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PubMed databases from January 2016 to February 2024.Literature that is not highly relevant,repetitive,or outdated was excluded.A total of 1 746 relevant literature were retrieved,and 92 articles were ultimately included.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.

BACKGROUND:Ferroptosis is a programmed cell death mode regulated by iron dependent lipid peroxidation,closely related to the occurrence,development,and outcome of ischemic brain injury.With the continuous deepening of research on ferroptosis in recent years,it has been found that Chinese herbal compounds and monomers can regulate ferroptosis by reducing iron overload,reducing the production of reactive oxygen species,and regulating lipid synthesis,to alleviate cerebral ischemic injury and promote neurological function recovery.OBJECTIVE:To explore the relationship between ferroptosis and ischemic brain injury,and the mechanism by which traditional Chinese medicine regulates ferroptosis in the treatment of ischemic brain injury.METHODS:Literature on ferroptosis and ischemic brain injury and the regulatory mechanism of traditional Chinese medicine published from January 2018 to May 2024 was searched in CNKI and PubMed databases.The search terms were"iron death,ischemic stroke,brain injury,reactive oxygen species,lipid metabolism,traditional Chinese medicine formulas,terpenes,flavonoids,phenols,alkaloids,phthalides"in Chinese and English,respectively.Irrelevant,duplicated or outdated literature was excluded.A total of 1 526 relevant literature were retrieved,and 87 articles were ultimately included.RESULTS AND CONCLUSION:Numerous experimental studies have confirmed that ferroptosis plays an important role in ischemic brain injury.Chinese medicine prescriptions can regulate ferroptosis through various approaches,for examples:total saponins of Panax notoginseng can regulate iron metabolism and inhibit lipid peroxidation;carvacrol inhibits neuronal ferroptosis by increasing glutathione peroxidase 4 expression;Chinese herbal compounds and monomeric active ingredients can regulate ferroptosis-related pathways,such as glutathione/glutathione peroxidase 4(GPX4),nuclear factor E2-related factor 2(Nrf2)/hemoglobin oxygenase 1(HO-1),ferric death inhibitory protein 1(FSP1)/CoQ10 and guanosine triphosphate cyclohydrolase 1(GCH1)/tetrahydrobiopterin(BH4),to reduce neuronal damage and death,and exert neuroprotective effects.

BACKGROUND:Research has shown that endoplasmic reticulum stress-induced autophagy of neurons in the ischemic penumbra is a key link in cerebral ischemia-reperfusion injury.Autophagy mediated by the dissociation and activation of endoplasmic reticulum transmembrane proteins PERK,IRE1 α,ATF6,and GRP78/BIP plays an important role in neuronal outcomes.Traditional Chinese medicine can regulate endoplasmic reticulum stress-autophagy,reduce neuronal damage or death,and exert neuroprotective effects.OBJECTIVE:To explore the role of endoplasmic reticulum stress-autophagy in cerebral ischemia-reperfusion injury and the research progress in the regulatory mechanisms of traditional Chinese medicine.METHODS:A literature retrieval was conducted in CNKI and PubMed for relevant literature related to endoplasmic reticulum stress,autophagy,cerebral ischemia-reperfusion injury,and regulation by traditional Chinese Medicine published from January 2015 to May 2024.The search terms were"cerebral ischemia-reperfusion injury,ischemic stroke,brain injury,endoplasmic reticulum stress,autophagy,traditional Chinese medicine,compounds,signaling pathways,saponins,polyphenols,alkaloids"in Chinese and English,respectively.Any literature that is inconsistent with the research content,outdated,or duplicated was excluded.A total of 1197 relevant literature were retrieved,and 71 articles were ultimately included.RESULTS AND CONCLUSION:(1)Numerous studies have suggested that endoplasmic reticulum stress-autophagy is closely related with cerebral ischemia-reperfusion injury.(2)The active ingredients and compound formulas of traditional Chinese medicine monomers can regulate the expression of endoplasmic reticulum stress-autophagy related proteins,alleviate neuronal damage,and exert neuroprotective effects by regulating signal pathways such as PERK-eIF2α-ATF4,IRE1α-ASK1-JNK,and IRE1α-XBP.

