Ischemic stroke,which presents a heavy medical,social,and economic burden worldwide,is now the second-leading cause of high morbidity,disability,mortality,and recurrence.However,its mechanism remains un-covered.Glycine,serves as a dual-role neurotransmitter,is involved in several cellular processes.Recent studies have shown that glycine can protect against ischemic stroke by reducing cell death,attenuating glutamate excitotoxicity,inhibit-ing inflammatory responses,and inducing vascular remodeling.This review aims to provide a comprehensive overview of glycine's biological functions,receptor characteristics,signal transduction mechanisms,and highlight glycine's protec-tive role in ischemic stroke.

Objective:To establish a detailed teaching syllabus for the standardized training of radiation oncology residents, apply it in clinical teaching practice, and evaluate its practical teaching value.Methods:Based on the radiation oncology teaching syllabus and clinical competency assessment content, a detailed teaching syllabus, scoring criteria, and a refined assessment scoring table were developed. From June 2022 to March 2023, 36 resident physicians rotating through the radiation oncology training base at the Cancer Hospital Chinese Academy of Medical Sciences were randomly divided into two groups using a random number table: the original syllabus group ( n=19) was trained according to the original teaching syllabus, while the detailed syllabus group ( n=17) was trained according to the refined teaching syllabus. The refined assessment scoring table was completed based on the scoring criteria, and the assessment results of the two groups were compared using independent sample t-tests. Results:A detailed teaching syllabus covering 25 tumors types across 4 categories (head and neck, thoracic, abdominopelvic, and gynecological) was established. The syllabus included 16 items: applied anatomy, clinical symptoms, physical examination, pathological characteristics, staging examinations / imaging, clinical / pathological staging, other diagnostic / therapeutic factors, general treatment principles, radiotherapy indications, localization methods, radiotherapy target areas / doses, special treatment fields, dose-limiting requirements, treatment-related adverse effects and management, prognosis, and essential reading literature. Corresponding scoring criteria and a refined scoring table were developed, encompassing key points and skills for medical history collection, specialized physical examination, and clinical reasoning. Assessment results showed that the overall score of the detailed syllabus group was 90.85±1.97, significantly higher than that of the original syllabus group (70.81±4.21), with a statistically significant difference ( t=17.94, P<0.001). In all 10 assessment items, the detailed syllabus group outperformed the original syllabus group (all P<0.01). Conclusion:Quantitative evaluation demonstrated that the detailed teaching syllabus for standardized training of radiation oncology residents significantly improved the clinical competency of resident physicians in teaching practice.

Ischemic stroke,which presents a heavy medical,social,and economic burden worldwide,is now the second-leading cause of high morbidity,disability,mortality,and recurrence.However,its mechanism remains un-covered.Glycine,serves as a dual-role neurotransmitter,is involved in several cellular processes.Recent studies have shown that glycine can protect against ischemic stroke by reducing cell death,attenuating glutamate excitotoxicity,inhibit-ing inflammatory responses,and inducing vascular remodeling.This review aims to provide a comprehensive overview of glycine's biological functions,receptor characteristics,signal transduction mechanisms,and highlight glycine's protec-tive role in ischemic stroke.

Objective:To establish a detailed teaching syllabus for the standardized training of radiation oncology residents, apply it in clinical teaching practice, and evaluate its practical teaching value.Methods:Based on the radiation oncology teaching syllabus and clinical competency assessment content, a detailed teaching syllabus, scoring criteria, and a refined assessment scoring table were developed. From June 2022 to March 2023, 36 resident physicians rotating through the radiation oncology training base at the Cancer Hospital Chinese Academy of Medical Sciences were randomly divided into two groups using a random number table: the original syllabus group ( n=19) was trained according to the original teaching syllabus, while the detailed syllabus group ( n=17) was trained according to the refined teaching syllabus. The refined assessment scoring table was completed based on the scoring criteria, and the assessment results of the two groups were compared using independent sample t-tests. Results:A detailed teaching syllabus covering 25 tumors types across 4 categories (head and neck, thoracic, abdominopelvic, and gynecological) was established. The syllabus included 16 items: applied anatomy, clinical symptoms, physical examination, pathological characteristics, staging examinations / imaging, clinical / pathological staging, other diagnostic / therapeutic factors, general treatment principles, radiotherapy indications, localization methods, radiotherapy target areas / doses, special treatment fields, dose-limiting requirements, treatment-related adverse effects and management, prognosis, and essential reading literature. Corresponding scoring criteria and a refined scoring table were developed, encompassing key points and skills for medical history collection, specialized physical examination, and clinical reasoning. Assessment results showed that the overall score of the detailed syllabus group was 90.85±1.97, significantly higher than that of the original syllabus group (70.81±4.21), with a statistically significant difference ( t=17.94, P<0.001). In all 10 assessment items, the detailed syllabus group outperformed the original syllabus group (all P<0.01). Conclusion:Quantitative evaluation demonstrated that the detailed teaching syllabus for standardized training of radiation oncology residents significantly improved the clinical competency of resident physicians in teaching practice.

