Pancreatic ductal adenocarcinoma （PDAC） is highly malignant and often has an extremely poor prognosis， and early postoperative liver metastasis is one of the key influencing factors for prognosis. With reference to the clinical and experimental studies in recent years， this article reviews the clinical risk factors for early liver metastasis after PDAC and systematically elaborates on major molecular events underlying early postoperative liver metastasis from various aspects of construction of the pre-metastatic niche in the liver driven by tumor-derived exosomes， the pro-metastatic microenvironment maintained by metastasis-associated macrophages and neutrophil extracellular traps， the invasive phenotype and liver-tropic migration of tumor cells， intrahepatic immunometabolic adaptation， and fibrotic remodeling， in order to provide a theoretical basis for perioperative risk stratification and the development of intervention strategies.

Objective:To investigate the efficacy of neuromuscular electrical stimulation (NMES) combined with limb rehabilitation therapy in improving limb function of patients with hemiplegia due to stroke.Methods:A randomized controlled study was conducted on 110 patients with hemiplegia due to stroke admitted to the 987 Hospital of the PLA Joint Logistic Support Force from January 2021 to January 2023. These patients were divided into a control group and an observation group, with 55 cases each, using a random number table method. The control group received conventional rehabilitation therapy, while the observation group received NMES combined with limb rehabilitation therapy. All patients were treated for 3 months. The Trunk Impairment Scale, Brunnstrom Motor Function Scale, Surface Electromyography, Brunel Balance Scale, Simple Gait Test Scale, and Modified Ashworth Scale were used to evaluate trunk control function, limb control function, neuromuscular disorders, balance control function (forward-backward inclination angle, left-right inclination angle), gait temporal-spatial parameters, symmetry parameters, and muscle tone recovery in both groups before and after treatment.Results:After treatment, the Total Impairment Scale and Brunnstrom scores for upper and lower limbs in the observation group were higher than those in the control group [(18.31 ± 1.61) vs. (14.38 ± 1.42), (3.78 ± 0.41) vs. (3.01 ± 0.63), (3.75 ± 0.42) vs. (3.28 ± 0.63), t = 13.58, 7.60, 4.60, all P < 0.05]. Additionally, the scores for tibialis anterior, fibularis brevis, fibularis longus, medial gastrocnemius, lateral gastrocnemius muscle control were higher in the observation group compared with the control group. The scores for Berg Balance Scale, forward-backward inclination angle, left-right inclination angle, step frequency, step length, step speed, and step width in the observation group were also superior to those in the control group. All differences were statistically significant ( t = 17.88, 20.15, 24.62, 19.53, 22.80, 3.31, 8.66, 7.88, 6.08, 4.21, 7.43, 3.35, all P < 0.05). Furthermore, the deviations in step length, the ratio of support on the affected side to the unaffected side, and the ratio of swing on the affected side to the unaffected side in the observation group were lower than those in the control group [(3.53 ± 2.55) vs. (5.35 ± 3.21), (1.11 ± 0.04) vs. (1.14 ± 0.03), (1.10 ± 0.06) vs. (1.24 ± 0.09), t = 3.29, 4.45, 9.60, all P < 0.05]. Additionally, the level of muscle tone recovery in the observation group was higher than that in the control group ( Z = 2.53, P = 0.011). Conclusions:In the treatment of hemiplegia due to stroke, NMES combined with limb rehabilitation therapy can effectively improve patients' trunk and limb control, enhance balance function, and greatly promote muscle strength recovery.