Mitochondrial autophagy is an important mechanism for maintaining cellular homeostasis,closely related to the occurrence and development of cerebral ischemic injury,and is an important way of neuronal death.In recent years,a large number of experimental studies have confirmed that traditional Chinese medicine has a significant effect on treating cerebral ischemic injury.Its advantages of multi-target,multi pathway,low toxicity and high efficiency have become an important component of the treatment of cerebral ischemic injury.Traditional Chinese medicine formulas and monomeric active ingredients such as Xiaoxuming decoction,Zishen Huoxue formula,flavonoids,alkaloids,etc.can regulate mitochondrial autophagy related signaling pathways and targets,inhibit neuronal autophagic death,alleviate pathological damage to brain tissue,and exert neuroprotective effects.This article analyzes the molecular mechanism of traditional Chinese medicine regulating mitochondrial autophagy in the treatment of cerebral ischemic injury from four aspects:an overview of mitochondrial autophagy,related signaling pathways,its relationship with cerebral ischemic injury,and the regulatory effects of traditional Chinese medicine.The aim is to provide ideas and references for future basic research and clinical treatment.

BACKGROUND:Ferroptosis is a programmed cell death mode regulated by iron dependent lipid peroxidation,closely related to the occurrence,development,and outcome of ischemic brain injury.With the continuous deepening of research on ferroptosis in recent years,it has been found that Chinese herbal compounds and monomers can regulate ferroptosis by reducing iron overload,reducing the production of reactive oxygen species,and regulating lipid synthesis,to alleviate cerebral ischemic injury and promote neurological function recovery.OBJECTIVE:To explore the relationship between ferroptosis and ischemic brain injury,and the mechanism by which traditional Chinese medicine regulates ferroptosis in the treatment of ischemic brain injury.METHODS:Literature on ferroptosis and ischemic brain injury and the regulatory mechanism of traditional Chinese medicine published from January 2018 to May 2024 was searched in CNKI and PubMed databases.The search terms were"iron death,ischemic stroke,brain injury,reactive oxygen species,lipid metabolism,traditional Chinese medicine formulas,terpenes,flavonoids,phenols,alkaloids,phthalides"in Chinese and English,respectively.Irrelevant,duplicated or outdated literature was excluded.A total of 1 526 relevant literature were retrieved,and 87 articles were ultimately included.RESULTS AND CONCLUSION:Numerous experimental studies have confirmed that ferroptosis plays an important role in ischemic brain injury.Chinese medicine prescriptions can regulate ferroptosis through various approaches,for examples:total saponins of Panax notoginseng can regulate iron metabolism and inhibit lipid peroxidation;carvacrol inhibits neuronal ferroptosis by increasing glutathione peroxidase 4 expression;Chinese herbal compounds and monomeric active ingredients can regulate ferroptosis-related pathways,such as glutathione/glutathione peroxidase 4(GPX4),nuclear factor E2-related factor 2(Nrf2)/hemoglobin oxygenase 1(HO-1),ferric death inhibitory protein 1(FSP1)/CoQ10 and guanosine triphosphate cyclohydrolase 1(GCH1)/tetrahydrobiopterin(BH4),to reduce neuronal damage and death,and exert neuroprotective effects.

BACKGROUND:Research has shown that endoplasmic reticulum stress-induced autophagy of neurons in the ischemic penumbra is a key link in cerebral ischemia-reperfusion injury.Autophagy mediated by the dissociation and activation of endoplasmic reticulum transmembrane proteins PERK,IRE1 α,ATF6,and GRP78/BIP plays an important role in neuronal outcomes.Traditional Chinese medicine can regulate endoplasmic reticulum stress-autophagy,reduce neuronal damage or death,and exert neuroprotective effects.OBJECTIVE:To explore the role of endoplasmic reticulum stress-autophagy in cerebral ischemia-reperfusion injury and the research progress in the regulatory mechanisms of traditional Chinese medicine.METHODS:A literature retrieval was conducted in CNKI and PubMed for relevant literature related to endoplasmic reticulum stress,autophagy,cerebral ischemia-reperfusion injury,and regulation by traditional Chinese Medicine published from January 2015 to May 2024.The search terms were"cerebral ischemia-reperfusion injury,ischemic stroke,brain injury,endoplasmic reticulum stress,autophagy,traditional Chinese medicine,compounds,signaling pathways,saponins,polyphenols,alkaloids"in Chinese and English,respectively.Any literature that is inconsistent with the research content,outdated,or duplicated was excluded.A total of 1197 relevant literature were retrieved,and 71 articles were ultimately included.RESULTS AND CONCLUSION:(1)Numerous studies have suggested that endoplasmic reticulum stress-autophagy is closely related with cerebral ischemia-reperfusion injury.(2)The active ingredients and compound formulas of traditional Chinese medicine monomers can regulate the expression of endoplasmic reticulum stress-autophagy related proteins,alleviate neuronal damage,and exert neuroprotective effects by regulating signal pathways such as PERK-eIF2α-ATF4,IRE1α-ASK1-JNK,and IRE1α-XBP.