Objective:To observe the effects of rolling manipulation with different durations on erector spinae muscle tonus and low back pain in patients with lumbar muscle strain and to explore the best duration for rolling manipulation in treating lumbar muscle strain. Methods:A total of 75 patients who met the inclusion criteria were randomized into a 5-minute rolling manipulation group,a 10-minute rolling manipulation group,and a 15-minute rolling manipulation group using the random number table method,with 25 cases in each group.All three groups were treated with the same rolling manipulation,while the treatment time was 5 min,10 min,and 15 min,respectively.The treatment was performed 3 times a week for 2 consecutive weeks.The muscle tonus of bilateral erector spinae and visual analog scale(VAS)score for low back pain were compared among the three groups before and after treatment. Results:A total of 63 patients completed the study.Before treatment and after the last treatment,there were no statistical differences in the muscle tonus of the left erector spinae and right erector spinae among the three groups(P>0.05).After the last treatment,bilateral erector spinae muscle tonus dropped compared with the baseline in all three groups(P<0.01).Before treatment and after the last treatment,there were no significant differences in comparing the low back pain VAS score among the three groups(P>0.05).After the last treatment,the VAS score for low back pain in all three groups decreased(P<0.01). Conclusion:Under the condition that the forward swing force is 50-70 N,the backward swing force is 20-40 N,and the frequency is 138 times/min,the 5-minute rolling manipulation can significantly reduce the muscle tonus of erector spinae and relieve low back pain.

Objectives:To assess the prognostic impact of the neoadjuvant rectal (NAR) score following neoadjuvant short-course radiotherapy and consolidation chemotherapy in locally advanced rectal cancer (LARC), as well as its value in guiding decisions for adjuvant chemotherapy.Methods:Between August 2015 and August 2018, patients were eligible from the STELLAR phase III trial (NCT02533271) who received short-course radiotherapy plus consolidation chemotherapy and for whom the NAR score could be calculated. Based on the NAR score, patients were categorized into low (＜8), intermediate (8-16), and high (＞16) groups. The Kaplan-Meier method, log rank tests, and multivariate Cox proportional hazard regression models were used to evaluate the impact of the NAR score on disease-free survival (DFS).Results:Out of the 232 patients, 24.1%, 48.7%, and 27.2% had low (56 cases), intermediate (113 cases), and high NAR scores (63 cases), respectively. The median follow-up period was 37 months, with 3-year DFS rates of 87.3%, 68.3%, and 53.4% ( P＜0.001) for the low, intermediate, and high NAR score groups. Multivariate analysis demonstrated that the NAR score (intermediate NAR score: HR, 3.10, 95% CI, 1.30-7.37, P=0.011; high NAR scores: HR=5.44, 95% CI, 2.26-13.09, P＜0.001), resection status ( HR, 3.00, 95% CI, 1.64-5.52, P＜0.001), and adjuvant chemotherapy ( HR, 3.25, 95% CI, 2.01-5.27, P＜0.001) were independent prognostic factors for DFS. In patients with R0 resection, the 3-year DFS rates were 97.8% and 78.0% for those with low and intermediate NAR scores who received adjuvant chemotherapy, significantly higher than the 43.2% and 50.6% for those who did not ( P＜0.001, P=0.002). There was no significant difference in the 3-year DFS rate (54.2% vs 53.3%, P=0.214) among high NAR score patients, regardless of adjuvant chemotherapy. Conclusions:The NAR score is a robust prognostic indicator in LARC following neoadjuvant short-course radiotherapy and consolidation chemotherapy, with potential implications for subsequent decisions regarding adjuvant chemotherapy. These findings warrant further validation in studies with larger sample sizes.

