Background and purpose: Paget's disease (PD) of the breast is a rare disease. The survival of PD was reported to be related to the characteristics of the underlying carcinoma. This study aimed to investigate the char-acteristics and survival of PD patients with underlying invasive breast carcinoma (IBC). Methods: Fifty-four patients diagnosed with PD and an associated IBC in Fudan University Shanghai Cancer Center from 2002 to 2007 were re-cruited in this study as study group. Since most PD overexpress HER-2, 72 patients with HER-2-overexpressing breast cancer were randomly recruited as control group. This study compared survival between these two groups. Results:Twenty-five (46.3％) patients in study group had no clinical manifestation of PD and were diagnosed unexpectedly by a histologic examination. Thirty-five (64.8％) patients in study group had tumors larger than 2 cm, twenty-six(48.1％) patients in study group had chance of axillary lymph node involvement. Compared with control group, patients in study group tended to have more events (5-year relapse-free survival: 76.4％ vs 48.5％, P<0.01). In the control group, most events occurred in the first 3 years after operation, while recurrence might happen all along in the 5 years after opera-tion in study group. Patients in study group also had a poorer overall survival than in control group (61.0％ vs 80.6％, P=0.01). Conclusion: Patients with Paget's disease and underlying invasive breast cancer tend to have poorer survival than those with HER-2-overexpressing breast cancer.

With the development of oral science and technology,combined surgical and orthodontic treatment becomes a new developing subject.This article clarifies the most important facets of the ethical problems for the successful combined surgical and orthodontic treatment;the author thinks noble medical morals, excellent medical technology,scrupulous science style and responsible attitude as the important subjective factors for this successful treatment.

Objective To investigate the effect of exception questions/miracle questions in SolutionFocused Approach in nursing on affects,confidence to solve problem,the perception of problem's difficulty,and actual solving problems,to provide practical basis for practitioners of Solution-Focused Approach.Methods A total of 102 nurses were randomly divided into exception questions in Solution-Focused Approach group (exception group),miracle questions in Solution-Focused Approach group (miracle group)and cause questions in the traditional psychotherapy pattern group(cause group).The difference among three groups on the aspect of the change of affects,confidence to solve problem and the perception of problem's difficulty,and the help form the questions immediately and after 1 week (immediate help and 1 week after help) were studied.Results Eventually subjects effectively,34 nurses in exception group,31 nurses in miracle group,31 nurses in cause group.The difference among three groups in aspect of the change of affects,the change of confidence to solve problem,immediate help and 1 week after help were statistically significant (Z=9.68-18.58,P＜ 0.05).Furthermore,change in problem solving confidence on exception group was higher than cause group(51.9 vs.35.6,P ＜ 0.05),change in affects on exception group and miracle group were higher than cause group (53.8,55.1 vs.36.0,P ＜ 0.05),the immediate help on exception group and cause group were higher than miracle group (59.8,52.5 vs.32.0,P ＜ 0.05),and 1 week after help on exception group was higher than miracle group and cause group(64.5 vs.42.3,37.0,P ＜ 0.05).Conclusions Exception/miracle questions can both improve the emotional state,and exception questions can enhance the confidence to solve problems and provide more help for nurses.

OBJECTIVETo investigate the changes in the craniofacial morphology ofdeepbite from childhood to adulthood using cross-sectional methods. To analyze the maxillofacial characteristics of adult deepbite.

METHODSThe sample included 159 children (with average age of 12.47 years old) and 81 adults (with average age of21.76 years old) with class III deepbite. The control group consisted of51 normal individuals (with average age of 18.41 years old). Lateral cephalometric radiographs were taken and recorded in a computer through a scanner. Cephalometric measurements were conducted by using Winceph 7.0 software, and results were analyzed with SPSS 12.0 software.

