BACKGROUND:Studies have shown that ischemia-induced cellular autophagy dysfunction is a key factor in brain injury.Autophagy related genes 6(ATG6),microtubule-associated protein 1 light chain(LC3),p62,and other autophagy key proteins are involved in the processes such as neuronal axonal degeneration,death,and intracellular homeostasis maintenance,playing an important role in the recovery of neural function. OBJECTIVE:To review the research progress in the role of cellular autophagy in cerebral ischemic injury and the regulatory mechanism of traditional Chinese medicine. METHODS:The first author used"ischemic stroke,brain tissue injury,cellular autophagy,signaling pathways,traditional Chinese medicine compounds,terpenoids,alkaloids,flavonoids,saponins,lignans,phthalates"as Chinese and English keywords respectively to search for literature on autophagy,cerebral ischemic injury,and the regulatory mechanisms of traditional Chinese medicine from China National Knowledge Infrastructure(CNKI)and PubMed databases from January 2016 to February 2024.Literature that is not highly relevant,repetitive,or outdated was excluded.A total of 1 746 relevant literature were retrieved,and 92 articles were ultimately included. RESULTS AND CONCLUSION:Numerous studies have confirmed that autophagy plays an important role in cerebral ischemic injury.Moderate autophagy can promote cell survival,while excessive autophagy exacerbates brain injury.Traditional Chinese medicine can regulate the expression of autophagy related proteins,inhibit neuronal necrosis and apoptosis,and exert neuroprotective effects at different stages of cerebral ischemia by regulating signaling pathways such as PI3K/Akt/mTOR,AMPK-mTOR,and mitogen activated protein kinase.

OBJECTIVE To investigate the establishment and promotion of a new standardized management model for anti- osteoporosis medication after fragility fracture surgery by resident clinical pharmacists， and provide references for resident pharmacists to carry out clinical pharmaceutical services. METHODS From July 2023 to March 2024，595 post-brittle fracture surgery patients were enrolled. Using the PDCA （plan-do-check-act） cycle，resident clinical pharmacists identified issues and conducted investigations in clinical practice. Through integrating clinical pharmacist intervention services before， during and after treatment， a medication treatment pathway was developed， thereby establishing a standardized management model for anti- osteoporosis treatment following fragility fracture surgery. Leveraging the National Brittle Fracture Big Data Platform （under the National Clinical Research Center for Orthopedics and Sports Rehabilitation）， a dedicated data module was constructed， providing big data support to evaluate the efficacy of this pharmaceutical care model. RESULTS Continuous PDCA cycle driven improvements significantly increased the proportion of osteoporosis diagnosis （from 9% before intervention to 81%） and proportion of drug treatment （from 4% to 75%）.The proportions of bone density and bone metabolism testing also rose markedly，positively impacting long-term patient outcomes. CONCLUSIONS The establishment of a standardized management model for anti- osteoporosis treatment following fragility fracture surgery by resident clinical pharmacists has enhanced clinicians’ diagnostic and therapeutic capabilities for osteoporosis， ensures rational medication use in osteoporosis patients， and demonstrates significant potential for widespread adoption and application.

Objective To explore the effects and influencing factors of traditional occupational health training on occupational health literacy (OHL) of employees in micro-, small- and medium-sized enterprises. Methods A total of 540 employees from 154 micro-, small- and medium-sized enterprises, who participated (347 employees) and not-participated (193 employees) in traditional occupational health training, and 171 community residents/students (not-participated in occupational health training) were selected as the research subjects using the convenient sampling method. The OHL level was investigated using Occupational Health Literacy Questionnaire of National Key Populations. Results The overall OHL level of employees was 43.3% (234/540). Among them, the overall OHL level of untrained and trained employees was 38.9% and 45.8%, respectively, and the overall OHL level of community residents/students was 43.3%. The results of multivariate logistic regression analysis showed that the higher the educational level, the higher the OHL level (all P<0.01). The OHL level of untrained and trained employees was higher than that of untrained community residents/students (all P<0.05). The interaction of education level and training status had no statistical difference on the OHL level of the research subjects (P>0.05). The results of factorial design analysis of variance showed that the overall OHL score rate of untrained employees and trained employees was higher than that of untrained community residents/students (all P<0.05). However, there was no significant difference in overall OHL score rate between untrained and trained employees (P>0.05). Conclusion The role of traditional occupational health training in improving the OHL level of employees in micro-, small- and medium-sized enterprises needs to be improved. The responsibility of enterprise occupational health training should be implemented, and multiple measures should be taken to enrich the ways and approaches of occupational health education for enterprise employees, to effectively improve the OHL of workers.

