to limit the dose to the thyroid during radiotherapy, thus reducing the incidence of HT.

Objective:To explore the clinical effect of a modified single-trunk arterialised venous flap in reconstruction of soft tissue defect in hand and foot.Methods:From January 2019 to June 2022, 25 patients with soft tissue defect in hand and foot were treated in the Department of Hand and Foot Plastic Surgery of Lecong Hospital of Shunde in Foshan. The soft tissue defects were reconstructed with a venous flap, of which a single trunk of vein was ligated and then a blood flux of the flap was re-established via a modified single vein trunk. One patient had soft tissue defect in dorsal foot and toes, 3 patients had defects in dorsal hand, 3 patients had defects in 2 digits and 18 patients had defects in single-digit. The sizes of defects were 2.0 cm×1.0 cm-10.0 cm×4.5 cm. The sizes of flaps were 2.0 cm×1.0 cm-12.0 cm×5.5 cm. Donor sites of the 19 cases were directly sutured and 6 were covered by skin grafts. The postoperative follow-ups were conducted at outpatient clinics and via telephone reviews to observe the survival of flaps. Functional recovery of 23 cases whose soft tissue defects in hand were evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association. The sensory recovery of flaps was evaluated according to the comprehensive flap scale.Results:All 25 single-trunk venous flaps survived successfully. There were small number of blisters on 5 flaps, due to tissue oedema. One patient lost in follow-up. The other 24 patients had 2-18 months of follow-up. The appearance of flaps was soft and thin, with wear-resistant. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the function recovery were excellent in 12 cases, good in 9 cases and poor in 2 cases. Sensations of the flaps were 90-99 point with an average of 97 point according to the comprehensive flap scale, of which 22 flaps were in excellent and 2 in good.Conclusion:The method of ligation of single vein-trunk to make a arterialised venous flap is a simple surgical procedure. There are many selections of donor site with minimum damage. It is an effective method and with satisfactory outcomes.

Objective:To explore the clinical effect of repairing interphalangeal joint defect of hand with free transfer of part of the 2nd metatarsophalangeal joint tissue flap precisely cut with the aid of digital 3D printing technology.Methods:From December 2016 to December 2020, 7 patients with partial joint defects of proximal interphalangeal joints of fingers were treated in Department of Hand and Foot Surgery, Shunde Hospital Affiliated to Guangzhou Medical University(Foshan Shunde Lecong Hospital). Before surgery, three-dimensional data of hand and foot bones were collected, and the 3D printing model was used to simulate the operation in vitro. During the operation, the first dorsal metatarsal artery-the 2nd dorsal metatarsal artery was used as the pedicle, and the 2nd metatarsophalangeal joint composite tissue flap with a required size was harvested with the assistance of the navigation template to tranfer and repair the small joint defects of hand. All 7 cases entered follow-up at outpatient and telephone. Results:All 7 cases survived. Postoperative follow-up was 3-24(mean 9.5) months, Range of motion of the repaired interphalangeal joint was (56 ± 6)°; According to the Evaluation Standard of Thumb and Finger Reconstruction Function of the Society of Hand Surgery of the Chinese Medical Association, 2 cases were excellent, 4 cases were good, and 1 case was poor.Conclusion:Transfer of the free 2nd metatarsophalangeal joint tissue flap assisted by 3D printing technology in repair of the small joint defect of the hand can accurately harvest the tissue flap, which is clinically reliable.

Objective:To construct a scientific and practical micro-course content framework of cross-cultural nursing hospice care from the perspective of attention, relevance, confidence and satisfaction (ARCS) model.Methods:The research team was established in November 2018. Using Delphi method, 16 experts in cross-cultural nursing, hospice care, nursing management, nursing education and other fields were consulted for 3 rounds of correspondence. According to scores of experts, the index weights were calculated to form micro-course content framework of cross-cultural nursing hospice care from the perspective of ARCS model.Results:The positive coefficient of experts surveyed by the questionnaire was 100%, the average value of expert authority coefficient was 0.81. The determined importance values of the first and second level indexes were all greater than 4.00. The coefficient of variation was 0 to 0.12, which were all less than 0.25 and met the requirements. In the end, a content framework containing 3 first-level indexes of professional concepts, professional knowledge and professional skills and 19 second-level micro-course content framework of cross-cultural nursing hospice care were formed.Conclusions:Based on the perspective of ARCS model, the construction process of content framework of the cross-cultural nursing hospice care micro-course is scientific and the setting is reasonable, which has a good guiding significance for the development of training for hospice care nurses.