RESULTSSignificant differences between child and adult deepbite were observed in the following: N-ANS, ANS-Me, A-Ms, A-Ptm, Wits, Mo-Ms, Ii-Ii, A-B plane angle to the mandibular plane angle, Gonial angle, L1 to NB length, overjet, mandibular body to anterior cranial base, Mo-Mi, posterior facial height, U1 to NA length, Pog-Go, Cd-Go, occlusion plane angle to SN, and U1 to SN. In addition, significant differences between adult deepbite and normal occlusion were observed in SNB, ANB, convexity, APDI, ODI, Wits, A-B plane to mandibular plane, Gonial angle, overjet, mandibular body to anterior cranial base, S-Ptm, Mo-Mi U1 to SN; Pog-Go, Cd-Go, posterior cranial base, and occlusion plane to SN and posterior facial height.

CONCLUSIONDeepbite patients have certain growth potential after puberty, but the sagittal relationship of their jaws exhibits no improvement. Adult deepbite patients exhibit significant problems in the vertical and sagittal jaw positions.

Adult ; Bone and Bones ; Cephalometry ; Child ; Cross-Sectional Studies ; Dental Occlusion ; Female ; Humans ; Male ; Mandible ; Sexual Maturation

OBJECTIVE To ascertain the current situations of nosocomial infection control in local general hospitals,and to provide reliable data for future work.METHODS A random sampling questionnaire(method) was adopted to investigate the current situations of nosocomial infection control in 15 local hospitals in eight counties and cities.RESULTS Altogether 15 hospitals at the county and urban levels have been surveyed,(among) which 14 hospitals have fewer than 300 sickbeds and only 1 hospital has over 500 sickbeds.Seven hospitals did not have full-time staff of infection control till 2003.In the 15 hospitals,each full-time staff was(responsible) for an average of 143.9(sickbeds);in terms of the constitution of the full-time staff,nurses accounted for 73.7%,doctors,21.9%,and technicians,5.2%;of the full-time staff,63.2% held an intermediate(professional) position,and 36.8% held a junior professional position;with regard to the chances of further professional training in other places,19 full-time staff had 56 chances.The applications of sterilized agents and protective equipments were increasing each year.CONCLUSIONS The(infection) control in local general hospitals is gradually on the right track,but in some aspects,improvements are still needed.The prerequisites for improving infection control work in local general hospitals are that leaders should pay more attention to nosocomial infection control,and that more human and(material) resources should be pooled in it.

Objective To investigate the relationship between cardiovascular risk factors and arterial elasticity in elderly hypertensive patients.Methods 253 subjects were divided into two groups:hypertension group (n=141) and non-hypertension group (n =112).Carotid-femoral pulse wave velocity (C-FPWV),carotid-radial PWV (C-RPWV),height and weight were determined.Fasting plasma levels of blood glucose (BG),blood lipids,insulin,endothelins (ET),nitric oxide (NO) and high sensitivity C-reactive protein (hsCRP) were assessed.Results C-FPWV and CRPWV were higher in hypertension group than in non-hypertension group [(11.7±1.9) m/s vs.(9.7±1.1)m/s,(11.7±1.7) m/s vs.(9.4±1.1)m/s,t=8.43 and-6.30,both P＜0.01].Body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),levels of triglyceride (TG),BG,ET,NO and hsCRP,HOMA-IR had significant differences between the two groups (t=-5.27,-4.18,-6.00,6.29,-4.18,-4.86,-3.41,respectively,all P＜0.05).Pearson correlation analysis showed that CFPWV was correlated with SBP,age,DBP,fasting BG,NO,ET,TG,HOMA IR,cholesterol (CHO),hsCRP (r=0.534,0.374,0.340,0.338,-0.306,0.242,0.228,0.225,-0.218,0.178,respectively,all P＜0.05); C-RPWV was correlated with age,DBP,SBP,NO,TG (r=0.312,0.319,0.241,-0.197,0.151,respectively,all P＜0.05).Multiple regression analysis demonstrated that C-FPWV=4.640 + 0.081× HOMA IR+ 0.047× age+0.035×SBP+0.29×TG-0.017×NO+0.014×ET+0.132×hsCRP,r2=0.514; CRPWV=3.161+0.034×age+0.033×DBP+0.313×fastingBG+0.013×ET-0.013×NO,r2=0.390.Conclusions The decreases of arterial elasticity are closely related with endothelial function,insulin resistance,levels of blood lipids and hsCRP in elderly patients with hypertension.

