Breast cancer prevention and treatment have become major issues that urgently need to be addressed in the field of global public health. As a key pathological transitional stage in the progression of breast cancer， preneoplastic breast cancer （PBC） carries a significant risk of clinical transformation. Effective intervention in the progression of PBC is of great clinical significance in preventing the occurrence of breast cancer. Pathological studies have shown that abnormal angiogenesis is a key mechanism driving the transformation of PBC into breast cancer. Vascular endothelial growth factor （VEGF）， as a core regulatory molecule that promotes angiogenesis， plays a pivotal role in this process. The malignant transformation of PBC is closely associated with the abnormal activation of the VEGF-mediated pro-angiogenic network. Although modern medicine has achieved certain therapeutic effects through surgery and endocrine therapy， clinical limitations such as invasiveness， drug resistance， and adverse reactions still exist. Recent studies have demonstrated that the VEGF signaling system mediates the phosphatidylinositol 3-kinase-protein kinase B （PI3K/Akt） signaling pathway and the mitogen-activated protein kinase （MAPK） pathway. In addition， the hypoxia-inducible factor-1α （HIF-1α）/VEGF signaling pathway and the delta-like ligand 4 （DLL4）/Notch receptor 1 （Notch1） signaling pathway， together with other pathways， form a complex regulatory network that plays a central role in angiogenesis during PBC. Traditional Chinese medicine （TCM）， characterized by multi-component synergy， multi-pathway regulation， and high safety， demonstrates significant advantages in inhibiting pathological angiogenesis and blocking PBC progression by targeting the VEGF signaling pathway. From the perspective of VEGF pathway regulation， this paper systematically reviews the latest research progress on TCM in inhibiting angiogenesis and intervening in PBC， and discusses its mechanisms and application value in the early prevention and treatment of PBC， with the aim of providing references for optimizing clinical intervention strategies for PBC.

Artificial intelligence technology brings new opportunities for the reform and innovation of medical imaging teaching and training models. We took the lead in building an artificial intelligence neuroimaging education platform. The platform included four modules: imaging case library, intelligent interactive learning, self-test and exercise, and online exam. The platform enables a more flexible and convenient education mode, a precise and individualized training method, which can motivate the enthusiasm and initiative of medical imaging students and resident trainees in learning, promote the rapid integration of theoretical knowledge and clinical practice, and improve the efficiency and quality of residency training.

Artificial intelligence technology brings new opportunities for the reform and innovation of medical imaging teaching and training models. We took the lead in building an artificial intelligence neuroimaging education platform. The platform included four modules: imaging case library, intelligent interactive learning, self-test and exercise, and online exam. The platform enables a more flexible and convenient education mode, a precise and individualized training method, which can motivate the enthusiasm and initiative of medical imaging students and resident trainees in learning, promote the rapid integration of theoretical knowledge and clinical practice, and improve the efficiency and quality of residency training.

ObjectiveTo explore the distribution mechanism of network modules in the combined treatment of liver cancer with Jiuwei Zhengxiao granules （JWZX） based on the analysis framework of module pharmacology. MethodThe cell experiment and the animal experiment were carried out to investigate the in vitro anti-liver cancer efficacy of JWZX of different concentrations and the effect on the survival time of H22 ascites tumor mice. By virtue of the analysis strategy of modular pharmacology，the distribution characteristics of nine Chinese drugs in the liver cancer disease network modules were investigated based on the constructed liver cancer disease network and module division by MCODE. In this study，the average degree （AD） of the nodes in the modules was used as an index to screen the main modules of the disease，and the intervention of the sovereign drugs，minister drugs，and assistant drugs on the main modules was explored. Finally，the Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment analysis was performed on the drug-acted modules by Metascape. ResultAs revealed by the cell experiment，JWZX could significantly inhibit the proliferation of H22 cells. The animal experiment demonstrated that the medium- and high-dose JWZX could significantly prolong the survival time of mice with H22 ascites tumor （P<0.05，P<0.01）. The distribution of targets of JWZX in the liver cancer disease network modules showed that JWZX interfered with tumor necrosis factor （TNF），epidermal growth factor receptor （EGFR），vascular endothelial growth factor A （VEGFA），transcription factor （JUN），tumor protein p53 （TP53），and other 26 targets and 8 modules. The sovereign drug Ginkgo Semen mainly intervened in modules 3 and 8，and the minister drugs such as Centipeda Herba jointly intervened in modules 1，3，5，8，10，and 12. Centipeda Herba and Phyllanthi Fructus intervened in module 7 and module 19 individually. Artemisiae Annuae Herba and other assistant drugs jointly intervened in modules 3，5，10，and 12. KEGG pathway enrichment analysis found that 135 pathways were enriched in 8 modules，and the pathway functions involved 12 categories including cancer，signal transduction，immune system，endocrine system，and amino acid metabolism. The functions of the four major modules involved cancer，signal transduction，and immune system. According to the results of literature verification，the key links of JWZX on the liver cancer disease network and the core mechanism were presumedly related to the inhibition of phosphoinositide 3-kinase （PI3K）/protein kinase B （Akt） and hypoxia-inducible factor-1 （HIF-1） signaling pathways，reduction of the immunosuppressive effect in the tumor microenvironment，and improvement of the anti-tumor immune response. ConclusionJWZX possesses pharmacological activity against liver cancer，and the therapeutic efficacy was achieved through the multiple targets，multiple modules，and multiple functions of drugs alone or in combination to intervene in the disease. The present study reduced the complexity of drug-disease target network analysis with module analysis strategy and explored the network module distribution mechanism of JWZX in the treatment of liver cancer，which provides a new idea for interpreting the complex mechanism of prescription compatibility.