Objective To analyze the symptomatic improvement effects of vitamin D in children with autism spectrum disorder(ASD)based on the microbiota-gut-brain axis.Methods Seventy-two children with ASD were randomly divided into an observation group and a control group,with 36 cases in each group.Three cases dropped out in the control group.The observation group received 1200 IU/day of vitamin D supplementation in addition to conventional rehabilitation training,while the control group received only conventional rehabilitation training.The intervention lasted for 12 weeks.Assessments were conducted before and after the intervention using the childhood autism rating scale(CARS),autism behavior checklist(ABC),and repetitive behavior scale-revised(RBS-R).Resting-state functional connectivity of the brain was measured using near-infrared functional imaging,and serum levels of 25(OH)D3,inflammatory cytokines,and gut microbiota were analyzed.The differences in these indicators before and after the intervention were compared between the two groups to evaluate clinical efficacy.Results The between-group differences in pre-and post-intervention changes showed that the observation group had significantly greater improvements than the control group in the following measures:CARS scores(-5.92±1.40 vs.-2.55±1.43),RBS-R scores(-5.99±1.01 vs.-3.10±1.47),resting-state brain functional connectivity(0.19±0.15 vs.0.10±0.18),serum 25(OH)D3 levels[(34.89±8.18)ng/mL vs.(0.68±6.73)ng/mL],serum interleukin-6(IL-6)levels[(-6.60±6.07)pg/mL vs.(-0.74±9.45)pg/mL],IL-1β levels[(-2.56±1.33)pg/mL vs.(-0.04±2.13)pg/mL],and tumor necrosis factor-α(TNF-α)levels[(-4.09±3.85)pg/mL vs.(0.21±4.05)pg/mL](P<0.05).Post-intervention,significant differences in gut microbial β-diversity were observed between the two groups(R2=0.030,P=0.040,Adonis).LEfSe analysis revealed that the observation group exhibited enrichment in Clostridia(LDA=4.747,P=0.003),Clostridiales(LDA=4.747,P=0.003),Clostridiaceae(LDA=3.476,P=0.001),Lachnospiraceae(LDA=4.709,P=0.004),Odoribacteraceae(LDA=3.458,P=0.027),Odoribacter(LDA=3.458,P=0.027),Burkholderiales(LDA=3.339,P=0.038),Firmicutes(LDA=4.764,P=0.003),and Betaproteobacteria(LDA=3.338,P=0.037).Conclusion Vitamin D supplementation can modulate gut microbial diversity in children with ASD,significantly influence the abundance of specific gut microbiota,reduce systemic inflammatory cytokines,enhance brain functional connectivity,and alleviate clinical symptoms of ASD.

Objective To assess the level of research integrity awareness among clinical nursing personnel in Yunnan Province,analyze the influencing factors,and identify related risks.Methods From June 2025 to July 2025,a research integrity awareness questionnaire was conducted on 697 clinical nursing personnel from a university-affiliated tumor hospital and children's hospital using the Questionnaire Star platform.The survey content included basic information,research integrity awareness status,research integrity construction awareness,and the causes of research misconduct.Data were analyzed using SPSS 27.0.Results The research integrity awareness score of clinical nursing personnel was(47.49±11.06),with an overall awareness rate of 51.48%.Univariate analysis showed statistically significant differences in awareness scores based on nursing categories(t=-2.45),marital status(F=5.557),age(F=2.735),work experience(F=4.775),highest education level(F=13.11),whether serving as a master's supervisor(t=2.693),participation in research projects(t=4.95),whether they had published papers as the first author or corresponding author(t=5.11),and attendance of research integrity training(t=12.48)(P<0.05).Multivariate linear regression analysis indicated that marital status,highest education level,and participation in research integrity training were significant factors influencing clinical nursing personnel's research integrity awareness(P<0.05).The main reason for research misconduct was lack of research integrity awareness The(76.47%),and 92.37%of clinical nursing personnel believed further strengthening of research integrity construction was necessary.Conclusion The research integrity awareness level of clinical nursing personnel needs improvement.Hospitals should enhance research integrity training,improve research integrity management systems,and optimize scientific talent evaluation mechanisms.

Objective To explore the effect of salidroside(Sal)on endoplasmic reticulum stress and connexin 43 in rats with myocardial ischemia-reperfusion injury(MIRI).Methods SD rats were randomly divided into Sham group,MIRI group,low-does Sal(Sal-L)group and high-does Sal(Sal-H)group.The Sham group and MIRI group were intraperitoneal injec-ted with 0.9％sodium chloride solution(10 mL·kg-1·d-1),the Sal-L group and Sal-H group were intraperitoneal injected at a volume of 10 mL·kg-1 with Sal(12,36 mg·kg-1·d-1),respectively.Each group was given a corresponding intervention once a day for 3 d.The MIRI model was established 30 min after the last administration in all groups except the Sham group.The patho-logical changes of myocardial tissue were observed by Hematoxylin-eosin(HE)staining.TdT-mediated-dUTP nick end labeling(TUNEL)was used to observe the apoptosis of cardiomyocyte,the genes and proteins expression of Cx43 and endoplasmic reticu-lum stress related factors such as GRP78,Caspasel2,CHOP and so on were detected by quantitative real-time polymerase chain reaction(q-PCR)and western blot analysis.Results Compared with the MIRI group,the degree of tissue and cell injury in each Sal group was alleviated,with a decreased apoptosis rate observed in the Sal-H group(P＜0.05),the gene expression of Cx43 was up-regulated while GRP78,Caspase12,and CHOP gene expressions were down-regulated in both does groups of Sal.The protein expressions of Cx43 and GRP78 were also be up-regulated and down-regulated respectively in both dose groups of Sal,meanwhile the protein expressions of CHOP,Bax,Caspasel2 and cleaved-Caspase3 were down-regulated and the protein expres-sion of Bcl-2 was up-regulated in SAL-H group(P＜0.05).Conclusion The protective effect of salidroside on cardiomyocytes may be related to the inhibition of endoplasmic reticulum stress-induced apoptosis and the imbalance of Cx43 metabolism.