Objective:To explore the patterns of failure after postoperative intensity-modulated radiotherapy for gastric cancer.Methods:Clinical data of patients diagnosed with gastric cancer or gastroesophageal junction carcinoma with pathological stages T 3-4N 0 or T xN 1-3 admitted to Cancer Hospital of Chinese Academy of Medical Sciences from May 2009 to December 2018 were retrospectively analyzed. All patients received postoperative radiotherapy. During the follow-up, tumor recurrence was confirmed by imaging or endoscopic or pathological data, etc. According to the location of tumor recurrence, recurrence patterns were divided into local, regional and distant recurrence. Differences in recurrence patterns among different groups were compared using t-test and Chi-square test. Patient survival was assessed through Kaplan-Meier method. Results:A total of 76 patients were enrolled, with a median age of 49 years old (27-67 years old), 34 cases (45%) were classified as T 3 stage, 40 cases (53%) of T 4 stage, and 75 cases (99%) of N 1-3 stage, respectively. Seventy-three patients (92%) were classified as stage Ⅲ, and 38 patients (50%) underwent D2 dissection. The median follow-up time was 32.8 months (7.1-138.5 months). The median time of recurrence was 17.6 months (2.9-113.6 months). The median survival time after recurrence was 8.19 months (0.6-91.9 months). There were 13 cases (17%) of local recurrence, 6 cases (8%) of regional recurrence, and 72 cases (95%) of distant metastasis in patients. Peritoneal metastasis (33 cases, 43%) and distant lymph node metastasis (12 cases, 16%) were the main patterns of distant recurrence. Conclusions:By intensity-modulated radiotherapy technology, adjuvant radiotherapy yields favorable local and regional control for gastric cancer. Distant metastasis is still the main pattern of recurrence.

Objective:To analyze the treatment efficacy, safety and dose parameters of optimized hippocampus-avoidance prophylactic cranial irradiation (HA-PCI) in limited-stage small cell lung cancer (LS-SCLC) and explore the corresponding dosimetric parameters under the condition of narrowing the hippocampus avoidance region as hippocampus region plus 2 mm in three dimensions.Methods:Clinical data of patients with LS-SCLC receiving HA-PCI (hippocampus avoidance region defined as hippocampus region plus 2 mm in three dimensions) in Cancer Hospital Chinese Academy of Medical Sciences from August 2014 to June 2020 were retrospectively analyzed. Dose parameters of HA-PCI and adverse events were analyzed using descriptive statistics analysis. Changes of neurocognitive function, such as mini-mental state examination (MMSE) and Hopkins verbal learning test-revised (HVLT-R) scores, were evaluated by analysis of variance and Kruskal-Wallis H test. Overall survival (OS), progression-free survival (PFS) and intracranial PFS (iPFS) were calculated using Kaplan-Meier method. The cumulative incidence of local-regional recurrence (LRR), extracranial distant metastases (EDM), and locoregional recurrence (LR) were investigated under competing risk analysis. Results:A total of 112 patients were included, the median follow-up time was 50 months (95% CI: 45.61-54.38). The median volume of hippocampus was 4.85 ml (range: 2.65-8.34 ml), with the average dose ≤9 Gy in 106 patients (94.6%), ≤8 Gy in 92 patients (82.1%). The median volume of hippocampus avoidance area was 15.00 ml (range: 8.61-28.06 ml), with the average dose ≤12 Gy in 109 patients (97.3%), ≤10 Gy in 101 patients (90.2%). The 2-year cumulative LRR, EDM, LR rates were 16.9%, 23.2% and 28.5%, respectively. The 5-year cumulative LRR, EDM, LR rates were 23.2%, 26.9% and 33.3%, respectively. The 2-year iPFS, PFS and OS rates were 66.1% (95% CI: 57.9%-75.4%), 53.6% (95% CI: 45.1%-63.7%) and 80.4% (95% CI: 73.3%-88.1%), respectively. The most common grade I-Ⅱ adverse events were nausea (33.9%) and dizziness (31.3%), and only 1 patient developed grade Ⅲ nausea and dizziness. MMSE ( n=57) and HVLT-R tests ( n=56) showed no significant decline. Conclusions:Optimized HA-PCI can achieve similar dose limitation with favorable efficacy and light toxicity. No significant decline is observed in short-term neurocognitive function in evaluable patients.

