This paper summarizes professor LIN Yi's clinical experience in treating brain metastases of triple-negative breast cancer （TNBC）. It is believed that the pathogenesis of this disease is fundamentally based on spleen and lung qi deficiency， with the binding of phlegm， stasis， and toxins acting as the critical link for disease progression， and qi stagnation serving as a major factor in its protracted course. The core therapeutic principle of "consolidating the root and cultivating the origin， resolving phlegm and dredging collaterals" is proposed. Clinically， the disease is staged into active， stable， and convalescent phases. During the active phase， characterized by spleen and lung qi deficiency alongside hyperactivity of phlegm-toxin pathogens， the treatment focuses on supplementing qi， fortifying the spleen， resolving phlegm， and dredging collaterals， utilizing the Yiqi Jiangtan Tongluo Formula （益气降痰通络方）. During the stable phase， marked by spleen deficiency， weak qi， and residual phlegm， stasis， and toxins lingering in the collaterals， the treatment aims to fortify spleen， cultivate the origin， expel pathogens， and dredge collaterals， using modified Baihua Qiling Formula （白花芪苓方）. During the convalescent phase， characterized by depletion of healthy qi， dysfunction of zang-fu （脏腑） organs， and deep-seated residual phlegm， stasis， and toxins within the brain collaterals， the treatment focuses on regulating qi movement， protecting body fluids， and applying constitution-based treatments， mostly using mild and nourishing medicinals.

This paper summarizes professor LIN Yi's clinical experience in treating brain metastases of triple-negative breast cancer （TNBC）. It is believed that the pathogenesis of this disease is fundamentally based on spleen and lung qi deficiency， with the binding of phlegm， stasis， and toxins acting as the critical link for disease progression， and qi stagnation serving as a major factor in its protracted course. The core therapeutic principle of "consolidating the root and cultivating the origin， resolving phlegm and dredging collaterals" is proposed. Clinically， the disease is staged into active， stable， and convalescent phases. During the active phase， characterized by spleen and lung qi deficiency alongside hyperactivity of phlegm-toxin pathogens， the treatment focuses on supplementing qi， fortifying the spleen， resolving phlegm， and dredging collaterals， utilizing the Yiqi Jiangtan Tongluo Formula （益气降痰通络方）. During the stable phase， marked by spleen deficiency， weak qi， and residual phlegm， stasis， and toxins lingering in the collaterals， the treatment aims to fortify spleen， cultivate the origin， expel pathogens， and dredge collaterals， using modified Baihua Qiling Formula （白花芪苓方）. During the convalescent phase， characterized by depletion of healthy qi， dysfunction of zang-fu （脏腑） organs， and deep-seated residual phlegm， stasis， and toxins within the brain collaterals， the treatment focuses on regulating qi movement， protecting body fluids， and applying constitution-based treatments， mostly using mild and nourishing medicinals.

By aggregating the essence of theories related with depressive syndrome from historical medical practitioners and based on the extensive clinical experience,traditional Chinese medicine(TCM)master Lin Yi proposed the theory of six-stagnation-based breast disease prevention and treatment.She pointed out that the occurrence of breast diseases is related to six stagnations(qi stagnancy,blood stagnancy,phlegm stagnancy,dampness stagnancy,food stagnancy,and fire stagnancy),and the treatment for breast diseases should start from the six stagnations.The development and progression of breast cancer is closely associated with the imbalance of internal environment and the formation of six stagnations,and breast cancer is one of the major diseases suitable for the TCM syndrome differentiation and treatment.For the treatment of early breast cancer,Professor Lin Yi proposed to divide early breast cancer into four stages,namely perioperative period,peri-chemotherapy period,peri-radiotherapy period,and consolidation period.Guided by the theory of six-stagnation-based breast disease prevention and treatment,therapies of soothing the liver,resolving phlegm,removing stasis,clearing heat,eliminating dampness,promoting digestion,fortifying the spleen,and tonifying the kidney are employed to harmonize the internal environment and alleviate symptoms.The theory of six-stagnation-based breast disease prevention and treatment enriches the TCM theory for the prevention and treatment of breast cancer,refines the principles and methods for the staging and syndrome differentiation of early breast cancer,and holds significant implications for enhancing the efficacy of integrated TCM and western medicine in managing early breast cancer.