Objective To analyze the symptomatic improvement effects of vitamin D in children with autism spectrum disorder(ASD)based on the microbiota-gut-brain axis.Methods Seventy-two children with ASD were randomly divided into an observation group and a control group,with 36 cases in each group.Three cases dropped out in the control group.The observation group received 1200 IU/day of vitamin D supplementation in addition to conventional rehabilitation training,while the control group received only conventional rehabilitation training.The intervention lasted for 12 weeks.Assessments were conducted before and after the intervention using the childhood autism rating scale(CARS),autism behavior checklist(ABC),and repetitive behavior scale-revised(RBS-R).Resting-state functional connectivity of the brain was measured using near-infrared functional imaging,and serum levels of 25(OH)D3,inflammatory cytokines,and gut microbiota were analyzed.The differences in these indicators before and after the intervention were compared between the two groups to evaluate clinical efficacy.Results The between-group differences in pre-and post-intervention changes showed that the observation group had significantly greater improvements than the control group in the following measures:CARS scores(-5.92±1.40 vs.-2.55±1.43),RBS-R scores(-5.99±1.01 vs.-3.10±1.47),resting-state brain functional connectivity(0.19±0.15 vs.0.10±0.18),serum 25(OH)D3 levels[(34.89±8.18)ng/mL vs.(0.68±6.73)ng/mL],serum interleukin-6(IL-6)levels[(-6.60±6.07)pg/mL vs.(-0.74±9.45)pg/mL],IL-1β levels[(-2.56±1.33)pg/mL vs.(-0.04±2.13)pg/mL],and tumor necrosis factor-α(TNF-α)levels[(-4.09±3.85)pg/mL vs.(0.21±4.05)pg/mL](P<0.05).Post-intervention,significant differences in gut microbial β-diversity were observed between the two groups(R2=0.030,P=0.040,Adonis).LEfSe analysis revealed that the observation group exhibited enrichment in Clostridia(LDA=4.747,P=0.003),Clostridiales(LDA=4.747,P=0.003),Clostridiaceae(LDA=3.476,P=0.001),Lachnospiraceae(LDA=4.709,P=0.004),Odoribacteraceae(LDA=3.458,P=0.027),Odoribacter(LDA=3.458,P=0.027),Burkholderiales(LDA=3.339,P=0.038),Firmicutes(LDA=4.764,P=0.003),and Betaproteobacteria(LDA=3.338,P=0.037).Conclusion Vitamin D supplementation can modulate gut microbial diversity in children with ASD,significantly influence the abundance of specific gut microbiota,reduce systemic inflammatory cytokines,enhance brain functional connectivity,and alleviate clinical symptoms of ASD.

Objective To explore the effect of salidroside(Sal)on endoplasmic reticulum stress and connexin 43 in rats with myocardial ischemia-reperfusion injury(MIRI).Methods SD rats were randomly divided into Sham group,MIRI group,low-does Sal(Sal-L)group and high-does Sal(Sal-H)group.The Sham group and MIRI group were intraperitoneal injec-ted with 0.9％sodium chloride solution(10 mL·kg-1·d-1),the Sal-L group and Sal-H group were intraperitoneal injected at a volume of 10 mL·kg-1 with Sal(12,36 mg·kg-1·d-1),respectively.Each group was given a corresponding intervention once a day for 3 d.The MIRI model was established 30 min after the last administration in all groups except the Sham group.The patho-logical changes of myocardial tissue were observed by Hematoxylin-eosin(HE)staining.TdT-mediated-dUTP nick end labeling(TUNEL)was used to observe the apoptosis of cardiomyocyte,the genes and proteins expression of Cx43 and endoplasmic reticu-lum stress related factors such as GRP78,Caspasel2,CHOP and so on were detected by quantitative real-time polymerase chain reaction(q-PCR)and western blot analysis.Results Compared with the MIRI group,the degree of tissue and cell injury in each Sal group was alleviated,with a decreased apoptosis rate observed in the Sal-H group(P＜0.05),the gene expression of Cx43 was up-regulated while GRP78,Caspase12,and CHOP gene expressions were down-regulated in both does groups of Sal.The protein expressions of Cx43 and GRP78 were also be up-regulated and down-regulated respectively in both dose groups of Sal,meanwhile the protein expressions of CHOP,Bax,Caspasel2 and cleaved-Caspase3 were down-regulated and the protein expres-sion of Bcl-2 was up-regulated in SAL-H group(P＜0.05).Conclusion The protective effect of salidroside on cardiomyocytes may be related to the inhibition of endoplasmic reticulum stress-induced apoptosis and the imbalance of Cx43 metabolism.

