Malnutrition is one of the main complications for gastric cancer patients, with an incidence rate as high as 65% to 85%, severely affecting their quality of life and survival rate. This issue is particularly prominent during out-of-hospital treatment, as patients often lack nutritional knowledge and do not receive continuous nutritional management. Therefore, ensuring that patients continue to receive effective nutritional management after discharge is crucial. This study explored three primary models of nutritional management for gastric cancer patients after discharge: the multidisciplinary team collaboration model, three-level nutritional management model, and the Internet+ model. It also analyzed the shortcomings and challenges these models face in practice, with the aim of providing a reference for clinical work.

Objective To explore the correlation between systemic inflammatory response index(SIRI)and the prognosis of elderly heart failure(HF)patients.Methods A retrospective study was conducted on 300 elderly HF patients with complete medical records hospitalized in our de-partment from January to December 2022.During the follow-up period for 1 year in different ways,46 of them were lost,and 254 were finally included.Baseline data,complete blood count at admission,and results of auxiliary examinations,and medicine adherence after discharge were col-lected and recorded.According to the occurrence of major adverse cardiovascular events(MACE),the subjected patients were divided into a MACE group(96 cases)and a non-MACE group(158 cases).The baseline data and relevant examination indicators were compared between the two groups,and the relevant factors for the occurrence were analyzed by using logistic regression.ROC curve analysis was employed to assess the predictive value of SIRI for MACE occurrence.Results The MACE group had significantly advanced age,larger proportion of diabetes mellitus,higher neutrophil and platelet counts,and elevated D-dimer level,but lower standardized medication rate when compared with the non-MACE group(P＜0.05,P＜0.01).The SIRI level was obviously higher in the MACE group than the non-MACE group[1.70(1.13,2.33)vs 1.29(0.85,2.06),P=0.002].Multivariate logistic regression analysis showed that atrial fibrillation,standardized medi-cation,mononuclear cells,and SIRI were independent risk factors for the occurrence of MACE in elderly HF patients(P＜0.05,P＜0.01).ROC curve analysis indicated that the AUC value of SIRI in predicting the occurrence of MACE was 0.614(95％CI:0.544-0.683),with a sensitivity of 0.813 and a specificity of 0.437.Conclusion SIRI is significantly correlated with the occurrence of MACE in elderly HF patients,and has a certain predictive value for their prognosis.

DeepSeek,a domestically developed generative artificial intelligence(AI)tool,is experiencing rapid growth within China's technological landscape.With its core advantages of open-source accessibility,cost-efficiency,vertical scenario specialization,and Chinese linguistic contextualization,it has been reconfiguring medical education.This development brings nu-merous innovative opportunities to postgraduate medical education,particularly in standardized training of resident physicians.On one hand,DeepSeek creates new possibilities for participants in residency training regarding knowledge acquisition,assisted learning,and teaching methodologies.On the other hand,its implementation raises concerns such as inadequate development of higher-order thinking skills,lack of realistic doctor-patient communication simulations,and diminished roles of clinical instruc-tors.Hospitals with a resident physician training base should promptly adapt to the new situation and move embrace intelligent de-velopment.By addressing the challenges posed by DeepSeek while fully utilizing emerging technologies,they can drive the high-quality development of standardized resident physician training.

Objective To explore the current research status,research hotspots,and development trends of clinician's post-competency in China using CiteSpace visualization analysis,thus providing insights into establishing professional teams and assisting in the high-quality development of hospitals.Methods Relevant literature on clinician post-competency was retrieved from the China National Knowledge Infrastructure(CNKI)database.The CiteSpace software was employed to create visualization maps of the publication volume,authors,and keywords of the relevant research.This analysis included author collaboration net-works,keyword co-occurrence,clustering,and burst analysis.Results A total of 710 articles meeting the inclusion criteria were retrieved.Research on clinician post-competency in China demonstrated a general upward trend from 2013 to 2024.Howev-er,collaboration among authors and institutions remained relatively limited.The primary research hotspots focused on fields such as medical education,teaching reform,and training models.The research frontier encompassed topics like reform of teaching modes,evaluation of post-competency among traditional Chinese medicine practitioners,and competency studies utilizing the Del-phi method.Conclusion Research on clinician post-competency in China grows rapidly,garnering increasing attention.To fur-ther advance this field,researchers should enhance collaboration and communication,conduct systematic investigations into re-search hotspots and cutting-edge issues,and continuously refine medical talent education and evaluation mechanisms.These ef-forts will provide a valuable foundation for promoting the high-quality development of hospitals.

The receptor-binding region(RBD)of the spike protein(S)on the surface of porcine epi-demic diarrhea virus(PEDV)is a critical structural domain mediating viral invasion of host cells and serves as a key target for inducing neutralizing antibodies.In order to prepare antibodies that can be used to study the biological function of PEDV RBD and develop novel diagnostic and thera-peutic methods,recombinant RBD protein expressed in Sf9 insect cells was utilized as an immuno-gen to immunize BALB/c mice.Monoclonal antibodies(mAbs)were generated via hybridoma tech-nology,and positive hybridoma clones were screened using indirect ELISA.The reactivity of the mAbs was subsequently characterized.The results of ELISA,Western blot,and indirect immuno-fluorescence assay(IFA)showed that three monoclonal antibodies screened(3E5,4F9 and 5A5)had good reactivity with the virus and RBD protein.Antibody subtype results showed that 3E5 and 4F9 were of IgG1 subtypes and 5A5 was of IgM subtype.Neutralization assay further revealed that 3E5 monoclonal antibody had viral neutralizing activity.In this study,three monoclonal antibodies against PEDV RBD proteins were successfully prepared,providing the basis for the study of the bi-ological function of RBD proteins,PEDV serologic detection and vaccine development.

