Ischemic stroke （CIS） refers to ischemic necrosis or softening of localized brain tissue caused by cerebral blood circulation disorders， ischemia and hypoxia. The incidence of CIS is the highest among cerebrovascular diseases. Reduced supply of oxygen and nutrients leads to severe loss of neurons and deficits in brain function in stroke patients. Developing treatments for ischemic stroke remains an important challenge in clinical medicine. The antioxidant N-acetylcysteine （NAC） is a precursor of glutathione， and evidence from animal models of ischemic stroke and some clinical studies suggest that NAC can effectively protect the brain from ischemic damage. In this paper， the mechanism of NAC in CIS is described from various aspects， such as anti-oxidation， inhibition of inflammation， protection of cerebral nerve and mitochondrial function， stabilization of arterial plaque and thrombolytic function， aiming to explore the relationship between NAC and CIS in depth from the basic level， and to provide a theoretical basis for the further application of NAC in the prevention and treatment of patients with ischemic stroke.

OBJECTIVE To investigate the mechanism of anti-colorectal cancer growth and metastasis-related effects of Astraga-lus mongholicus Bunge-Curcuma aromatica-Paridis Rhizoma(Qi-Zhu-Zao)pairing through PERK/eIF2α/ATF4 signaling pathway mediating endoplasmic reticulum stress.METHODS Twenty-four BALB/c male mice were randomly divided into sham-operated group,model group,5-FU(5-fluorouracil)group(25 mg·kg-1),and Qi-Zhu-Zao high dose group(5.85 g·kg-1),Qi-Zhu-Zao low dose group(2.925 g·kg-1)(n=6)to construct a mouse model of colorectal cancer in situ transplantation tumor,and the inter-vention effect of Qi-Zhu-Zao combination on tumor growth was assessed by the change of tumor volume size after 15 days of administra-tion;the intervention effect of Qi-Zhu-Zao combination on tumor growth was assessed by H&E.Pathological staining was used to eval-uate the effect of Qi-Zhu-Zao combination on the liver and tumor tissues of mice.The changes of MDA,SOD and GSH-Px levels were detected by enzyme-linked immunosorbent assay(ELISA);the expression of PERK/eIF2α/ATF4 signaling pathway and EMT-related proteins were detected by protein immunoblotting(Western blot).RESULTS Compared with the model group,the tumor volume was significantly reduced(P＜0.000 1),liver and spleen metastases were less pronounced in the Qi-Zhu-Zao high-dose group,and his-topathological staining results of liver tissue and tumor produced changes in oxidative stress indicators SOD,MDA,and GSH-Px,up-regulation of ER stress-related proteins p-PERK,p-IF2α,and ATF4,etc.,upregulated the protein expression levels of E-Cadherin,downregulated N-Cadherin,Vimentin,and Snail,and inhibited the EMT process(P＜0.01 or P＜0.05).CONCLUSION In this paper,we investigated the regulatory mechanism related to the inhibition of colorectal cancer growth and metastasis by the combination of Qi-Zhu-Zao trigonal medicine,and demonstrated that it may inhibit the growth and metastasis of colorectal cancer by activating the PERK/eIF2α/ATF4 pathway to induce sustained ER stress and affect the EMT process of colorectal cancer.

Sleep disorders are characterized by abnormal amounts of sleep and unusual behavior during sleep.Long-term sleep disorders can lead to the disruption of normal social functioning or neurological conditions.In recent years,the role of sound wave therapy in improving sleep quality has attracted much attention.This article aims to review the research progress related to the role of sound wave therapy in enhancing sleep quality,cognitive function,and alleviating fatigue in patients with sleep disorders in hopes of contributing to clinical applications.

Lipophagy, the selective engulfment of lipid droplets (LDs) by autophagosomes for lysosomal degradation, is critical to lipid and energy homeostasis. Here we show that the lipid transfer protein ORP8 is located on LDs and mediates the encapsulation of LDs by autophagosomal membranes. This function of ORP8 is independent of its lipid transporter activity and is achieved through direct interaction with phagophore-anchored LC3/GABARAPs. Upon lipophagy induction, ORP8 has increased localization on LDs and is phosphorylated by AMPK, thereby enhancing its affinity for LC3/GABARAPs. Deletion of ORP8 or interruption of ORP8-LC3/GABARAP interaction results in accumulation of LDs and increased intracellular triglyceride. Overexpression of ORP8 alleviates LD and triglyceride deposition in the liver of ob/ob mice, and Osbpl8-/- mice exhibit liver lipid clearance defects. Our results suggest that ORP8 is a lipophagy receptor that plays a key role in cellular lipid metabolism.
Animals ; Mice ; Lipid Droplets ; Autophagy ; Autophagosomes ; Homeostasis ; Triglycerides

In order to construct the online teaching mode of clinical clerkship course and improve the online clerkship teaching system of clinical medicine in China, based on the "3P" model, a complete set of online clinical clerkship mode has been constructed from three links of teaching, pre-class preparation, classroom teaching and after-class evaluation, and applied to clinical teaching practice of Internal Medicine. The practice suggests that students are highly satisfied and the teaching effect is good, which provides a new idea for the reform of online clerkship teaching of clinical medicine.

