ObjectiveTo investigate the current situation of mutual recognition for ethical review outcomes in multicenter clinical research across 10 contracting medical institutions in Guangdong Province， analyze existing issues and propose improvement recommendations， thereby promoting the standardized management of mutual recognition for ethical review outcomes in medical institutions. MethodsData from 381 multicenter clinical studies conducted in these 10 medical institutions from January 24 to October 31， 2024， were collected. Text visualization was performed using Python and the WordCloud library， and statistical analyses were conducted with SPSS 25.0. ResultsOf the 381 studies investigated， industry-sponsored clinical trials （ISTs） accounted for 51.71%， while investigator-initiated clinical trials （IITs） constituted 48.29%. The proportions of ethical committees serving as primary reviewers and collaborative reviewers were 33.33% and 66.67%， respectively. The confirmation methods of mutual recognition outcomes were primarily expedited reviews （50.66%） and meeting reviews （49.34%）， and no cases of “direct confirmation” were found. The Chi-square test revealed statistically significant differences in review confirmation methods based on project type （χ²=14.851， P<0.001） and ethics committee role （χ²= 69.435， P<0.001）. The frequency distribution trend of the contingency table showed that IST projects and primary ethics committees preferred to employ meeting review （58.88% and 79.53% respectively， both higher than the average level of 49.34%）， while IIT projects and the collaborative ethics committees more frequently utilized expedited review （60.87% and 65.75% respectively， both higher than the average level of 50.66%）. ConclusionThe confirmation methods of mutual recognition for ethical review outcomes in multicenter clinical research are significantly associated with the role of the ethics committee and the type of project. It is recommended to improve management systems， enhance information construction and personnel training， as well as clarify mutual recognition responsibilities and strengthen supervision. This aims to ensure review quality while improving mutual recognition efficiency， thereby safeguarding the rights and interests of research participants.

ObjectiveTo explore the regional differences and service supply mechanism of hospice care in China from the perspective of policy tools， and provide references for optimizing hospice care policies. MethodsBased on the perspective of policy tools and a content analysis method， 140 Chinese hospice care policy texts from 2017 to 2024 were encoded. A three-dimensional analysis framework of policy tools， regions， and service supply mechanisms was constructed to analyze the use of policy tools and regional differences， as well as the allocation situation of service supply mechanisms. ResultsA total of 459 coding units were obtained through the inclusion of 140 policy texts. Supply-side， demand-side， and environmental policy tools accounted for 21.13% （97/459）， 23.53% （108/459）， and 55.34% （254/459）， respectively. Eastern regions exhibited the highest frequency of policy tool application， western regions ranked second， and central and northeastern regions showed a lower frequency. Service supply mechanisms were predominantly administered by government entities， with the market playing a supplementary role. ConclusionThe employment of policy tools demonstrates structural imbalance， with certain measures proving difficult to implement. Significant regional disparities exist in policy levels， and market efficiency remains underutilized. It is essential to optimize the structural framework of policy tools， enhance policy implementation， narrow regional disparities， and expand the market share.

The"Regulations on Human Organ Donation and Transplantation"clearly stipulate that medical institutions may only obtain cadaveric organs with the consent of the Human Organ Transplantation Ethics Committee.In order to better safeguard human life and health and uphold human dignity,and on the basis of respecting and protecting the legitimate rights and interests of(potential)donors and their families,as well as organ transplant recipients,this work Guidelines for Ethical Review of Cadaveric Organ Donation is formulated to guide the ethical review committees of Organ Procurement Organization or their affiliated medical institutions to conduct ethical reviews of cadaveric organ donation in a standardized and orderly manner,with the participation of all relevant parties.This manual,oriented by the organizational structure,procedures,content,and supervision of ethical review of cadaveric organ donation,as well as the prominent ethical dilemmas encountered in practice,has been developed through a review of domestic and international literature and in combination with practical experience in the ethical review of cadaveric organ donation.It consists of 10 recommendations aimed at providing a standardized and practical guide for the ethical review of cadaveric organ donation and ensuring the procedural protection of cadaveric organ donation.

Objective To explore the clinical significance of TMED4 expression in colorectal cancer and its relationship with the im-mune microenvironment.Methods Based on the cancer genome atlas(TCGA)database,the expression level of TMED4 in colorectal cancer and its prognostic value were analyzed using R language.Clinical samples were collected for polymerase chain reaction(PCR)ex-periments to verify its expression,and the correlation with clinicopathological features and prognostic value were analyzed.The functional role of TMED4 was detected through gene set enrichment analysis(GSEA)and immune infiltration analysis.Results The expression level of TMED4 was upregulated in colorectal cancer samples.The expression level of TMED4 was closely associated with the pathological stage,lymphatic metastasis,and distant metastasis of colorectal cancer.The increase in TMED4 expression was closely related to the over-all survival(OS)and disease-specific survival(DSS)of patients.Univariate analysis and multivariate COX analysis found that TMED4might be an independent high-risk factor for DSS in colorectal cancer patients.Receiver operating characteristic(ROC)curve a-nalysis showed that TMED4has the potential to become a potential biomarker for the diagnosis of colorectal cancer.GSEA revealed that TMED4might be involved in multiple pathways,mainly concentrated in transport and catabolic pathways,glycan biosynthesis and metabo-lism pathways,and lipid metabolism pathways.Conclusion High expression of TMED4 is closely related to poor prognosis of colorectal cancer and immune cell infiltration.It may serve as an independent biomarker for predicting the prognosis of colorectal cancer and a poten-tial therapeutic target.

Prostate cancer is a common malignant tumor in males.Androgen deprivation treatment(ADT)is the main therapeutic method for prostate cancer,which often leads to changes of body composition(BC)characterized by sarcopenia,centripetal fat redistribution and osteoporosis.Imaging techniques can accurately and conveniently assess changes of BC.The research progresses of imaging evaluation on BC changes in prostate cancer patients after ADT were reviewed in this article.

