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 explore the language deficits in a single case of posterior aphasic to test the dual-system model of language processing and provide neurolinguistic basis for clinical language therapy.Method:A circumscribed posterior aphasic was selected,whose language data were collected through spontaneous talk,WAB test,and other language production tasks including picture-naming and sentence repetition.The language data were analyzed with the emphasis on syntax-lexicon dissociation and noun-verb dissociation.Result:For the posterior aphasic,lexicon was severely impaired while syntax was preserved relatively well;in comparison to lexical production,lexical comprehension was preserved better;noun-verb dissociation,especially NSD,was discovered.Conclusion:The syntax-lexicon dissociation and the relevant noun-verb dissociation can serve as powerful evidence for the dual-system model of language processing,and throw light on language therapy for posterior aphasics.

The nutritional status of 162 patients with maintenance hemodialysis (MHD) was screened by Nutritional Risk Screening 2002 (NRS-2002) and assessed by Subjective Global Assessment (SGA) at the next day of admission.Among 150 MHD patients who met the study requirement,the nutritional risk was 29.3％ as screened with NRS-2002,and the rate of nutrition deficiency was 41.3％ with SGA assessment,there was no difference between two methods (x2 =18.155,P =0.109) ; According to BMI,the incidence of nutrition deficiencies,overweight and obesity in MHD patients was 13.3％,30.7％ and 29.3％.NRS-2002 and SGA are applicable to nutritional deficiencies assessment in MHD patients,but NRS-2002 is more comprehensive and feasible than SGA.

Objective To investigate the protective effect of melatonin and its possible mechanism for repairing in the immature white matter damage due to brain hypoxia-ischemia (HI).Methods Forty-eight three-day SD rats after birth were randomly divided into 3 groups:sham-operated(SHAM) group,HI group and melatonin treatment(MT) group.Periventricular white matter damage (PWMD) to animal models were estabished according to Rice modeling.MT group was treated with melatonin pre-operatively,immediately postoperation,1 hour postoperation and 24 hours postoperation via intraperitoneal injection,and the other groups were injected with the same volume of dissolvent.The rats were executed by decollation after 2 days and 14 days.The histological changes in periventricular white matter were observed by HE staining and immunohistochemistry.Results For the 3 groups,the structure in ope-ration side of the white matter in the peripheral ventricles of the brain 2 days postoperation were significant different (P ＜0.05).The O4 positive cells decreased one by one/greatest in the SHAM group[(75.548 ± 7.333)/hpf] followed by MT group [(59.971 ± 3.635)/hpf],and HI group [(40.511 ± 2.848)/hpf] (P ＜ 0.05).The expression of Casepase-3 increased in the SHAM group (107.724 ± 10.266),MT group (132.289 ± 8.537),and HI group (202.168 ± 14.367),and the difference was statically significant (P ＜ 0.05).Ventricular index was greater in operation side of the white matter in the peripheral ventricles of the 14-day-brain in the SHAM group(0.928 ±0.063),MT group (1.813 ± 0.110),HI group (2.752 ± 0.201),increasingly,while absorbance value of myelin basic protein decreased one by one in sequence(39.504 ± 1.673,21.729 ± 1.614,11.344 ± 1.118).Conclusions MT plays a role in protecting the periventricular white matter via inhibiting the apoptosis of oligodendrocyte progenitor cell,and thus benefits the PWMD.

Distortion product otoacoustic emission (DPOAE) signal can be used for diagnosis of hearing loss so that it has an important clinical value. Continuously using sweeping primaries to measure DPOAE provides an efficient tool to record DPOAE data rapidly when DPOAE is measured in a large frequency range. In this paper, locally weighted least squares estimation (LWLSE) of 2f1-f2 DPOAE is presented based on least-squares-fit (LSF) algorithm, in which DPOAE is evoked by continuously sweeping tones. In our study, we used a weighted error function as the loss function and the weighting matrixes in the local sense to obtain a smaller estimated variance. Firstly, ordinary least squares estimation of the DPOAE parameters was obtained. Then the error vectors were grouped and the different local weighting matrixes were calculated in each group. And finally, the parameters of the DPOAE signal were estimated based on least squares estimation principle using the local weighting matrixes. The simulation results showed that the estimate variance and fluctuation errors were reduced, so the method estimates DPOAE and stimuli more accurately and stably, which facilitates extraction of clearer DPOAE fine structure.
Algorithms ; Hearing Loss ; diagnosis ; Humans ; Least-Squares Analysis ; Otoacoustic Emissions, Spontaneous ; Regression Analysis