Objective:To investigate the self-management of elderly chronic heart failure (CHF) patients and to explore the structural equation modeling (SEM) on the influencing factors of self-management behavior among CHF patients so as to provide a basis for constructing the self-management education plan for elderly CHF patients suitable for the characteristics of our country.Methods:From January 2015 to June 2017, The study selected 6 124 elderly patients in 102 hospitals of 16 provinces, cities and autonomous region from 5 areas, east China, west China, south China, north China and central China by random cluster sampling as subjects. All of patients were investigated with the self-management scale of heart failure patients, heart failure knowledge questionnaire, chronic disease self-efficacy scale, self-concept scale and the medica coping modes questionnaire. AMOS 22.0 was used to construct the model on the influencing factors of self-management behavior among CHF patients.Results:The total score self-management of 6 124 elderly CHF patients was [49.00 (43.00, 54.00) ] with 61.25% for the scoring rate. The SEM on the direct or indirect influencing factors of self-management among elderly CHF patients fitted well. The influencing factors of self-management included the per-capita incomes, works, self-care, nations, religious belief, education levels, heart failure knowledge, self-concept, self-efficacy, coping styles.Conclusions:Self-management of elderly CHF patients are in the below average level influenced by different demographers, cultural background and heart failure knowledge. Medical staff should formulate a systematic and individual self-management education plan for elderly CHF patients based on patients' demographic characteristics, cultural background, heart failure knowledge, self-concept and self-efficacy to improve their self-management.

Objective To explore the validity of two-staged revision for hip periprosthetic joint injection and intermediate-term clinical effects.Methods The clinical data of 31 cases who were underwent two-staged revision for unilateral hip periprosthetic joint infection in Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University from March 2014 to September 2016 were analyzed retrospectively.There were 13 males and 18 females,aged (67.5 ±7.8) years,with an age range of 52-79 years.All patients underwent two-staged revision,taking preoperative and intraoperative joint puncture fluid,intraoperative infection of soft tissue for bacterial culture was to clear medication.In first stage,prosthesis removed,debridement performed and antibiotic spacer implanted were performed.Antibiotics were used for 8 to 12 weeks for infection.In second stage,total hip arthroplasty revision was performed while infection was controlled.Harris hip scores,Short form 36 health status scores (SF-36),white blood cell counts,C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)were compared between preoperative and postoperative follow-up in all patients,and postoperative complications were recorded.Postoperative outpatient follow-up was 30.1 to 59.3 months,and reviewed every 12 months after 3 months,6 months,and 12 months.The follow-up deadline was April 2019.Measurement data were expressed as mean ± standard deviation (Mean ± SD).The t test was used to compare the preoperative and postoperative follow-up.Results All 29 patients were followed up for follow-up except 2 patients were lost to follow-up.Preoperative Harris hip score,SF-36,white blood cell count,CRP and ESR were (39.4 ± 5.6) scores,(398.8 ± 39.2) scores,(12.5 ± 0.6) × 109/L,(63.3 ± 10.1) mg/L and (83.7 ± 12.5) mm/h,respectively.The last follow-up oftbe above indicators were (76.9 ±9.3) scores,(649.3 ±67.5) scores,(9.1 ±0.5) × 109/L,(5.3 ± 1.7) mg/L and (10.2 ± 1.6) mm/h,respectively.The results of final followed-up were much better than the preoperative results and there were significant differences between postoperation and preoperation for all indexes.One patient developed postoperative hip dislocation and was treated with manual reduction under general anesthesia.The two patients were diagnosed hip periprosthetic joint infection of joint at 8 months and 15 months respectively after two-staged revision and treated by removing the hip prosthesis.One patient was performed revision again and the other was not performed any operation for poor health condition.The remaining 26 patients had no complications.Conclusions Two-staged revision for periprosthetic joint infection of hip joint can not only treat infection effectively but also can recover hip function significantly.The early and intermediate-term clinical effects of the surgical treatment is satisfied.