Objective: To assess the interobserver variations in delineating the planning target volume (PTV) and organs at risk (OAR) using different contouring methods during intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC), aiming to provide references for the quality control of multi-center clinical trials. Methods: The PTV and OAR of CT image of 1 NPC patient manually delineated by 10 physicians from 8 different radiation centers were defined as the " manual contour group" , and the OAR auto-contoured using the ABAS software and modified by the physicians were defined as the " auto+ manual contour group" . The maximum/minimum ratio (MMR) of the PTV and OAR volumes, and the coefficient of variation (CV) for different delineated contours were comparatively evaluated. Results: Large variation was observed in the PTV and OAR volumes in the manual contour group. The MMR and CV of the PTV were 1.72-3.41 and 0.16-0.39, with the most significant variation in the PTV_nd (MMR=3.41 and CV=0.39 for the PTV_nd-L). The MMR and CV of the manually contoured OAR were 1.30-7.89 and 0.07-0.67. The MMR of the temporal lobe, spinal cord, temporomandibular joint, optic nerve and pituitary gland exceeded 2.0. Compared with the manual contour group, the average contouring time in the auto+ manual group was shortened by 68% and the interobserver variation of the OAR volume was reduced with an MMR of 1.04-2.44 and CV of 0.01-0.37. Conclusions Large variation may occur in the PTV and OAR contours during IMRT plans for NPC delineated by different clinicians from multiple medical centers. Auto-contouring+ manually modification can reduce the interobserver variation of OAR delineation, whereas the variation in the delineation of small organs remains above 1.5 times. The consistency of the PTV and OAR delineation and the possible impact upon clinical outcomes should be reviewed and evaluated in multi-center clinical trials.

Objective To evaluate the clinical effects of the laparoscopic Roux-en-Y gastric bypass (LRYGB) on patients with type 2 diabetes mellitus (T2DM).Methods From Dec.2013 to Dec.2015,83 cases with T2DM received LRYGB were enrolled to this study.They were divided into low body mass index group (LBMI,25≤BMI＜28),intermediate body mass index group (IBMI,28≤BMI＜32) and high body mass index group (HBMI,BMI≥33).Meanwhile,the clinical effects and side-effects were evaluated among three groups.The factors of adverse effects were evaluated by Cox multivariate analysis.Results Only one patient in HBMI was conversed to open surgery,all the others received LRYGB.The surgery time,intraoperative blood loss and complica tion were positively related to BMI,and the difference was statistically significant between the 3 groups(P＜0.05).The main side-effect of LRYGB was gastrointestinal reaction.The level of fasting blood-glucose,postprandial 2 hours blood sugar,HbA1c and cholesterol total in three groups were lower than baseline (P＜0.05),however,there was no significant difference among the three groups (P＞0.05).The rate of clinical effects in three groups was 89.5％,89.3％ and 91.7％.There was no significant difference among the three groups(P＞0.05);In Cox multivariate analysis,cholesterol total and BMI were independent prognostic indicator for LRGB adverse.Conclusions LRYGB is a safe and effective method for patients with T2DM,which can effectively improve glucose and lipid metabolism.The increased BMI can increase the incidence of LRYGB complications.Total cholesterol is an independent prognostic indicator for the adverse of LRYGB.

Objective To assess the association of single nucleotide polymorphisms (SNPs)of biliverdin reductase A (BLVRA) with neonatal hyperbilirubinemia from Fujian area.Methods A total of 286 patients with neonatal hyperbilirubinemia and 250 healthy controls were enrolled.Genotypes of 5 SNPs within BLVRA gene including rs699512,rs1802846,rs7738,rs1637530 and rs2302032 were determined with matrix-assisted laser desorption ionization/time of flight mass spectrometer.The frequencies of genotype,allele,haplotype and their differentiations were analyzed.Results All 5 SNPs had conformed to Hardy-Weinberg equilibrium (all P ＞ 0.05).rs699512 and rs1637530 showed a significant difference between the 2 groups in both allelic and genotypic frequencies (all P ＜ 0.05),but no significant differences were found in the other SNPs(all P ＞ O.05).In recessive model,the frequency of rs699512 GG genotype of patients was significantly lower than that of the healthy control group(OR =0.494,95％ CI:0.276-0.886,P =0.018),while in dominant model,the frequencies of rs699512 GG + AG and rs1637530 TT + CT genotype of patients were significantly lower than that of the healthy control group(OR =0.678,0.627;95％ CI:0.482-0.954,0.444-0.885;P =0.026,0.008).Based on linkage disequilibrium analysis and haplotype construction,rs1637530,rs2302032,rs699512 and rs1802846 locus in the same area.Based on haplotype CGAT,TGGT,CTAT and CGGT had significant differences between the 2 groups (all P ＜ 0.05),and could reduce the risk of high blood bilirubin (OR =0.588,0.687,0.501;95％ CI:0.434-0.797,0.496-0.952,0.250-1.004).Conclusions rs699512 and rs1637530 may be associated with neonatal hyperbilirubinemia,A allele in rs699512 and C allele in rs1637530 may be associated with significantly increased risk of neonatal hyperbilirubinemia.

