Vertebrobasilar dolichoectasia (VBD) is a disease characterized by the dilation, elongation, and tortuosity of the vertebrobasilar artery. Cerebral microbleeds (CMBs) are brain parenchymal injuries mainly caused by punctate microbleeds due to small vessel lesions. Recent studies have shown that VBD can increase the incidence rate of CMBs, but the correlation and pathophysiological mechanism of the two remain unclear. Multiple factors can induce VBD to accompany CMBs. A deep understanding of the causal relationship and related mechanisms between VBD and CMBs is helpful for the clinical prevention and treatment of such cerebrovascular diseases.

Objective:The aim of the study is analyze the recurrence, metastasis and prognosis of early breast cancer patients and evaluate the long-term safety of tracer sentinel lymph node biopsy (SLNB) using indocyanine green (ICG) and methylene blue (MB) in early breast cancer.Methods:A total of 394 breast cancer patients were enrolled from January 1, 2014 to December 31, 2014 in Affiliated Hospital of Chengde Medical University. The baseline data and clinical characteristics of 222 patients who met the inclusion criteria were analyzed.Results:The median follow-up time of 222 patients was 57 months. The detection rate of sentinel lymph nodes (SLNs) using ICG or MB alone was 96.4% and 84.7% ( P=0.02); the number of SLNs detected was 740 and 604 ( P<0.001); the positive SLN detection rates were 100% and 91% ( P=0.014), and the positive SLNs were 221 and 195 ( P<0.001). The local recurrence rates were 0.7% in patients without axillary lymph node dissection (ALND) and 1.4% ( P=0.57) in patients with ALND, and the distant metastasis rates were 5.3% and 15.7% ( P=0.01), respectively. The 5-year overall survival (OS) was 4.7% and 91.7% ( P=0.421), and the disease-free survival (DFS) was 90.5% and 85.9% ( P=0.285). The OS and DFS of the 222 patients were 100%, 96.8%, 94.1% and 100%, 96.4% and 89.2% respectively at 1, 3 and 5 years after operation. Multivariate COX regression model showed that age ≤50 years old, triple negative molecular classification and primary tumor >2 cm were independent risk factors for prognosis, and HR were 3.254, 7.321 and 3.507, respectively (all P<0.05). Conclusions:Sentinel lymph node biopsy with indocyanine green combined with methylene blue is a safe and reliable method for axillary staging of breast cancer. The COX regression models showed that patients with younger age, three-negative molecular type and larger primary tumor were more likely to have adverse events.

Objective:To develop an evaluation index system for the management ability of general practice team leaders in community health service centers.Methods:Based on literature review, key insider interviews and other methods, the framework and indicator pool for management capability of general practice team leaders were formed. Two rounds of Delphi consultations with 15 experts were conducted from July to October 2021, and the evaluation index system of general practice team leaders' management ability established.Results:All 15 experts had at least 5 years of work experience, including 10 engaging in clinical general practice, 3 in public health and 2 in community management. The response rates for the two rounds of expert consultation was 15/15, and the expert authority coefficient was 0.84, with Kendall's W coefficient of 0.35 ( P<0.001) and 0.46 ( P<0.001), respectively. Finally, the evaluation index system of the management ability of general practice team leaders was established, which consisted of 5 primary indicators (personal quality, special business management, organizational management, teaching and research management, strategy and culture building), 11 secondary indicators and 37 tertiary indicators. Conclusions:The management capability evaluation index system general practitioner team leaders of the community health centers has been established in this stu, which may be used for the training and selection of general practice team leaders in the community health centers.

ObjectiveTo establish a mouse model of basilar artery dolichoectasia （BAD） and explore the mechanism of modified Tongqiao Huoxuetang （JTQHX） in regulating BAD via phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） pathway. MethodSixty C57/BL6 female mice were randomized into sham operation （injected with 10 U·mL^-1 inactivate elastase）， model， atorvastatin calcium tablets （2.6 mg·kg·d^-1）， and low- and high-dose （crude drug 3.4， 17 g·kg^-1·d^-1， respectively） JTQHX groups. The mouse model of BAD was established by injection with 10 U·mL^-1 elastase. After 14 days of modeling， the sham operation group and model group were administrated with equal volumes of pure water by gavage， and other groups with corresponding drugs for 2 months. The levels of interleukin-6 （IL-6） and calpain （LpA） in the serum were measured by enzyme-linked immunosorbent assay （ELISA）. Verhoeff 's Van Gieson （EVG） staining was employed to observe the pathological changes of blood vessels. Terminal-deoxynucleotidyl transferase mediated nick end labeling （TUNEL） was employed to examine the apoptosis rate of vascular smooth muscle cells （VSMCs）. Image Pro Plus was used to observe and calculate the curvature index， elongation length， percentage increase in vessel diameter， and curvature angle of the basilar artery vessels in mice. Western blot was employed to determine the expression levels of PI3K and Akt in the vascular tissue. ResultCompared with the sham operation group， the model group showed lowered IL-6 level （P<0.01）， no significant change in LpA level， increased apoptosis of VSMCs （P<0.01）， and increased curvature index， elongation length， percentage increase in vessel diameter， and curvature angle （P<0.01）. Furthermore， the modeling up-regulated the protein levels of PI3K and Akt in blood vessels （P<0.01） and aggravated the destruction of the inner elastic layer， atrophy of the muscular layer， and hyaline changes in the connective tissue of the medial membrane of the basilar artery wall. Compared with the model group， 2 months of treatment with JTQHX elevated the IL-6 level （P<0.01）， reduced the apoptosis of VSMCs （P<0.01）， decreased the curvature index， elongation length， percentage increase in vessel diameter， and curvature angle （P<0.05， P<0.01）， and down-regulated the protein levels of PI3K and Akt in blood vessels （P<0.01）. In addition， the treatment alleviated the destruction of the inner elastic layer， atrophy of the muscular layer， and hyaline changes in the connective tissue of the medial membrane of the basilar artery wall. ConclusionJTQHX inhibits the elongation， expansion， and curvature of basilar artery vessels and alleviates the pathological changes by reducing the apoptosis of VSMCs and down-regulating the expression of PI3K/Akt pathway.