Objective To investigate the application of multi-sliced CT on breast cancer and early lymph node metastasis (LNM). Methods 30 cases with infiltrative ductal carcinoma (IDC)confirmed by pathology were collected and set as Study Group,30 fibro-mas as Control Group.128-slice CT plain and 2 phrase enhance scan was undergone.Image signs of mass of two groups were com-pared.Image signs of early lymph node metastasis were analyzed.Results In MSCT images,IDC masses had irregular shape,burr rim.2-phrase MSCI demonstrated obvious enhancement in artery phrase,persistence enhancement in vein phrase and ring shape en-hancement.There were significant different between 2 groups in mass shape,rim and enhancement mode(P<0.05).MSCT demon-strated 22 LNM,but 6 of them had no swelling but obvious enhancement.Conclusion 2-phrase MSCT plays an important role in as-sessing breast cancer and early lymph node metastasis.

Objective To analyze the effects of fetal reduction in early pregnancy on obstetric and neonatal outcomes of spontaneously or selectively reduced multiple pregnancies produced by in vitro fertilization-embryo transfer (IVF-ET). Methods Retrospective study of 6917 clinical pregnancies from IVF-ET cycles, including 754 multiple pregnancies divided into two groups according to the remaining fetus number: reduced singleton group (n=599) and reduced twin group (n=155); and maternal and neonatal outcomes of two groups were compared to primary singleton group (n=3589) and primary twin group (n=2574). Results The rate of pregnancy complication [9.85%(59/599) versus 6.21%(223/3589)], preterm birth [19.37%(116/599) versus 10.73%(385/3589)], low birth weight [9.71%(56/577) versus 4.57%(152/3324)], perinatal death [0.69%(4/577) versus 0.12%(4/3324)] and malformation [2.95%(17/577) versus 1.02%(34/3324)] in reduced singleton group were significantly higher than those in primary singleton group (all P<0.01). There were no significant differences between reduced twin group and primary twin group (all P>0.05). In reduced singleton group, birth defect rate was 2.95%, which was higher than those of the other three groups (P<0.05), in this group spontaneous pregnancy reduction accounted for 89.3%(535/599). Conclusions (1) The rate of pregnancy complication, preterm birth, low birth weight, perinatal death and malformation in reduced singleton group are still higher than primary singletons, suggesting embryo reduction only is a compensated method in multiple pregnancies. Limiting the number of embryos transferred is the essential solution. (2) The rate of birth defect in spontaneous pregnancy reduction group is higher, so prenatal examination should be reinforced in this group.

Objective To explore the value of multi-slice computed tomography (MSCT) on the typing and staging of bronchiolitis obliterans (BO) in children.Methods Twenty-eight BO patients were recruited and underwent X-ray and MSCT from August 2012 to August 2015.The classification of MSCT signs and radiological manifestations in different stages of BO were discussed.Results Mosaic sign and bronchial wall thickening appeared in all cases and pulmonary atelectasis in 6 patients.MSCT signs were divided into 18 cascs of simple type and 10 of pneumonic type,respectively.Radiological imaging undergone after treatment for 2 ～ 4 weeks indicated that 20 patients turned normal,but 8 patients to chronic stage,including pulmonary interstitial fibrosis (7 cases),bronchoiectasis (6 cases),calcification in bronchial distal (3 cases) and pleural adhesions (2 cases).Conclusion Mosaic sign is a distinctive MSCT manifestation for BO in early phase,and CT typing and staging contribute to guiding the treatment.