Objective:To compare the effects of different acupoint compatibility on the efficacy of acupuncture-drug balanced anesthesia in the patients undergoing laparoscopic cholecystectomy.Methods:A total of 140 patients of both sexes, aged 18-64 yr, with body mass index of 18.5-24.0 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, undergoing elective laparoscopic cholecystectomy under general anesthesia, were divided into 4 groups ( n=35 each) by a random number table method: general anesthesia group (group A), Hegu plus Neiguan group (group B), Hegu plus Neiguan plus Zusanli group (group C), and Hegu plus Neiguan plus Zusanli plus Sanyinjiao group (group D). Group B, group C and group D underwent percutaneous electrical stimulation of the corresponding acupoints from 30 min before induction of anesthesia to the end of operation, with a frequency of 2/100 Hz and disperse-dense waves.The intensity of stimulation was the maximum current that patients could tolerate.The intraoperative consumption of propofol and remifentanil and requirement for rescue analgesia were recorded.Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) at 24 h before surgery and 24, 48 and 72 h after surgery.The extubation time and postoperative length of hospital stay were recorded.Adverse events such as intraoperative hypertension, hypotension, bradycardia and tachycardia were recorded. Results:Compared with group A, the intraoperative consumption of propofol and remifentanil and postoperative requirement for rescue analgesia were significantly reduced, the extubation time and postoperative length of hospital stay were shortened, and PSQI was decreased at 24 and 48 h after surgery in B, C and D groups ( P<0.05). Compared with group B and group C, PSQI was significantly decreased at 24 and 48 h after surgery, and postoperative hospitalization time was shortened in group D ( P<0.05). There was no significant difference in the PSQI and incidence of intraoperative hypertension, hypotension, bradycardia and tachycardia among the four groups ( P>0.05). Conclusion:Combination of Hegu, Neiguan, Zusanli and Sanyinjiao has a better effect on the efficacy of acupuncture-drug balanced anesthesia in the patients undergoing laparoscopic cholecystectomy.

Objective:To evaluate the effect of inhaled aerosolized budesonide and salbutamol on lung function during one-lung ventilation (OLV) in rabbits.Methods:Thirty-two healthy male New Zealand white rabbits, aged 5-6 months, weighing 2.5-3.0 kg, were randomized into 4 groups ( n=8 each) using a random number table method: two-lung ventilation (TLV) group, OLV group, inhalation of aerosolized budesonide group (group B) and inhalation of aerosolized budesonide and salbutamol group (group B+ S). Bilateral lungs were ventilated for 3 h in group TLV, the left lung was ventilated for 2 h followed by 1-h TLV in OLV, B and B+ S groups, aerosolized budesonide 1 mg (diluted to 2 ml in normal saline) was inhaled before OLV in group B, and aerosolized salbutamol 0.15 mg/kg plus budesonide 0.5 mg was inhaled before OLV in group B+ S.The equal volume of aerosolized normal saline was delivered in TLV and OLV groups.Volume-controlled ventilation was used in all groups.Arterial blood samples were obtained for blood gas analysis before aerosol inhalation (T 0), 15 min and 1 h after aerosol inhalation (T 1, 2), and at the end of ventilation (T 3). Oxygenation index was calculated.Mixed venous blood samples were collected to determine the corresponding parameters.The pulmonary shunt (Qs/Qt) was calculated.Peak airway pressure (P peak), airway platform pressure (P plat), airway resistance (Raw), and lung compliance (C dyn) were continuously monitored and recorded at T 0-T 3. Results:Compared with group TLV, the concentration of lactic acid was significantly increased at T 2, 3, oxygenation index and C dyn were decreased at T 1-3, and Qs/Qt, Raw, P plat and P peak were increased in OLV, B and B+ S groups ( P<0.05). Compared with group OLV, the concentration of lactic acid was significantly decreased at T 2, 3, oxygenation index and C dyn were increased at T 1-3, and Qs/Qt, Raw, P plat and P peak were decreased in B and B+ S groups ( P<0.05). Compared with group BD, the C dyn was significantly increased at T 1-3, and Qs/Qt, Raw and P peak were decreased in group B+ S ( P<0.05). Conclusion:Inhaled aerosolized budesonide and salbutamol can effectively improve lung function during OLV in rabbits.