The"Regulations on Human Organ Donation and Transplantation"clearly stipulate that medical institutions may only obtain cadaveric organs with the consent of the Human Organ Transplantation Ethics Committee.In order to better safeguard human life and health and uphold human dignity,and on the basis of respecting and protecting the legitimate rights and interests of(potential)donors and their families,as well as organ transplant recipients,this work Guidelines for Ethical Review of Cadaveric Organ Donation is formulated to guide the ethical review committees of Organ Procurement Organization or their affiliated medical institutions to conduct ethical reviews of cadaveric organ donation in a standardized and orderly manner,with the participation of all relevant parties.This manual,oriented by the organizational structure,procedures,content,and supervision of ethical review of cadaveric organ donation,as well as the prominent ethical dilemmas encountered in practice,has been developed through a review of domestic and international literature and in combination with practical experience in the ethical review of cadaveric organ donation.It consists of 10 recommendations aimed at providing a standardized and practical guide for the ethical review of cadaveric organ donation and ensuring the procedural protection of cadaveric organ donation.

Objective To investigate the anxiety and its related factors in medical staff during field training,so as to provide evidence for psychological education before field training.Methods A total of 81 medical staff who participated in field training were recruited in this cross-sectional study as research objects.The Hamilton Anxiety Scale(HAMA)and self-compiled questionnaires of related factors were used to measure the general states of the staff.Univariate analysis was used to screen relevant variables that affect anxiety,and then a logistic regression model was used for multivarate analysis to determine independent influencing factors.Results The detection rate of anxiety was 14.81%in the research objects.There were significant differences in the degree of anxiety among the medical staff with different variables such as gender,the number of exercises attended,childlessness,parental physical condition,tolerable training time,pastime activities,and personal title(P<0.05).Multivariate regression analysis indicated that gender and parental physical status were independent factors affecting anxiety(P<0.05).Conclusion During field training,a part of medical staff has anxiety,which may affect by multi-factors such as personal,family,and training environment.Therefore,psychological education and counseling before field training should be performed from multiple aspects.

Objective:To examine the therapeutic effects and molecular mechanisms of nuclear receptor NR4A1 in alleviating postoperative ileus (POI) in a rat model.Methods:Twenty-four Sprague-Dawley rats were randomly(random number) divided into four groups ( n=6/group): sham-operated control, POI model, POI model + NR4A1 stimultior (Cytosporone B, 13 mg/kg), and POI model + NR4A1 antagonist (DIM-C-pPhCO2Me, 2 mg/kg). After 24 hours, intestinal tissues and serum were collected for analysis. We assessed: (1) histopathological changes, (2) intestinal motility via propulsion rate, (3) NR4A1 expression by immunohistochemistry, (4) epithelial apoptosis via TUNEL assay, (5) inflammatory cytokines (IL-6, IL-4) by ELISA, (6) tight junction protein (occludin) by Western blot, and (7) p38MAPK/NF-κB pathway activation through combined western blot and immunofluorescence analyses. Results:Compared with sham controls, POI model rats showed (all P<0.05): significantly reduced NR4A1 expression, severe mucosal damage, increased inflammatory infiltration, elevated epithelial apoptosis, decreased occludin expression, impaired intestinal motility, upregulated pro-inflammatory cytokines (IL-6, IL-4), and activated p38MAPK/NF-κB signaling. NR4A1 activation with Cytosporone B significantly reversed these pathological changes (all P<0.05), while NR4A1 inhibition exacerbated them. Conclusions:NR4A1 activation attenuates POI by suppressing p38MAPK/NF-κB-mediated inflammation and preserving intestinal barrier function, suggesting its potential as a therapeutic target for postoperative ileus.

Objective To explore the clinical significance of TMED4 expression in colorectal cancer and its relationship with the im-mune microenvironment.Methods Based on the cancer genome atlas(TCGA)database,the expression level of TMED4 in colorectal cancer and its prognostic value were analyzed using R language.Clinical samples were collected for polymerase chain reaction(PCR)ex-periments to verify its expression,and the correlation with clinicopathological features and prognostic value were analyzed.The functional role of TMED4 was detected through gene set enrichment analysis(GSEA)and immune infiltration analysis.Results The expression level of TMED4 was upregulated in colorectal cancer samples.The expression level of TMED4 was closely associated with the pathological stage,lymphatic metastasis,and distant metastasis of colorectal cancer.The increase in TMED4 expression was closely related to the over-all survival(OS)and disease-specific survival(DSS)of patients.Univariate analysis and multivariate COX analysis found that TMED4might be an independent high-risk factor for DSS in colorectal cancer patients.Receiver operating characteristic(ROC)curve a-nalysis showed that TMED4has the potential to become a potential biomarker for the diagnosis of colorectal cancer.GSEA revealed that TMED4might be involved in multiple pathways,mainly concentrated in transport and catabolic pathways,glycan biosynthesis and metabo-lism pathways,and lipid metabolism pathways.Conclusion High expression of TMED4 is closely related to poor prognosis of colorectal cancer and immune cell infiltration.It may serve as an independent biomarker for predicting the prognosis of colorectal cancer and a poten-tial therapeutic target.

Prostate cancer is a common malignant tumor in males.Androgen deprivation treatment(ADT)is the main therapeutic method for prostate cancer,which often leads to changes of body composition(BC)characterized by sarcopenia,centripetal fat redistribution and osteoporosis.Imaging techniques can accurately and conveniently assess changes of BC.The research progresses of imaging evaluation on BC changes in prostate cancer patients after ADT were reviewed in this article.