Objective To investigate the relationship between snoring and newly-diagnosed type 2 diabetes mellitus among elderly urban and rural residents in Renqiu of Hebei province.Methods By random clustered sam-pling inspection,the residents aged 60 to 70 years old were selected in the study,the questionnaire investigation by an-thropometric measurements and laboratory tests were performed in 5 010 elderly people.Screen for 3 604 people who had no previous history of diabetes and currently not to control blood sugar by diet,exercise,medication.The average age was (64.32 ±3.06)years,including 1 608 male(44.6%) and 1 996 female cases(55.4%),snorers 994 cases (27.6%),non-snorers 2 610 cases(72.4%).The patients were followed up for one year.The correlation between snoring and newly-diagnosed type 2 diabetes mellitus was analyzed.Results There were 217 cases(6.0%) of new-ly-diagnosed type 2 diabetes mellitus,which accounted for 79 cases of snoring(36.4%),3 387 cases of non-dia-betic group,which accounted for 915 cases of snoring(27.0%),the difference between the two groups was significant (χ2 =9.003,P<0.05).Took the newly-diagnosed type 2 diabetes mellitus as the dependent variable,univariate analysis showed that gender(OR=0.479,95% CI:0.639~0.852),history of hypertension(OR=1.463,95% CI:1.111~1.927),family history of diabetes(OR=1.768,95% CI:1.259~2.183),history of stroke or TIA(OR=1.549,95%CI:1.106~2.168),central obesity(OR=1.658,95% CI:1.016 ~1.448),BMI≥28kg/m2 (OR=1.063,95% CI:1.025 ~1.102),fasting glucose(OR=2.065,95% CI:1.854 ~2.299),fasting insulin levels (OR=1.021,95%CI:1.008 ~1.035),cholesterol(OR=1.216,95% CI:1.051 ~1.407),triglycerides(OR=1.188,95%CI:1.089~1.296),snoring(OR=1.547,95% CI:1.161 ~2.060) were related with newly-diag-nosed type 2 diabetes mellitus.Multivariate logistic regression analysis showed that gender(OR=0.595,95% CI:0.368~0.963),history of stroke or TIA(OR=1.586,95%CI:1.085~2.318),fasting glucose(OR=2.059,95%CI:1.833~2.312),snoring(OR=1.592,95% CI:1.089~2.328) were independent risk factor for newly-diag-nosed type 2 diabetes mellitus.Conclusion People aged 60 to 70 in Renqiu suffered newly-diagnosed type 2 diabe-tes mellitus population prevalence of snoring, snoring is closely related to the occurrence and development of type 2 diabetes,type 2 diabetes is increased independent risk factor.Positive and effective screening and control on snoring can effectively reduce the incidence of type 2 diabetes.

