Objective To investigate the value of ultrasound and contrast enhanced ultrasound(CEUS)in the differential diagnosis of pancreatic neuroendocrine tumor(PNET)and pancreatic ductal adenocarcinoma(PDAC).Methods A retrospective analysis was performed on the clinical data,ultrasound findings,and CEUS findings of 74 patients with PNET and their characteristic manifestations were analyzed and compared with those of 74 patients with PDAC.Data of the two groups were compared using the t-test and x 2 test,or Fisher's exact test.Results There were 18,26,and 30 patients with PNET lesions and 52,8,and 14 patients with PDAC located in the head,body,and tail of the pancreas,respectively.The patients with hypoechoic lesions,regular lesion morphology,clear boundaries,pancreatic duct dilatation or cutoff,and blood flow signal accounted for 86.49％,83.78％,78.38％,18.92％and 32.43％in the PNET group,respectively,whereas in the PDAC group,such patients accounted for 94.59％,29.73％,27.03％,75.68％and 21.62％,respec-tively.There was a significant intergroup differences in lesion location,morphology,boundaries and pancreatic duct dilatation or cutoff(x 2=31.862,x2=44.048,x 2=39.141,and x 2=47.815,respectively,P＜0.05),with no significant differences in hypoechoic and blood flow signal(x2=2.840 and x2=2.193,P＞0.05).Among the 52 patients with PNET,CEUS showed that 38 had hyperenhancement and 14 had iso-enhancement in the arterial phase,whereas 40 had iso-enhancement and 12 had hypoenhancement in the venous phase.CEUS was performed in 74 patients with PDAC;70 patients showed hypoenhancement in the arterial phase and 72 showed hypoenhancement in the venous phase.There were significant differences in the enhancement pattern in the arterial and venous phases between the two groups(x 2=56.582 and x 2=37.852,P＜0.05).Conclusion Ultrasound and CEUS revealed some characteristics of PNET that can be used for the differential diagnosis of PNET and PDAC,when combined with enhancement pattern.

Objective To investigate the value of ultrasound and contrast enhanced ultrasound(CEUS)in the differential diagnosis of pancreatic neuroendocrine tumor(PNET)and pancreatic ductal adenocarcinoma(PDAC).Methods A retrospective analysis was performed on the clinical data,ultrasound findings,and CEUS findings of 74 patients with PNET and their characteristic manifestations were analyzed and compared with those of 74 patients with PDAC.Data of the two groups were compared using the t-test and x 2 test,or Fisher's exact test.Results There were 18,26,and 30 patients with PNET lesions and 52,8,and 14 patients with PDAC located in the head,body,and tail of the pancreas,respectively.The patients with hypoechoic lesions,regular lesion morphology,clear boundaries,pancreatic duct dilatation or cutoff,and blood flow signal accounted for 86.49％,83.78％,78.38％,18.92％and 32.43％in the PNET group,respectively,whereas in the PDAC group,such patients accounted for 94.59％,29.73％,27.03％,75.68％and 21.62％,respec-tively.There was a significant intergroup differences in lesion location,morphology,boundaries and pancreatic duct dilatation or cutoff(x 2=31.862,x2=44.048,x 2=39.141,and x 2=47.815,respectively,P＜0.05),with no significant differences in hypoechoic and blood flow signal(x2=2.840 and x2=2.193,P＞0.05).Among the 52 patients with PNET,CEUS showed that 38 had hyperenhancement and 14 had iso-enhancement in the arterial phase,whereas 40 had iso-enhancement and 12 had hypoenhancement in the venous phase.CEUS was performed in 74 patients with PDAC;70 patients showed hypoenhancement in the arterial phase and 72 showed hypoenhancement in the venous phase.There were significant differences in the enhancement pattern in the arterial and venous phases between the two groups(x 2=56.582 and x 2=37.852,P＜0.05).Conclusion Ultrasound and CEUS revealed some characteristics of PNET that can be used for the differential diagnosis of PNET and PDAC,when combined with enhancement pattern.