Objective:To investigate the prognostic value of deep learning-based automated quantification of tumor-stroma ratio (TSR) in patients undergoing neoadjuvant therapy (NAT) for breast cancer.Methods:Specimens were collected from 209 breast cancer patients who received NAT at Renmin Hospital of Wuhan University from October 2019 to June 2023. TSR levels in pre-NAT biopsy specimens were automatically computed using a deep learning algorithm and categorized into low stroma (TSR≤30%), intermediate stroma (TSR 30% to ≤60%), and high stroma (TSR>60%) groups. Residual cancer burden (RCB) grading of post-NAT surgical specimens was determined to compare the relationship between TSR expression levels and RCB grades. The correlation of TSR with NAT efficacy was analyzed, and the association between TSR expression and patient prognosis was further investigated.Results:There were 85 cases with low stroma (TSR≤30%), 93 cases with intermediate stroma (TSR 30% to ≤60%), and 31 cases with high stroma (TSR>60%). Different TSR expression levels showed significant differences between various RCB grades ( P<0.05). Logistic univariate and multivariate analyses showed that TSR was a risk factor for obtaining a complete pathological remission from neoadjuvant therapy for breast cancer when it was used as a continuous variable ( P<0.05); COX regression and survival analyses showed that the lower the percentage of tumorigenic mesenchyme was, the better the prognosis of the patient was ( P<0.05). Conclusions:The deep learning-based model enables automatic and accurate quantification of TSR. A lower pre-treatment tumoral stroma is associated with a lower RCB score and a higher rate of pathologic complete response, indicating that TSR can predict the efficacy of neoadjuvant therapy in breast cancer and thus holds prognostic significance. Therefore, TSR may serve as a biomarker for predicting therapeutic outcomes in breast cancer neoadjuvant therapy.

Objective:To investigate the prognostic value of deep learning-based automated quantification of tumor-stroma ratio (TSR) in patients undergoing neoadjuvant therapy (NAT) for breast cancer.Methods:Specimens were collected from 209 breast cancer patients who received NAT at Renmin Hospital of Wuhan University from October 2019 to June 2023. TSR levels in pre-NAT biopsy specimens were automatically computed using a deep learning algorithm and categorized into low stroma (TSR≤30%), intermediate stroma (TSR 30% to ≤60%), and high stroma (TSR>60%) groups. Residual cancer burden (RCB) grading of post-NAT surgical specimens was determined to compare the relationship between TSR expression levels and RCB grades. The correlation of TSR with NAT efficacy was analyzed, and the association between TSR expression and patient prognosis was further investigated.Results:There were 85 cases with low stroma (TSR≤30%), 93 cases with intermediate stroma (TSR 30% to ≤60%), and 31 cases with high stroma (TSR>60%). Different TSR expression levels showed significant differences between various RCB grades ( P<0.05). Logistic univariate and multivariate analyses showed that TSR was a risk factor for obtaining a complete pathological remission from neoadjuvant therapy for breast cancer when it was used as a continuous variable ( P<0.05); COX regression and survival analyses showed that the lower the percentage of tumorigenic mesenchyme was, the better the prognosis of the patient was ( P<0.05). Conclusions:The deep learning-based model enables automatic and accurate quantification of TSR. A lower pre-treatment tumoral stroma is associated with a lower RCB score and a higher rate of pathologic complete response, indicating that TSR can predict the efficacy of neoadjuvant therapy in breast cancer and thus holds prognostic significance. Therefore, TSR may serve as a biomarker for predicting therapeutic outcomes in breast cancer neoadjuvant therapy.

Pancreatic cancer remains one of the most lethal malignancies worldwide. The combination of the first-line standard agent gemcitabine (GEM) with the molecular-targeted drug erlotinib (Er) has emerged as a promising strategy for pancreatic cancer treatment. However, the clinical benefit from this combination is still far from satisfactory due to the unfavorable drug antagonism and the fibrotic tumor microenvironment. Herein, we propose a membrane-camouflaged dual stimuli-responsive delivery system for the co-delivery of GEM and Er into pancreatic cancer cells and tissues to block the antagonism, as well as reshapes profibrotic tumor microenvironment via simultaneous delivery of small interference RNA (siRNA) for synergistic pancreatic cancer treatment. This "all-in-one" delivery system exhibits sensitive GSH and pH-dependent drug release profiles and enhances the inhibitory effects on the proliferation and migration of tumor cells in vitro. Excitingly, the systemic injection of such a biomimetic drug co-delivery system not only resulted in superior inhibitory effects against orthotopic pancreatic tumor and patient-derived tumor (PDX), but also greatly extended the survival rate of tumor-bearing mice. Our findings provide a promising therapeutic strategy against pancreatic cancer through the enhanced synergistic effect of target therapy, chemotherapy and anti-fibrotic therapy, which represents an appealing way for pancreatic cancer treatment.