Objective : To investigate the relationship between vitamin D receptor (VDR) gene polymorphisms and the clinical prognosis of acute pancreatitis (AP) , and to provide a genetic basis for early identification of critically ill patients. Methods : A total of fourteen single nucleotide polymorphisms (SNPs) on the VDR gene were detected in 508 AP patients by using improved ligase detection reaction (imLDR) technology. Unconditional Logistic regression analysis was used to explore the association of VDR gene polymorphisms with outcome ( sepsis/severe AP/death) of AP patients after adjusting for age , sex , body mass index(BMI) , smoking and drinking status and APACHE II score under different genetic models. Results : Rs12721375 GA/AA genotype had a lower risk of sepsis than GG (P = 0. 02) and the A allele had a lower risk of sepsis than G (P = 0. 009) . Rs2853559 GA and GA/AA had higher risks of sepsis than GG (P = 0. 022 and 0. 026 respectively) . Rs11168287 AA had a higher risk of severe AP than GG and GG/GA (P = 0. 030 and 0. 022 respectively) . Rs2853559 AA genotype had a higher risk of severe AP than GG and GG/GA ( P = 0. 022 and 0. 021 respectively) . The risk of death of rs11168283 CT/TT genotype was lower than that of CC (P = 0. 046) . Conclusion VDR gene polymorphisms are related to the clinical outcome of AP patients in Chinese Han population. VDR gene is involved in the progression of AP.

Neuroinflammation is a key contributor to the pathogenic cascades induced by hypoxic-ischemic (HI) insult in the neonatal brain. AD-16 is a novel anti-inflammatory compound, recently found to exert potent inhibition of the lipopolysaccharide-induced production of pro-inflammatory and neurotoxic mediators. In this study, we evaluated the effect of AD-16 on primary astrocytes and neurons under oxygen-glucose deprivation (OGD) in vitro and in mice with neonatal HI brain injury in vivo. We demonstrated that AD-16 protected against OGD-induced astrocytic and neuronal cell injury. Single dose post-treatment with AD-16 (1 mg/kg) improved the neurobehavioral outcome and reduced the infarct volume with a therapeutic window of up to 6 h. Chronic administration reduced the mortality rate and preserved whole-brain morphology following neonatal HI. The in vitro and in vivo effects suggest that AD-16 offers promising therapeutic efficacy in attenuating the progression of HI brain injury and protecting against the associated mortality and morbidity.
Animals ; Animals, Newborn ; Astrocytes/pathology* ; Brain/pathology* ; Brain Injuries/pathology* ; Glucose ; Hypoxia ; Hypoxia-Ischemia, Brain/drug therapy* ; Mice ; Neuroinflammatory Diseases ; Neuroprotective Agents/therapeutic use* ; Oxygen/therapeutic use*

Objective:To construct the online teaching model of clinical clerkship teaching and improve the online teaching system of clinical medicine in China.Methods:Based on "3P" teaching model, a complete online clinical clerkship teaching model was constructed from three links: pre-class preparation, classroom teaching and after class evaluation. It was applied to practical teaching in 101 students in 2017 batch of clinical medicine "5+3" class, 2017 batch of five-year pediatrics class and 2017 batch of basic medicine class. After practice, all students were surveyed and the results were analyzed.Results:Through the analysis of questionnaire, 89.5% of the students were satisfied with the online course design, 81.61% of the students thought that the online design was scientific and reasonable, 86.6% of the students thought that the clerkship teaching process was attractive and could stimulate students' interest in learning, and 90.72% of the students thought that the goal of clerkship teaching was clear and the key problems and difficulties were clear.Conclusion:The online teaching mode of clinical clerkship has high student satisfaction and good teaching effect, which provides a new way for online clerkship model.

Objective:To explore the application of PDCA cycle combined with project management method in the assessment and management of special skills training in clinical skills center.Methods:From January to December in 2018, the PDCA cycle combined with project management method was used to manage the special skills training project team. The utilization rate of special skills simulation equipment before and after management was compared. A questionnaire survey was conducted to investigate the satisfaction with the management model among the students involved in the special skills training in 2018.The data was analyzed by SPSS 13.0.Results:The utilization rate of special skills simulation equipment was significantly improved, and the students were highly satisfied with the management model.Conclusion:Using PDCA cycle combined with project management method, this paper explores a management model of special skills training and assessment in clinical skills center, which improves the quality of special skills training and assessment management in clinical skills center, and is worthy of further exploration and practice.

Sepsis is a life-threatening organ dysfunction caused by the host's imbalance in response to infection, which is still the leading cause of death in critically ill patients. In recent years, studies have found that vitamin D deficiency or insufficiency is common in critically ill patients, especially sepsis. The relationship between vitamin D and sepsis has attracted more and more attention. The mechanism of vitamin D in sepsis is described from the aspects of immune regulation, inflammation regulation, endothelial cell protection, carbon monoxide regulation, and receptor gene polymorphism, by analyzing the related literatures of vitamin D and sepsis in recent years in order to provide new ideas for clinical diagnosis and treatment of sepsis.