Objectives To detect the carotid artery intima-media thickness (CIMT)with color Doppler ultrasound and to investigate the relationship between CIMT and new ischemic cerebrovascular disease. Methods From May 2012 to October 2013,the cluster random sampling method was used to consecutively enroll 4 412 60 -70 year old residences in Reqiu City for prospective study,including face to face health questionnaire survey,human body measurement,laboratory test,and neck vascular color Doppler ultrasonography. According to whether having new ischemic cerebrovascular disease,the patients who had ischemic cerebrovascular disease in 2013 were divided into either a case group (n = 251)or a control group (n =4 161). The single factor analysis,such as baseline data and CIMT levels in both groups were compared, and the related risk factors for ischemic cerebrovascular disease were analyzed. Results (1)The detection rates of hypertension,cerebrovascular disease,taking antiplatelet agents,carotid artery plaque of the case group were higher than those of the control group (62. 2% [n = 156]vs. 44. 2% [n = 1 838],45. 0%[n = 113]vs. 14. 9% [n = 622],55. 0% [n = 138]vs. 40. 0% [n = 1 663],and 65. 7% [n = 165]vs. 54. 5% [n = 2 266],all P < 0. 05). The systolic blood pressure,insulin,and CIMT levels were higher than those of the control group (158 [141,177]mmHg vs. 152 [137,169]mmHg,8. 07 [4. 77,12. 48]μU/ L vs. 6. 93 [4. 27,11. 60]μU/ L,0. 950 [0. 900,1. 000]mm vs. 0. 925 [0. 900,1. 000]mm,all P <0. 05). The cholesterol level was lower than that of the control group (4. 59 [4. 17,5. 26]mmol/ L vs. 4. 78 [4. 20,5. 36]mmol/ L,P < 0. 05). There were significant differences between the 2 groups. (2)Multivari-ate logistic regression analysis showed that histories of hypertension and cerebral vascular disease and CIMT thickening were the independent risk factors for new ischemic cerebrovascular disease (hypertension:OR, 1. 534,95% CI 1. 166 -2. 017,P = 0. 002;history of cerebral vascular disease:OR,3. 940,95% CI 2. 997 -5.180,P =0.000;and CIMT thickening:OR,12.122,95%CI 2. 327 -63. 163,P =0. 003). Conclusion CIMT, hypertension,and cerebrovascular disease are the independent risk factors for ischemic cerebrovascular disease in Renqiu City,and the monitoring of CIMT is very important.

Objective To investigate waist-to-height ratio(WHtR) and body mass index(BMI) for the screening and prediction of metabolic syndrome and explore the best indicator for predicting metabolic syndrome(MS) in the elderly.Methods A cluster random sampling method was used.5 010 cases aged 60-70 years old of Renqiu permanent residents were selected as a screening subjects.The face to face health questionnaires,anthropometric measurements,and laboratory testing were conducted.Receiver operatiug characteristic (ROC) was used to analyze and calculate the area under the curve(AUC).Results WHtR predict the best point of tangency of MS were 0.54 (men),0.5 5 (women),BMI predict the best point of tangency of MS were 25.25kg/m2 (men),2 5.0 5 kg/m2 (women).In the same gender,the contrast of WHtR and BMI in predicts MS area under the curve,WHtR area under the curve of the larger,WHtR was higher than BMI,WHtR was a better indicator in predicted of MS.Conclusion WHtR and BMI have important roles in the screening and prediction of MS,and WHtR seems to be the best parameter in the screening and prediction of MS in the elderly.

Objective To investigate the hyperuricemia(HUA)and the correlation of blood lipids of the 60 -70years peple in Renqiu area,and to provide the basis for guiding prevention and treatment of the elderly disease the region.Methods According to the cluster random sampling method,Renqiu permanent residents with the age of 60 to 70 years were selected as a screening object.In the total 5 010 cases screened object,2 163 were male(43.2%),2 847 were female(56.8%),with an average age of(64.29 ±3.05)years.The data of blood uric acid and total cholesterol(TC), triglyceride(TG),high -density lipoprotein(HDL -C),low -density lipoprotein(LDL -C)were collected.The rela-tionship between blood uric acid and blood lipids were analyzed.Logistic regression method was used to analysis the relationship between the hyperuricemia and lipids components.Results The overall prevalence of hyperuricemia in Renqiu was 6.1%(9.8% in male,3.2% in female).In men HUA group,the levels of blood uric acid,TG and LDL-L were 464.10(438.00 -508.65)μmol/L,1.54(1.00 -2.19)mmol/Land 2.66(2.25 -3.22)mmol/L,which were higher than those of normal uric acid group of 294.00(249.90 -338.08)μmol/L,1.13(0.84 -1.65)mmol/L and 2.57(2.12 -3.01)mmol/L(P <0.05).In women HUA group,the levels of blood uric acid,TG and LDL -L were 454.15(434.15 -480.78)μmol/L,2.14(1.47 -3.18)mmol/L and 2.96(2.52 -3.76)mmol/L,which were higher than those of normal uric acid group of 250.80(209.00 -299.80)μmol/L,1.53(1.10 -2.20)mmol/L and 2.87(2.40 -3.33)mmol/L(P <0.05).Logistic multi -factor regression analysis showed that TG was an independ-ent risk factor for hyperuricemia,and that HDL -L and gender were protective factors.Conclusion Hyperuricemia is closely associated with blood lipid,especially with TG and HDL -L,so we could screening HUA by blood lipid,which can reduce the occurrence of cardiovascular disease effectively.