Objective To evaluate the perinatal outcome of three types of monochorionic diamniotic (MCDA) twins with selective intrauterine growth restriction (sIUGR).Methods From January 2010 to June 2013 clinical data of 37 pairs of MCDA twins (74 fetuses)with sIUGR and 40 pairs of normal MCDA twins (80 fetuses) in the same period were analyzed retrospectively.Fetuses with sIUGR were classified into three groups based on umbilical artery Doppler flow.There were 20 cases of type Ⅰ,11 cases of type Ⅱ and 6 cases of type Ⅲ.The perinatal outcome was compared between sIUGR and normal MCDA twins,and among the three types of sIUGR as well.Perinatal outcomes included gestational age at delivery,rate of intrauterine fetal death (IUFD),birth weight,twins discordance of birth weight,neonatal death and survival rate at 6 months.Results The gestational age of sIUGR group at delivery was significantly earlier than that of control group [(33.1 ± 3.0),(36.9 ± 3.2) weeks,respectively],and the rate of IUFD of both fetuses of sIUGR group was significantly higher [5.4％ (4/74),0,respectively],there was significant difference(P ＜ 0.05).In sIUGR group,the average birth weight of large or small twins [(2 030.8 ± 353.4),(1 529.0 ± 432.9) g] was smaller than those in control group [(2 471.5 ± 500.9),(2 346.0 ± 460.3) g],there was significant difference (P ＜ 0.05).The twins discordance of birth weight in sIUGR group was significantly larger [(27.2 ± 2.6)％] than that in control group [(8.0 ± 1.6)％] (P ＜0.05).The gestational age at delivery in type Ⅱ and type Ⅲ [(33.1 ± 5.0),(34.3 ± 2.8) weeks] was significantly earlier than that in control group (P ＜ 0.05).The rate of IUFD of both fetuses in type Ⅱ (18.2％,4/22) was significantly higher than that in type Ⅰ (0) and control group (0) (P ＜ 0.05).In sIUGR group,the average birth weight of small twins in type Ⅰ,type Ⅱ and type Ⅲ was (1 646.0 ± 433.5),(1 332.8 ± 310.5),(1 504.5 ± 382.2) g respectively,all of which was significantly smaller than that in control group (P ＜ 0.05).The average birth weight of small twins in type Ⅱ was smaller than type Ⅰ and the difference was statistically significant (P ＜ 0.05).In sIUGR group,the twins discordance of birth weight in type Ⅰ,type Ⅱ and type Ⅲ was (26.3 ±5.1)％,(31.0 ±1.6)％,(31.4 ±3.3)％ respectively,all of which was significantly larger than that in control group (P ＜0.05).There were no significant difference of the twins discordance of birth weight among the three types of sIUGR (P ＞ 0.05).Survival rate at 6 months in type Ⅱ (63.6％,14/22) was significantly lower than type Ⅰ (95.0％,38/40) and control group (92.5 ％,74/80) (P ＜ 0.05).Conclusions The perinatal outcome of MCDA twins with sIUGR is poor.The outcome is different among the three types of sIUGR,and type Ⅱ is the worst.Type Ⅱ is associated with a high risk of intrauterine fetal demise.It is important to monitor the intrauterine situation closely.

The effect of recombinant human phospholipase D2(rhPLD2)in vivo was investigated on the secretion of serum glycosyl phosphatidylinositol-specific phospholipase D(GPI-PLD)in guinea pigs of chronic asthma．Ater treating the guinea pigs attacked by chronic asthma with rhPLD2,the GPI-PLD activity detection was canrried out by phase separation of human placental alkaline phosphatase in Triton X-114．Compared with the healthy guinea pigs(NS group),the serum GPI-PLD in the guinea pigs of chronic asthma are much higher than that of control groups,P≤0．01．Our results showed that rhPLD2 could significantly reduce the secretion of GPI-PLD when the guinea pigs were attacked by chronic asthma．

Objective:To evaluate the clinical application of human serum albumin in the inpatients in our hospital to promote its rational use. Methods:Totally 1 183 cases were selected from the inpatients treated with human serum albumin from January to De-cember in 2014, the clinical department, classification of diseases, age distribution and relevant concentration checks of serum albumin in the inpatients were analytically reviewed. Results: Totally 26 clinical departments were involved in the use of human serum albu-min,mainly in the digestive departments and ICU. The elderly patients aged above 65 years accounted for great proportion (47. 68%). In addition, all patients had relevant concentration checks of serum albumin. Conclusion:The patients with digestive diseases tend to have the largest consumption proportion of human serum albumin in our hospital. It is important for physicians to strictly follow the indi-cations of medication in using human serum albumin.

OBJECTIVE:To isolate and purify three principal degraded impurities of mitiglinide calcium (impurity A,B,C) and identify their structures,establish HPLC method for content determination of impurity A,B,C. METHODS:Mitiglinide calci-um was used as raw material and reacted with acid;3 impurities were then separated by HPLC and their structures were elucidated by IR,MS,1H NMR,13C NMR,LC-ESI-MS and ORD. 3 impurities of 3 batches of mitiglinide calcium were determined,and the determination was performed on Agilent Extend-C18 column with mobile phase consisted of 0.01 mol/L sodium acetate solution-ace-tonitrile-triethylamine(60:40:0.1,pH=3.0)at the flow rate of 1.0 ml/min. The detection wavelength was set at 210 nm and sam-ple size was 20 μl. The response tests of 3 impurities and mitiglinide calcium were conducted. RESULTS:After treated with acid, impurity A,B,C had been obtained,and their purity were 99.05%,98.87%,99.98%,respectively after isolation and purifica-tion;after identifying the structure, 3 impurities were S-2-bezylsuccinic acid, S-2-bezylsuccinic acid-4-methyl ester, methyl (2S)-2-benzyl-3-(cis-hexahydroisoindolin-2-ylcarbonyl) propionate;methodological study of content determination of impurities were all up to the requirement. The linear range of impurity A,B,C were 0.387 5-3.875,0.395-3.95 and 0.392 5-3.925 μg/ml(all r were 1.000 0). The response value of impurity A,B,C and mitiglinide calcium were 2.316 1,2.636 1,2.617 8 and 2.620 4,re-spectively. CONCLUSIONS:The structures of 3 principal degraded impurities of mitiglinide calcium have been identified and con-firmed;the content of them can be determined by HPLC main component self-comparison method.