Objectives:To assess the prognostic impact of the neoadjuvant rectal (NAR) score following neoadjuvant short-course radiotherapy and consolidation chemotherapy in locally advanced rectal cancer (LARC), as well as its value in guiding decisions for adjuvant chemotherapy.Methods:Between August 2015 and August 2018, patients were eligible from the STELLAR phase III trial (NCT02533271) who received short-course radiotherapy plus consolidation chemotherapy and for whom the NAR score could be calculated. Based on the NAR score, patients were categorized into low (＜8), intermediate (8-16), and high (＞16) groups. The Kaplan-Meier method, log rank tests, and multivariate Cox proportional hazard regression models were used to evaluate the impact of the NAR score on disease-free survival (DFS).Results:Out of the 232 patients, 24.1%, 48.7%, and 27.2% had low (56 cases), intermediate (113 cases), and high NAR scores (63 cases), respectively. The median follow-up period was 37 months, with 3-year DFS rates of 87.3%, 68.3%, and 53.4% ( P＜0.001) for the low, intermediate, and high NAR score groups. Multivariate analysis demonstrated that the NAR score (intermediate NAR score: HR, 3.10, 95% CI, 1.30-7.37, P=0.011; high NAR scores: HR=5.44, 95% CI, 2.26-13.09, P＜0.001), resection status ( HR, 3.00, 95% CI, 1.64-5.52, P＜0.001), and adjuvant chemotherapy ( HR, 3.25, 95% CI, 2.01-5.27, P＜0.001) were independent prognostic factors for DFS. In patients with R0 resection, the 3-year DFS rates were 97.8% and 78.0% for those with low and intermediate NAR scores who received adjuvant chemotherapy, significantly higher than the 43.2% and 50.6% for those who did not ( P＜0.001, P=0.002). There was no significant difference in the 3-year DFS rate (54.2% vs 53.3%, P=0.214) among high NAR score patients, regardless of adjuvant chemotherapy. Conclusions:The NAR score is a robust prognostic indicator in LARC following neoadjuvant short-course radiotherapy and consolidation chemotherapy, with potential implications for subsequent decisions regarding adjuvant chemotherapy. These findings warrant further validation in studies with larger sample sizes.

Objective:To evaluate the predictive value of hematological inflammatory markers such as preoperative monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and several tumor-related factors in differentiating malignant and benign primary retroperitoneal tumors (PRTs) .Methods:This study retrospectively collected the data of 159 pathologic confirmed PRTs patients who underwent surgery in the First Affiliated Hospital of Wenzhou Medical University and Taizhou Municipal Hospital between Dec. 2009 and Aug. 2020. Univariate analysis of clinic data was performed to identify the differences between the benign and malignant PRTs. Logistic regression analysis was used to determine the independent predictive parameters for malignant PRTs.Results:Among the 159 patients with PRTs, 80 were malignant, 68 were benign, and 11 were borderline. Contrast with benign and borderline tumor, univariate analysis demonstrated that tumor size, preoperative neutrophil count, platelet count, albumin level, MLR, NLR and PLR exhibited significant differences in malignant tumor (all P<0.05). PLR (HR=1.025, P=0.020) and tumor size (HR=1.085, P=0.006) were independent risk factors for predicting malignant PRTs in the multivariate logistic analyses. According to the ROC curve, the optimal cutoff value of tumor size and PLR for predicting malignant PRTs were 194.85 (sensitivity 38.7%, specificity 93.5%), 8.75 cm (sensitivity 69.3%, specificity 72.7%), respectively. Conclusions:Preoperative PLR is useful in differentiating malignant and benign PRTs and it is an independent risk parameter for malignant PRTs. Preoperative PLR could be considered as a new significant predictor for malignant PRTs.