Chronic urticaria （CU） is a common skin disease worldwide， and its incidence is increasing year by year in various regions. Clinical manifestations such as severe itching can affect normal work， sleep， and daily life and increase the negative psychological burden caused by stress， anxiety， and depression. Mast cell activation and degranulation induced by immunoglobulin（Ig）E hypersensitivity is one of the core pathogenic mechanisms of CU， and there is no cure. Antihistamines such as cetirizine and loratadine are preferred for the clinical treatment of CU. Although they can effectively improve clinical manifestations such as itchiness， long-term application can increase the risk of adverse reactions and drug resistance. The phosphatidylinositol kinase/serine-threonine protein kinase B（PI3K/Akt） signaling pathway， as a classical signaling pathway regulated by phosphatidylinositol and tyrosine kinase receptor （RTK）， is a key target regulating the production and release of cytokines in macrophages and affecting the migration of leukocytes and the activation of mast cells and inflammation， and it can be involved in a variety of metabolic processes， such as mast cell activation and degranulation induced by IgE hypersensitivity and abnormal activation of the complement system so that the PI3K/Akt molecular pathway could be an important target for the future eradication of CU. However， the mechanism and potential role of the PI3K/Akt signaling pathway in the treatment of CU are less reported in China. Now， this paper reviewed the molecular mechanism of PI3K/Akt signaling pathway regulation in the treatment of CU and provided corroborative evidence and therapeutic strategy choices for the treatment of CU with traditional Chinese medicine （TCM） from the perspectives of molecular regulation and network pharmacology analysis.

OBJECTIVE To explore the mechanism of Compound lizard powder reducing cisplatin resistance in gastric cancer by regulating glycolytic activity based on phosphoinositide 3-kinase（PI3K）/protein kinase B（Akt） signaling pathway. METHODS Human gastric cancer MKN45 and MKN45/DDP （cisplatin-resistant） cells were cultured in vitro and intervened with different mass concentrations of cisplatin （0.1， 0.2， 0.4， 0.8， 1.6， 3.2 μg/mL） to detect the survival rate， half inhibitory concentration （IC50） and drug resistance index. MKN45/DDP cells were inoculated subcutaneously in the right anterior axilla of nude mice to prepare a transplanted tumor model of gastric cancer. After successful modeling， they were randomly divided into model group， cisplatin group （0.002 g/kg）， Compound lizard powder group （2.8 g/kg） and combination group （the same dose as each single drug group）， with 8 nude mice in each group. Each administration group was given relevant solution， twice a week （cisplatin， i.p.） or twice a day （Compound lizard powder， i. g.）， for 4 consecutive weeks. During the experiment， the body weight of nude mice was monitored， and tumor volume and inhibitory rate of tumor were calculated. The levels of inflammatory factors （tumor necrosis factor- α， interleukin-6） in tumor tissue， the mRNA and protein expressions of multidrug resistance-associated protein 1 （MRP1）， P-glycoprotein （P-gp）， glucose transporter-1 （GLUT1） and lactate dehydrogenase A （LDHA）， as well as the protein expressions of PI3K， phosphorylated PI3K （p-PI3K）， Akt， phosphorylated Akt （p-Akt）， hexokinase-2 （HK2） and pyruvate kinase M2 （PKM2） were all detected. RESULTS With the intervention of different concentrations of cisplatin， the survival rate of MKN45/DDP-resistant cells was significantly higher than that of MKN45 parent cells （P＜0.05）. IC50 value of MKN45/DDP and MKN45 cells were（1.052 0±0.221 9） and （0.372 1±0.238 0）μg/mL， and the drug resistant index was 2.827. Compared with the model group， cisplatin group， Compound lizard powder group and combination group all had certain inhibitory effects on the tumor growth in nude mice； the inhibitory rates of tumor increased significantly （P＜0.05）； the levels of inflammatory factors， the mRNA and protein expressions of MRP1， P-gp， GLUT1 and LDHA （except for cisplatin group）， the phosphorylation levels of PI3K and Akt protein （except for cisplatin group） as well as the protein expressions of HK2 and PKM2 were decreased significantly， while the combination group was significantly better than the cisplatin group （P＜0.05）. CONCLUSIONS Compound lizard powder may inhibit tumor growth in transplanted tumor model nude mice with gastric cancer-resistant cells by reducing the secretion of tumor-related inflammatory factors， inhibiting the expression of glycolysis， drug resistance-related proteins and genes， inhibiting the activation of the PI3K/Akt signaling pathway， thus having a certain effect of enhancing cisplatin efficacy and reversing drug resistance.

Objective To construct the competency and professional activities of pediatric rehabilitation therapists in China based on World Health Organization rehabilitation competency framework(RCF). Methods Competencies,activities,and tasks in the field of pediatric rehabilitation were collected through literature,offi-cial websites and interviews with key informants using RCF.Competency requirements suitable for pediatric re-habilitation therapists were selected,competency dimensions and activities were adjusted based on the context of pediatric rehabilitation therapy.Similar content was integrated through thematic framework analysis and content analysis.Competencies were matched with typical professional activities.A competency framework and profes-sional activities for Chinese pediatric rehabilitation therapists were developed,and the Delphi method was used to survey 22 experts,ultimately confirming competency dimensions and activity content. Results The enthusiasm coefficient of experts was 88.00%,the authority coefficient was 0.84,and the expert opinions were more focused on importance.The CV values of all competency dimensions and activities were≤0.25,and the W test was statistically significant(P<0.05),indicating a high degree of coordination among experts.A com-petency framework for pediatric rehabilitation therapists in China,included 17 competency dimensions and 17 professional activities. Conclusion To explore the competency of typical professions through RCF may enhance the application of research re-sults in the field of rehabilitation,which provides a reference for clarifying the job content and cultivating the competency of Chinese pediatric rehabilitation therapists.