To study the risk factors and the clinical characteristics of non-tuberculous mycobacterial (NTM) pulmonary diseases in patients with mechanical ventilation. Methods Retrospective survey was carried out in the patients with mechanical ventilation who combined with NTM pulmonary disease admitted to intensive care unit (ICU) of the First Affiliated Hospital of Guangzhou Medical University from May 2016 to May 2019. The general information, basic diseases, symptoms, signs, biochemical examinations, acid-fast stain test, mycobacterium culture and strain identification results, and chest CT data were collected to summarize the clinical characteristics of patients with mechanical ventilation combined with NTM pulmonary disease. Results There were 12 patients with mechanical ventilation combined with NTM pulmonary disease, 6 males and 6 females, 37-82 years old, with an average age of 65 years. In these 12 cases, patients with cancer (lung cancer were 4 cases, mediastinal tumor was 1 case) and after lung transplantation (use of anti-rejection drugs at the same time) were 5 and 2 respectively. Patients with at least 3 underlying diseases [included hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease (COPD), bronchiectasis, chronic renal insufficiency] were 5. Clinical symptoms of the 12 cases were non-specific. The CT findings were not characteristic, including nodules, patchy infiltrations and fibrous streak. Pleural effusion was common among these subjects but nodular bronchiectatic patterns were absence. Routine laboratory indicators of bacterial infection were non-specific. But the number of lymphocytes of all cases decreased. Mycobacteria cultures were positive with the rapid growth of mycobacteria in these 12 cases. Mycobacterium avium (4 cases), Mycobacterium chelonae (4 cases), Mycobacterium chelonae-abscessus complex (2 cases) and Mycobacterium intracellulare (2 cases) were isolated. Anti-NTM therapy was given to the patients when the acid-fast staining test of their airway secretion was positive and the TB-DNA test was negative, including oral levofloxacin and clarithromycin. Finally, all patients were successfully weaned and discharged from ICU. Conclusions The clinical symptoms of NTM patients with pulmonary disease are non-specific, and the imaging features of chest CT are varied. Patients with mechanical ventilation in ICU, who have the risk of immune dysfunction or underlying structural lung diseases, and who have difficult controlled lung infection, accompanied by pleural effusion and with decreased lymphocytes, should be aware that pneumonia may be caused by non-tuberculous mycobacteria.

Objective To evaluate the modifying efficacy of transversus abdominis plane (TAP) block combined with general anesthesia in elderly patients undergoing laparoscopic surgery.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 65-80 yr,with body mass index of 18.5-24.0 kg/m2,scheduled for elective abdominal laparoscopic surgery,were divided into 2 groups (n =30 each) using a random number table:general anesthesia group (group GA) and TAP block combined with general anesthesia group (group TAP+GA).In group TAP+GA,bilateral TAP block was performed using the posterior approach,and 0.25％ ropivacaine 20 ml was injected into the two sides.Anesthesia was induced with Ⅳ midazolam,etomidate,sufentanil and cisatracurium besylate.Anesthesia was maintained using total intravenous anesthesia.When postoperative visual analog scale score ≥4,dezocine 5 mg was intravenously injected for analgesia.At 5 rmin after admission to the operating room,at 2 min after skin incision and at the end of pneumoperitoneum,venous blood samples were collected for determination of plasma norepinephrine concentrations.The intraoperative consumption of propofol and remifentanil and intraoperative requirement for sufentanil and postoperative requirement for dezocine were recorded.The development of adverse reactions was also recorded.Results Compared with group GA,the plasma norepinephrine concentrations were significantly decreased at 2 min after skin incision and at the end of pneumoperitoneum,the intraoperative consumption of propofol and remifentanil was reduced,the intraoperative requirement for sufentanil and postoperative requirement for dezocine were decreased (P＜0.05),and no significant change was found in the incidence of adverse reactions in group TAP+GA (P＞0.05).Conclusion When TAP block combined with general anesthesia is used in elderly patients undergoing laparoscopic surgery,it is helpful in carrying out anesthetic model of low-consumption opioids and more helpful in inhibiting intraoperative stress responses and postoperative pain responses than general anesthesia alone.

