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.

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.

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.

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 evaluate the effect of autophagy-related factors LC3 and Bnip-3 and apoptosis related factors Bcl-2 and Bax on brain damage in experimental diabetic rats .Methods Thirty SD rats were randomly divided into diabetic group and control group .The diabetic group was injected with 1% streptozotocin ( 60 mg/kg body mass ) and the control group with citrate buffer .The rats were sacrificed after 12 weeks feeding and brain tissues were obtained .Pathological chan-ges were observed and the expression of LC 3, Bnip-3, Bcl-2 and Bax in brain tissues of the rats was detected by immuno-histochemical SP method .Results Compared with the control group ,the diabetic rat brain pathology showed that the cell arrangment was more disorderly and distributed more unevenly , the cell body was smaller , cytoplasm was lighter red , and the number of nerve cells of normal morphology was smaller .The positive number of LC3, Bnip-3 and Bax in brain tissues of diabetic rats was significantly larger than in the control group ,and the difference was statistically significant (P<0.05). However ,the positive number of Bcl-2 was significantly smaller than in the control group ,and the difference was statistically significant (P<0.001).In diabetic rats, LC3 and Bnip-3 showed a weak positive correlation(P<0.05), Bcl-2 and Bax were irrelevant, Bnip-3 and Bax were positively weakly-correlated(P<0.05),Bcl-2 was not correlated;and Bcl-2 and Bax were irrelevant.Conclusion LC3,Bnip-3 and Bax in the brain tissue of diabetic rats are overexpressed , while Bcl-2 shows weak expression , indicating that autophagy factors and apoptotic factors are involved in the process of brain injury in diabet -ic rats, which may be one of the mechanisms of brain tissue damage .

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.

PurposeTo evaluate the value of combined employment of thyroid imaging-reporting and data system (TI-RADS) and ultrasound elastography (UE) in the differentiation of benign and malignant thyroid nodules.Materials and Methods The clinical data of 174 patients with 232 thyroid nodules confirmed surgically or pathologically with puncture biopsy were retrospectively analyzed. All nodules were examined by ultrasound and UE. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TI-RADS, UE and the combination of the two methods were calculated respectively, and the receiver operating characteristic curve (ROC) was drawn to evaluate the value of each of the three methods in differentiating benign and malignant thyroid nodules by comparison of area under curve (AUC).Results The diagnostic sensitivity, specificity and accuracy of UE (number of benign nodules: 155, number of malignant nodules: 77) were 88.9%, 91.8% and 90.9%, respectively; those of TI-RADS (number of benign nodules: 153, number of malignant nodules: 79) were 76.4%, 85.0% and 82.3%, respectively. The values measured by UE were significantly higher than those by TI-RADS (χ2=3.920 and 7.446,P<0.05). The sensitivity, specificity and accuracy measured by the combined use of the two methods (number of benign nodules: 155, number of malignant nodules: 77) were 93.0%, 93.7% and 93.5%, respectively, which were higher than either of the methods, and the difference was statistically significant (χ2=7.725, 6.450 and 13.728,P<0.05). The areas under the curve (AUC) were 0.833 and 0.812 respectively for UE and TI-RADS; the AUC for the combination of the two methods was 0.914, which had significantly higher diagnosis accuracy than that by any single method, and the difference was statistically significant (Z=1.95 and 2.55,P<0.05). Conclusion Compared with gray scale ultrasound, the combination of TI-RADS and UE has higher diagnostic sensitivity and accuracy for excluding malignancy in diagnose of thyroid nodules.

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.