Objective:To systematically evaluate correlation between the risk of malignancy and dapagliflozin in type 2 diabetes mellitus.Methods:The databases such as PubMed, the Cochrane Library, American Clinical Trial Registry, Embase, JAMA, Wiley-Blackwell, Springer Link, Elsevier, Ovid, Taylor & Francis Online, CNKI, Wanfang, and VIP (up to March 2021) were searched. The randomized controlled trials (RCTs) on dapagliflozin with outcome indicators including malignancy occurrence were collected. Data extraction and quality analysis were performed for the enrolled literature, and meta-analysis was conducted using RevMan 5.3 software.Results:A total of 22 studies were enrolled in the analysis, all of which were multicenter RCTs, and the quality evaluation results were all grade A. Thirty-one thousand four hundred and fifty-one patients were involved in the 22 studies, of which 16 267 were in the experimental group (dapagliflozin 5 or 10 mg daily) and 15 184 in the control group (placebo or other hypoglycemic drugs). The course of treatment in the 22 studies ranged from 24 weeks to 5.2 years and it was 24 weeks in 15 studies (68.2%). A total of 1 302 patients developed malignancy during the trials, including 661 in the experimental group and 641 in the control group. The results of the meta-analysis showed that, regardless in the overall study of different dapagliflozin doses or in studies of dapagliflozin 5 or 10 mg/d, the differences in the risk of malignancy between the experimental group and the control group were not statistically significant [overall study: 4.2% (661/15 911) vs. 4.1% (648/15 884), RR=1.02, 95 %CI: 0.92-1.13, P=0.72; dapagliflozin 5 mg/d: 0.8% (10/1 181) vs. 0.6% (7/1 172), RR=1.35, 95 %CI: 0.57-3.17, P=0.49; dapagliflozin 10 mg/d: 4.4% (651/14 730) vs. 4.4% (641/14 712), RR=1.01, 95 %CI: 0.91-1.13, P=0.78]; the differences in the risk of breast cancer were not statistically significant [overall study: 0.2% (25/12 216) vs. 0.2% (25/12 215), RR=1.00, 95 %CI: 0.59-1.69, P=1.00; dapagliflozin 5 mg/d: 0.6% (2/348) vs. 0 (0/347), RR=3.00, 95 %CI: 0.31-28.65, P=0.34; dapagliflozin 10 mg/d: 0.2% (23/11 868) vs. 0.2% (25/11 868), RR=0.93, 95 %CI: 0.54-1.59, P=0.78]; the differences in the risk of bladder cancer were not significantly significant [overall study: 0.1% (16/12 021) vs. 0.2% (28/12 019), RR=0.59, 95 %CI: 0.33-1.07), P=0.08; dapagliflozin 5 mg/d: 0.7% (1/137) vs. 0 (0/137), RR=3.00, 95 %CI: 0.12-73.00, P=0.50; dapagliflozin 10 mg/d: 0.1% (15/11 884) vs. 0.2% (28/11 882), RR=0.55, 95 %CI: 0.30-1.02, P=0.06]. Conclusion:Dapagliflozin may not increase the risk of malignancy in patients with type 2 diabetes mellitus, but its long-term safety needs further study.

Objective:To systematically evaluate correlation between the risk of malignancy and dapagliflozin in type 2 diabetes mellitus.Methods:The databases such as PubMed, the Cochrane Library, American Clinical Trial Registry, Embase, JAMA, Wiley-Blackwell, Springer Link, Elsevier, Ovid, Taylor & Francis Online, CNKI, Wanfang, and VIP (up to March 2021) were searched. The randomized controlled trials (RCTs) on dapagliflozin with outcome indicators including malignancy occurrence were collected. Data extraction and quality analysis were performed for the enrolled literature, and meta-analysis was conducted using RevMan 5.3 software.Results:A total of 22 studies were enrolled in the analysis, all of which were multicenter RCTs, and the quality evaluation results were all grade A. Thirty-one thousand four hundred and fifty-one patients were involved in the 22 studies, of which 16 267 were in the experimental group (dapagliflozin 5 or 10 mg daily) and 15 184 in the control group (placebo or other hypoglycemic drugs). The course of treatment in the 22 studies ranged from 24 weeks to 5.2 years and it was 24 weeks in 15 studies (68.2%). A total of 1 302 patients developed malignancy during the trials, including 661 in the experimental group and 641 in the control group. The results of the meta-analysis showed that, regardless in the overall study of different dapagliflozin doses or in studies of dapagliflozin 5 or 10 mg/d, the differences in the risk of malignancy between the experimental group and the control group were not statistically significant [overall study: 4.2% (661/15 911) vs. 4.1% (648/15 884), RR=1.02, 95 %CI: 0.92-1.13, P=0.72; dapagliflozin 5 mg/d: 0.8% (10/1 181) vs. 0.6% (7/1 172), RR=1.35, 95 %CI: 0.57-3.17, P=0.49; dapagliflozin 10 mg/d: 4.4% (651/14 730) vs. 4.4% (641/14 712), RR=1.01, 95 %CI: 0.91-1.13, P=0.78]; the differences in the risk of breast cancer were not statistically significant [overall study: 0.2% (25/12 216) vs. 0.2% (25/12 215), RR=1.00, 95 %CI: 0.59-1.69, P=1.00; dapagliflozin 5 mg/d: 0.6% (2/348) vs. 0 (0/347), RR=3.00, 95 %CI: 0.31-28.65, P=0.34; dapagliflozin 10 mg/d: 0.2% (23/11 868) vs. 0.2% (25/11 868), RR=0.93, 95 %CI: 0.54-1.59, P=0.78]; the differences in the risk of bladder cancer were not significantly significant [overall study: 0.1% (16/12 021) vs. 0.2% (28/12 019), RR=0.59, 95 %CI: 0.33-1.07), P=0.08; dapagliflozin 5 mg/d: 0.7% (1/137) vs. 0 (0/137), RR=3.00, 95 %CI: 0.12-73.00, P=0.50; dapagliflozin 10 mg/d: 0.1% (15/11 884) vs. 0.2% (28/11 882), RR=0.55, 95 %CI: 0.30-1.02, P=0.06]. Conclusion:Dapagliflozin may not increase the risk of malignancy in patients with type 2 diabetes mellitus, but its long-term safety needs further study.