Mitochondrial autophagy is an important mechanism for maintaining cellular homeostasis,closely related to the occurrence and development of cerebral ischemic injury,and is an important way of neuronal death.In recent years,a large number of experimental studies have confirmed that traditional Chinese medicine has a significant effect on treating cerebral ischemic injury.Its advantages of multi-target,multi pathway,low toxicity and high efficiency have become an important component of the treatment of cerebral ischemic injury.Traditional Chinese medicine formulas and monomeric active ingredients such as Xiaoxuming decoction,Zishen Huoxue formula,flavonoids,alkaloids,etc.can regulate mitochondrial autophagy related signaling pathways and targets,inhibit neuronal autophagic death,alleviate pathological damage to brain tissue,and exert neuroprotective effects.This article analyzes the molecular mechanism of traditional Chinese medicine regulating mitochondrial autophagy in the treatment of cerebral ischemic injury from four aspects:an overview of mitochondrial autophagy,related signaling pathways,its relationship with cerebral ischemic injury,and the regulatory effects of traditional Chinese medicine.The aim is to provide ideas and references for future basic research and clinical treatment.

Objective To assess inter-observer variations(IOV)in the delineation of target volumes and organs-at-risk(OAR)for intensity-modulated radiotherapy(IMRT)of nasopharyngeal carcinoma(NPC)among physicians from different levels of cancer centers,thereby providing a reference for quality control in multi-center clinical trials.Methods Twelve patients with NPC of different TMN stages were randomly selected.Three physicians from the same municipal cancer center manually delineated the target volume(GTVnx)and OAR for each patient.The manually modified and confirmed target volume(GTVnx)and OAR delineation structures by radiotherapy experts from the regional cancer center were used as the standard delineation.The absolute volume difference ratio(△V_diff),maximum/minimum volume ratio(MMR),coefficient of variation(CV),and Dice similarity coefficient(DSC)were used to compare the differences in organ delineation among physicians from different levels of cancer centers and among the 3 physicians from the same municipal cancer center.Furthermore,the IOV of GTVnx and OAR among physicians from different levels cancer centers were compared across different TMN stages.Results Significant differences in the delineation of GTVnx were observed among physicians from different levels of cancer centers.Among the 3 physicians,the maximum values of △V_diff,MMR,and CV were 97.23%±83.45%,2.19±0.75,and 0.31±0.14,respectively,with an average DSC of less than 0.7.Additionally,there were considerable differences in the delineation of small-volume OAR such as the left and right optic nerves,chiasm,and pituitary,with average MMR>2.8,CV>0.37,and DSC<0.51.However,relatively smaller differences were observed in the delineation of large-volume OAR such as the brainstem,spinal cord,left and right eyeballs,and left and right mandible,with average△V_diff<42%,MMR<1.55,and DSC>0.7.Compared with the differences among physicians from different levels cancer centers,the differences among the 3 physicians from the municipal cancer center were slightly reduced.Furthermore,there were also differences in the delineation of target volumes for NPC among physicians from different levels cancer centers,depending on the staging of the disease.Compared with the delineation of target volumes for earlier stage patients(stages I or II),the differences among physicians in the delineation of target volumes for advanced stage patients(stages III or IV)were smaller,with average △V_diff and DSC of 98.31%±67.36%vs 69.38%±72.61%(P<0.05)and 0.55±0.08 vs 0.72±0.12(P<0.05),respectively.Conclusion There are differences in the delineation of GTVnx and OAR in radiation therapy for NPC among physicians from different levels of cancer centers,especially in the delineation of target volume(GTVnx)and small-volume OAR for early-stage patients.To ensure the accuracy of multicenter clinical trials,it is recommended to provide unified training to physicians from different levels of cancer centers and review their delineation results to reduce the effect of differences on treatment outcomes.