Objective To screen stroke risks among middle-aged and elderly people in community outpatient clinics in Shanghai.Methods A stroke risk screening was conducted among people aged 45-75 years selected with convenient sampling method from 10 community health service centers in Putuo district,Yangpu district and Pudong New Area of Shanghai during January to July 2017.The questionnaire and clinical measurement were used for screening.Multivariate logistic regression analysis was used to analyze the risk factors in subjects with high stroke risk.Results In this study,1 094 individuals with high stroke risk were screened out from 1 750 participants (62.5％).The proportion of high risk cases was higher among men (66.7％,473/709) than that among women (59.7％,621/1 041),unmarried,divorced or widowed (75.0％,90/120)than married or cohabitants (61.6％,1 004/1 630),living alone (72.1％,70/97) than living with others (61.9％,1 024/1 653) (x5=8.969,8.571,4.081;P＜0.01).Compared with non-high-risk subjects,the high-risk subjects had higher BMI,systolic blood pressure,diastolic blood pressure,fasting blood glucose,glycated hemoglobin,total cholesterol,triglycerides,serum creatinine and homocysteine,and were more likely to have carotid plaques or stenosis,the difference was statistically significant (P＜0.05).Multiple logistic regression analysis showed that unmarried/divorce/widowed,high BMI,systolic blood pressure,fasting blood glucose,total cholesterol,and carotid plaque or stenosis were positively associated with high stroke risk(OR=2.015,1.173,1.013,1.456,1.139,1.026,2.103;P＜0.05).Conclusions The proportion of high stroke risk individuals among middle-aged and elderly people is higher in community general practice outpatient clinics in Shanghai.Patients with high BMI,systolic blood pressure,fasting blood glucose and total cholesterol,and carotid plaque or stenosis,as well as those unmarried/divorced/widower should be the subjects for stroke intervention.

Objective To study the rehabilitation effects of the cochlear implants on prelingually deaf children with alba abnormality.Methods A retrospective analysis of the effects of CIs was conducted in the prelingually deaf children of 11 cases of the children with abnormal alba(the research group) and 18 cases of the children who had normal alba(the control group) at the First Affiliated Hospital of Fujian medical university.All the operations were completed by the same doctor.There were no obvious complications during and after the operation.The cochlear implants were turned on after one month and the prelingually deaf children with extremely severe bilateral sensorineural deafness were trained for speech at the rehabilitation centre.The assessment criteria of the categories of auditory performance(CAP) and speech intelligibility rate(SIR) were used.After six months and twelve months of the operation, the family members were followed who have direct contacts with the children.The evaluation of data between the research and the control groups was administered.Results In the research group, the average level of CAP after six months'' post-operation was 2.41±0.47.But in the control group, the average level was 3.28±0.45.In the research group, the average level of SIR after six months'' post-operation was 1.27±0.44.There were 3 children in the research group at level 2, but in the control group, the average level was 1.89±0.31.Two children in the control group were level 1 while the others were level 2.In the research group, the average level of CAP after twelve months'' post-operation was 4.00±0.43 while only one child at level 3.There was one child at level 5 in the research group, the rest were level 4.There was a statistically significant difference in the average level of the CAP after six months'' post-operation(t=4.983, P<0.05) and in the average level of the SIR after six months'' post-operation(t=4.371, P<0.05).There was no statistical difference in the average level of the CAP after twelve months'' post-operation(t=1.033, P>0.05) and in the average level of the SIR after twelve months'' post-operation(t=0.434, P>0.05).Conclusion There is no significant difference of the rehabilitation effects of post-operation between the prelingually deaf children with alba abnormality and those with normal alba.