Objective:To explore the influences of abdominal pressure monitoring in different positions on patients with abdominal hypertension.Methods:From January to June 2019, convenience sampling was used to select 100 critical ill patients with abdominal hypertension who were admitted to the Intensive Care Unit of General Surgery of the General Hospital of Eastern Theater Command as the research object. The abdominal pressure was monitored by indirectly measuring the bladder pressure. We measured the abdominal pressure when patients were in stable condition and in 30° lying position, 45° lying position as well as the supine position respectively, recorded the single measurement data of the patient's abdominal pressure in different positions, and performed another position measurement rest for 15 minutes after changing the position.Results:The abdominal pressures measured in 100 critical ill patients with abdominal hypertension in the supine position, 30° lying position and 45° lying position were (19.18±3.95) , (23.40±3.87) and (28.17±3.60) mmHg (1 mmHg=0.133kPa) respectively, and the difference was statistically significant ( P<0.01) . The abdominal pressure monitored in the supine position was lower than those in the 30° lying position and 45° lying position, the difference was statistically significant (supine position vs. 30° lying position, P<0.01; supine position vs. 45° lying position, P<0.01) . The abdominal pressure monitored in the 30 ° lying position and 45 ° lying position was higher than that in the supine position by one to two levels. With the increase of the bed head elevation angle, the abdominal pressure value is getting higher and higher, regardless of the level of abdominal pressure in critical ill patients with abdominal hypertension. Conclusions:The abdominal pressure monitoring in actual positions can reflect the true situation of the patient well, and can provide a relatively true and reliable monitoring data for clinical nursing decision-making.

Objective? To summarize the key content of nursing of stepped drainage new model for severe acute pancreatitis (SAP) patients with necrosis and infection. Methods? From January 2014 to December 2016, we selected 417 SAP patients with infected pancreatic necrosis (IPN) in General Surgery Intensive Care Unit at Nanjing General Hospital, People's Liberation Army. The "four-step" stepped drainage model was adopted during treatment including four stages, percutaneous catheter drainage, continuous negative pressure irrigation drainage, endoscopic drainage and laparotomy necrotic tissue debridement drainage. All stages of nursing had something in common and different emphasis points. Nursing care paid attention to strengthening the nursing for abdominal puncture catheter, abdominal double pipe, endoscopic operation cooperation and postoperative nursing of laparotomy. Results? Among 417 SAP patients with IPN, a total of 413 patients were with percutaneous catheter drainage and single patient was with one to seven drainage tubes, a total of 2 252 tubes; 315 patients were with abdominal double pipe irrigation drainage and single patient was with two to seven double pipes, a total of 1 386 double pipes; 186 patients were with endoscopic drainage and single patient was with two to five times of endoscopic necrotic tissue debridement, a total of 725 times; 91 patients were with laparotomy and single patient was with laparotomy one to three times. During nursing care, totals of 13 percutaneous drainage catheters and abdominal double pipes slipped off; 109 cases of poor drainage happened to double pipe drainage with 56 cases of obstructed drainage;there were 30 cases of folding, 7 cases of hemorrhage and 16 cases of shifting. Those problems were all found and handled timely with no consequence caused by poor drainage and improper nursing care. Conclusions? Among SAP patients with IPN, keys to guarantee high quality of nursing included mastering nursing emphasis of all stages, taking targeted nursing, keeping abdominal puncture catheter unobstructed, abdominal double pipes effectively sucking, cooperating on endoscopic necrotic tissue debridement and strengthening postoperative monitoring and wound management.