Objective To investigate the current situation of competency and professional activities of pediatric rehabilitation thera-pists in Jiangsu,Shanghai and Zhejiang. Methods A questionnaire survey was conducted on 168 pediatric rehabilitation therapists in Jiangsu,Shanghai and Zheji-ang,from December,2022 to February,2023,and the general information and the competency were obtained.A total of 35 pediatric rehabilitation therapists were interviewed one-on-one,from October,2022 to January,2023,using thematic framework. Results A total of 162 effective questionnaires were collected.The level of competency of pediatric rehabilitation thera-pists was(3.44±0.87);and it was higher in professional literacy(3.90±0.77)and practice(3.83±0.77),and lower in management and leadership(2.92±1.44),and research(2.14±1.64).Latent class analysis showed that the thera-pists could be divided into four categories,of which the"medium competency"accounted for the most proportion(34.57%),and"low learning and research"was the least(8.64%).The interviews identified problems of compe-tency such as maintaining communication with children's families and managing self-professional development. Conclusion Self-reported rehabilitation competency levels of pediatric rehabilitation therapists in three provinces and cit-ies are above three points in all four dimensions,except for the management and leadership dimension,where the score is below three points.

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The influence of female pre-pregnancy body mass index (BMI) on maternal and neonatal outcomes is well recognized. Similarly, the role of male BMI on pregnancy complications in their partners and offspring birth outcomes has also caught increasing public attention. Male obesity may negatively affect their partners and fetuses through a variety of mechanisms, such as changes in semen composition, sperm morphology and physiology, and epigenetic modifications. Unhealthy lifestyles shared by couples can also contribute to these issues. Some animal studies have attempted to explore the related mechanisms. This article reviews the effect of male BMI on female pregnancy complications and neonatal outcomes, and investigations into the potential mechanisms involved using animal models. This study emphasizes the importance of taking paternal factors into diagnostic evaluations for healthcare professionals and the significance of male BMI control for better protecting their partners and offspring.

The influence of female pre-pregnancy body mass index (BMI) on maternal and neonatal outcomes is well recognized. Similarly, the role of male BMI on pregnancy complications in their partners and offspring birth outcomes has also caught increasing public attention. Male obesity may negatively affect their partners and fetuses through a variety of mechanisms, such as changes in semen composition, sperm morphology and physiology, and epigenetic modifications. Unhealthy lifestyles shared by couples can also contribute to these issues. Some animal studies have attempted to explore the related mechanisms. This article reviews the effect of male BMI on female pregnancy complications and neonatal outcomes, and investigations into the potential mechanisms involved using animal models. This study emphasizes the importance of taking paternal factors into diagnostic evaluations for healthcare professionals and the significance of male BMI control for better protecting their partners and offspring.

Chemotherapy is an important adjuvant treatment of glioma, while the efficacy is far from satisfactory, due not only to the biological barriers of blood‒brain barrier (BBB) and blood‒tumor barrier (BTB) but also to the intrinsic resistance of glioma cells via multiple survival mechanisms such as up-regulation of P-glycoprotein (P-gp). To address these limitations, we report a bacteria-based drug delivery strategy for BBB/BTB transportation, glioma targeting, and chemo-sensitization. Bacteria selectively colonized into hypoxic tumor region and modulated tumor microenvironment, including macrophages repolarization and neutrophils infiltration. Specifically, tumor migration of neutrophils was employed as hitchhiking delivery of doxorubicin (DOX)-loaded bacterial outer membrane vesicles (OMVs/DOX). By virtue of the surface pathogen-associated molecular patterns derived from native bacteria, OMVs/DOX could be selectively recognized by neutrophils, thus facilitating glioma targeted delivery of drug with significantly enhanced tumor accumulation by 18-fold as compared to the classical passive targeting effect. Moreover, the P-gp expression on tumor cells was silenced by bacteria type III secretion effector to sensitize the efficacy of DOX, resulting in complete tumor eradication with 100% survival of all treated mice. In addition, the colonized bacteria were finally cleared by anti-bacterial activity of DOX to minimize the potential infection risk, and cardiotoxicity of DOX was also avoided, achieving excellent compatibility. This work provides an efficient trans-BBB/BTB drug delivery strategy via cell hitchhiking for enhanced glioma therapy.