Objective To evaluate the short-term clinical efficacy of three dimension printed titanium augments for the reconstruction of acetabular bone defects in revision total hip arthroplasty.Methods The retrospective study was conducted.To retrospectively analyze clinical data of 21 patients who were underwent revision total hip arthroplasty with severe acetabular bone defects reconstructed by three dimension printed titanium augment from March 2016 to September 2017 from Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University.There were 9 males and 12 females,age (58.9 ± 6.3) years,51-67 years,body mass index (23.8 ± 2.9) kg/m2.According preoperative CT scan of hip joints,three dimension printed titanium augments were designed for acetabular defects personality.The data including the vertical distance from centre of rotation to the interteardrop line in X-ray examination,preoperative Harris score,final follow-up Harris score of hip postoperatively,and complications were recorded.Outpatient visits ranged from 11.8 to 19.6 months.Measurement data were expressed as (Mean ± SD),and t test was used before and after surgery.Results For X-ray examination,the average vertical distance from centre of rotation to the interteardrop line was (6.1 ± 1.2) cm preoperatively and (2.8 ± 0.7) cm postoperatively,and the difference was statistically significant (P ＜ 0.01).The hip Harris score increased from preoperative (47.5 ± 6.4) scores to the last follow-up (84.6 ± 5.9) scores,and the difference was statistically significant (P ＜ 0.01).The final follow-up data showed the acetabular prosthesis and augments were stable,while there were no hip joint dislocation,periprosthetic joint infection,loosening of acetabular components and other complications.Conclusion Three dimension printed augments can reconstruct severe acetabular bone defects and restore the hip rotation centre.

Objective? To understand the self-management status among elderly chronic heart failure (CHF) patients and to compare the regional differences of self-management. Methods? By random cluster sampling, we investigated 6 124 elderly CHF patients from 102 hospitals in five regions, East China (Jiangxi Province, Shanghai Municipality, Zhejiang Province), West China (Qinghai Province, Xinjiang Uygur Autonomous Region, Shaanxi Province, Gansu Province, Ningxia Hui Autonomous Region, Yunnan Province), South China (Hainan Province, Guangxi Zhuang Autonomous Region), North China (Heilongjiang Province, Inner Mongolia Autonomous Region), Central China (Henan Province, Hubei Province, Hunan Province). The investigation result statistics were carried out and regional differences were compared. Results? The self-management of elderly CHF patients had a low to medium level with 61.25% (49/80) ＜80% for the scoring rate. The scores of East China and Central China were higher and the score of West China was low; the regional differences were statistical (H=59.07, P＜0.01). The score of diet management was highest with 66.67% for the scoring rate (8/12); East China had the highest score, and West China had the lowest score; the regional differences were statistical (H=92.49, P＜0.01). The scoring rate of medication management was 65.00% (13/20) with the highest in East China and low in North China and West China; the regional differences were statistical (H=351.10, P＜0.01). Mental/social adjustment management was poor with 60.00% (12/20) for the scoring rate; the scores of Ease China were higher than those of North and West China; the regional differences were statistical (H=8.84, P＜0.01). Symptom management was the worst with 57.14% (16/28) for the scoring rate; the scores of East and Central China were high;the regional differences were also statistical (H=17.62,P＜0.01). Conclusions? Self-management of elderly CHF patients needs to be improved. Systematic and targeted health education for different regions should be carried out to improve patients' self-management and to reduce the disease burden.

Objective? To investigate the level of self-management and identify the influencing factors in elderly patients in Inner Mongolia with chronic heart failure(CHF). Methods? By convenience sampling, a total of 1 051 elder patients with CHF from 9 Class Ⅱ & Ⅲ hospitals in 5 cities of Inner Mongolia Autonomous Region were recruited to participate in this study from December of 2015 to July of 2018. The elderly CHF patients were investigated with General Data Questionnaire and Self-management Scale for Heart Failure Patients. Results? The total score of Self-management Scale for Heart Failure Patientsof 1 051 elderly patients with CHF was (47.9±7.7) with a scoring rate of 59.9%. Multivariate linear regression analysis showed that ethnicity,work status and marital status were the influencing factors of self-management level of elderly CHF patients. Conclusions? The self-management status of elderly CHF patients in Inner Mongolia is not ideal. Corresponding intervention measures should be formulated according to the influencing factors of self-management level of elderly CHF patients in Inner Mongolia.

This paper summarizes the application of health coaching in self-management of patients with cardiovascular diseases. Health coaching can help patients with cardiovascular diseases gain the knowledge, skills, tools, and confidence that they need to become active participants in their self-health and enhance their self-management. The form of health coaching includes motivational interview, self-management support and remote home monitoring. Health coaching can enhance the medication adherence among patients with cardiovascular diseases, promote healthy lifestyles and maintain good psychology in patients, and finally strengthen their self-management. Finally, this paper proposes that China should pay more attention to the health coaching, such as establishing the relevant departments of health coaching, strengthening the training and certification of health coaches through the examination of theory and skills, and exploring the establishment of a technical program for health coaching and intervention that is suitable for China, so that patients with cardiovascular diseases can be benefited.