Objective:To investigate the efficacy of neuromuscular electrical stimulation (NMES) combined with limb rehabilitation therapy in improving limb function of patients with hemiplegia due to stroke.Methods:A randomized controlled study was conducted on 110 patients with hemiplegia due to stroke admitted to the 987 Hospital of the PLA Joint Logistic Support Force from January 2021 to January 2023. These patients were divided into a control group and an observation group, with 55 cases each, using a random number table method. The control group received conventional rehabilitation therapy, while the observation group received NMES combined with limb rehabilitation therapy. All patients were treated for 3 months. The Trunk Impairment Scale, Brunnstrom Motor Function Scale, Surface Electromyography, Brunel Balance Scale, Simple Gait Test Scale, and Modified Ashworth Scale were used to evaluate trunk control function, limb control function, neuromuscular disorders, balance control function (forward-backward inclination angle, left-right inclination angle), gait temporal-spatial parameters, symmetry parameters, and muscle tone recovery in both groups before and after treatment.Results:After treatment, the Total Impairment Scale and Brunnstrom scores for upper and lower limbs in the observation group were higher than those in the control group [(18.31 ± 1.61) vs. (14.38 ± 1.42), (3.78 ± 0.41) vs. (3.01 ± 0.63), (3.75 ± 0.42) vs. (3.28 ± 0.63), t = 13.58, 7.60, 4.60, all P < 0.05]. Additionally, the scores for tibialis anterior, fibularis brevis, fibularis longus, medial gastrocnemius, lateral gastrocnemius muscle control were higher in the observation group compared with the control group. The scores for Berg Balance Scale, forward-backward inclination angle, left-right inclination angle, step frequency, step length, step speed, and step width in the observation group were also superior to those in the control group. All differences were statistically significant ( t = 17.88, 20.15, 24.62, 19.53, 22.80, 3.31, 8.66, 7.88, 6.08, 4.21, 7.43, 3.35, all P < 0.05). Furthermore, the deviations in step length, the ratio of support on the affected side to the unaffected side, and the ratio of swing on the affected side to the unaffected side in the observation group were lower than those in the control group [(3.53 ± 2.55) vs. (5.35 ± 3.21), (1.11 ± 0.04) vs. (1.14 ± 0.03), (1.10 ± 0.06) vs. (1.24 ± 0.09), t = 3.29, 4.45, 9.60, all P < 0.05]. Additionally, the level of muscle tone recovery in the observation group was higher than that in the control group ( Z = 2.53, P = 0.011). Conclusions:In the treatment of hemiplegia due to stroke, NMES combined with limb rehabilitation therapy can effectively improve patients' trunk and limb control, enhance balance function, and greatly promote muscle strength recovery.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

Objective To analyze the fairness of human resource allocation in professional public health agency (PHA) in Guangdong Province in 2022. Methods Health technical staff, other technical staff, and management staff from PHAs in Guangdong Province, such as disease prevention and control centers, specialized disease prevention and treatment institutions, maternal and child health institutions, health education centers, emergency centers/stations, blood collection and supply institutions, health supervision agencies, and family planning service centers under health departments, were selected as the study subjects. Data on human resource allocation in PHAs were collected, and the Lorenz curve, Gini coefficient, and Theil index were used to analyze the fairness of personnel allocation based on three dimensions: year-end resident population, geographical area, and regional gross domestic product. Results The number of PHA personnel per 10 000 population in four regions of the Pearl River Delta, eastern, western and mountain area in Guangdong Province was (7.49±3.74), (4.74±0.87), (8.73±1.67) and (10.33±1.80), respectively. There was no correlation between the per capita regional gross dumestic product of each prefecture level city and the number of PHA personnel (Spearman′s rank correlation coefficient=0.43, P>0.05). PHA resource allocation based on year-end resident population was more equitable than allocations based on geographical area or regional gross dumestic product, as indicated by the Lorenz curve being closest to the 45° standard line and the lowest Gini coefficient. The fairness of personnel allocation from high to low was ranked as follows: practicing (assistant) physicians, health technicians, registered nurses, managers personnel, and other technical personnel, with Theil indices of 0.035 0, 0.036 4, 0.044 6, 0.048 4, and 0.053 5, respectively. The differences in configuration fairness were derived from within group differences, with contribution rates of 76.0%, 73.9%, 71.8%, 82.9%, and 92.2%. The Lorenz curve, Gini coefficient, and Theil index were consistent in the distribution of permanent residents at the end of the year. Conclusion The fairness of professional human resource allocation in Guangdong Province based on the distribution of permanent residents at the end of the year is better than that based on geographical area and regional gross domestic product. The fairness of the allocation of practicing (assistant) physicians is better than that of other professional categories. Regional differences are the main reason for the relatively unfair allocation of PHA human resources in Guangdong Province.