Background The presence of formaldehyde, ammonia, benzene, toluene, and xylene in indoor air of public places has been confirmed to cause health damage. The employees of barber and beauty shops are exposed to relatively enclosed space for a long time, and could surfer more serious health risks from indoor air chemical pollutants. Objective To analyze the concentrations of common indoor air chemical pollutants in barber shops and beauty salons in Liaocheng City, and explore potential health risks of the pollutants for employees. Methods Using a stratified randomized sampling method, 8 to 10 barber shops and 5 to 10 beauty salons were selected in the main urban area of Liaocheng City to conduct monitoring of the sanitary conditions of public places in winter and summer every year from 2016 to 2021; the indoor air concentrations of formaldehyde, ammonia, benzene, toluene, and xylene in the selected sites were measured, and a questionnaire survey was conducted to collect exposure characteristics of indoor pollutants. The concentration distributions of the five chemical pollutants were obtained from the monitoring data for 6 consecutive years, and the health risk assessment model recommended by the U.S. Environmental Protection Agency was used to perform health risk assessment of inhalation exposure. Results In 2016–2021, the median indoor air concentrations of formaldehyde, ammonia, benzene, toluene, and xylene in the two types of sites were lower than the limits of Hygienic Indicators and Limits for Public Places (GB 37488-2019), but the concentrations of some monitoring sites were higher than the limits. The disqualification rates of the five pollutants in the barber shops were 16.8%, 2.7%, 2.4%, 6.4%, and 12.0%, respectively. The disqualification rate of formaldehyde was the highest in all pollutants (22.0%), while the disqualification rates of ammonia, toluene, and xylene were 1.3%, 2.0%, and 2.0% in beauty salons respectively. Both formaldehyde and benzene were found to have carcinogenic risks (CR) in the two types of public places. Both median values of CR were greater than 1.0×10⁻⁶, and both maximum values were greater than 1.0×10⁻⁴. Formaldehyde had the highest non-carcinogenic risk in the indoor air of barber shops and beauty salons. The median non-carcinogenic hazard quotients (HQ) of formaldehyde were both greater than 1, and the maximum values were 16.72 and 12.19 times of the standard value; ammonia and toluene had the lowest non-carcinogenic risks, and their maximum values of HQ were less than 1; the median HQs of benzene and xylene were far less than 1, but their maximum risk values of barber shop were greater than 1. Conclusion For the sake of worker's health, formaldehyde and benzene should be the indoor air pollutant control priority for barber shops and beauty salons in Liaocheng; formaldehyde poses the most serious health hazard to practitioners and should be given high attention and necessary measures to reduce the hazard; benzene poses certain carcinogenic risks, with some of its highest values exceeding 10⁻⁴, which is higher than the recommended safety threshold.

Objective:To investigate the effect of flipped classroom model in the theory teaching of psychiatry for medical undergraduates.Methods:A total of 121 students from grade 2014 were randomly divided into observation group and control group. The observation group was given flipped classroom teaching and the control group was given traditional teaching. In order to evaluate the teaching effect of flipped classroom, the students in the observation group were evaluated by comparing the test scores of the two groups in class and using the self-made questionnaire. SPSS 18.0 was used to conduct t-test. Results:The results showed that the average score of the observation group was significantly higher than that of the control group ( P < 0.05). The results of teaching effect showed that there were 60 students in the observation group, among which 96.7% (58 students) believed that flipped classroom teaching was beneficial to promoting pre-class preview, improving teamwork ability, autonomous learning ability and teacher-student communication; 95.0% (57 students) thought they were satisfied with flipped classroom teaching, which was conducive to linking theory with practice; 93.3% (56 students) thought that they could arouse their interest in learning, improve their attention, and improve their ability to analyze and solve problems; 90.0% (54 students) thought flipped classroom was superior to traditional classroom and helpful to their future study; 86.7% (52 students) did not think their study burden was increased. Conclusion:The flipped classroom model can stimulate students' interest and attention, and promote the combination of independent learning and interactive learning, which has a better effect than the traditional teaching model in the theory teaching of psychiatry and is easily accepted by students. Therefore, it holds promise for application.