As an important setting for the administration of vaccinations, the reasonable setting up and standardized management of vaccination clinics will enhance immunization service quality, public satisfaction, and improve the vaccination rate to protect people′s health. In recent years, various provinces in China are continuously promoting the standardized construction and management of vaccination clinics. However, the level of standardization management remains unbalanced, and the capacity of vaccination services needs to be further improved. This paper reviews the standardized management process of vaccination clinics, summarizes the practice and achievements in various regions, and analyzes the challenges and issues during these processes, to provide reference for improving the standardized management level of vaccination clinics in the future.

The receptor-binding region(RBD)of the spike protein(S)on the surface of porcine epi-demic diarrhea virus(PEDV)is a critical structural domain mediating viral invasion of host cells and serves as a key target for inducing neutralizing antibodies.In order to prepare antibodies that can be used to study the biological function of PEDV RBD and develop novel diagnostic and thera-peutic methods,recombinant RBD protein expressed in Sf9 insect cells was utilized as an immuno-gen to immunize BALB/c mice.Monoclonal antibodies(mAbs)were generated via hybridoma tech-nology,and positive hybridoma clones were screened using indirect ELISA.The reactivity of the mAbs was subsequently characterized.The results of ELISA,Western blot,and indirect immuno-fluorescence assay(IFA)showed that three monoclonal antibodies screened(3E5,4F9 and 5A5)had good reactivity with the virus and RBD protein.Antibody subtype results showed that 3E5 and 4F9 were of IgG1 subtypes and 5A5 was of IgM subtype.Neutralization assay further revealed that 3E5 monoclonal antibody had viral neutralizing activity.In this study,three monoclonal antibodies against PEDV RBD proteins were successfully prepared,providing the basis for the study of the bi-ological function of RBD proteins,PEDV serologic detection and vaccine development.

Objective:To report the 5-year survival outcomes and recurrence patterns of robotic total gastrectomy (RTG) for locally advanced proximal gastric cancer in order to provide more valuable long-term follow-up results for clinical practice.Methods:This was a prospective, single-arm, open-label clinical trial (FUGES-014; Clinical-Trials.gov, NCT03524287). Patients with locally advanced proximal gastric cancer who underwent RTG at Fujian Medical University Union Hospital from March 5, 2018, to February 10, 2020, were included in the analysis. To evaluate the long-term efficacy of RTG in the most objective manner possible, we performed a propensity score-matched (1∶2) comparative analysis with historical control patients who had undergone laparoscopic total gastrectomy (LTG) from the FUGES-002 study (ClinicalTrials.gov, NCT02333721) in which the 5-year disease-free survival (DFS), 5-year overall survival (OS), and recurrence patterns were compared between the two groups.Results:Prior to matching, there were 48 cases in the RTG group and 263 cases in the LTG group; patients in the LTG group had more advanced cT and pT stages ( P=0.044 and 0.006, respectively) compared to the RTG group. After matching, there were 48 cases in the RTG group and 96 cases in the LTG group; however, no statistically significant differences were observed in the baseline clinical characteristics between the two groups (all P>0.05). Both groups had a median follow-up of 72 months. The 5-year DFS rates were 75.0% (95%CI: 63.7%- 88.3%) in the RTG group and 61.4% (95%CI: 52.5%-72.0%) in the LTG group ( P=0.116). Similarly, the 5-year OS rates were 79.2% (95%CI: 68.5%-91.5%) and 64.6% (95%CI: 55.7%-74.9%) in the RTG and LTG groups, respectively ( P=0.100). Within 5 years after surgery, tumor recurrence occurred in 10 patients (20.8%) in the RTG group and 33 patients (34.4%) in the LTG group ( P=0.124), and peritoneal recurrence was the predominant pattern in both groups (8.3%[4/48] vs. 10.4%[10/96]; risk difference: -0.02, P=0.554). Gastric cancer-related death was the predominant cause of death in both groups (16.7% [8/48] vs. 31.2% [30/96]; risk difference: -0.15, P=0.064). Among patients stratified by different pathological stages, no statistically significant differences were found in DFS, OS, or recurrence rates between the RTG and LTG groups (all P>0.05). Conclusions:We find the long-term oncological outcomes of RTG for locally advanced proximal gastric cancer to be noninferior to those of LTG. RTG should therefore be considered as a valid option for standardized minimally invasive surgery for locally advanced proximal gastric cancer.

Emotions are an integral part of animal welfare.Facial expressions are increasingly used as a non-invasive method for assessing the emotional state of animals.Dogs(Canis familiaris)are closely related to humans,and facial expressions are crucial for interspecies communication and emotional expression.This paper reviews the neurobiological mechanisms of facial expressions and the anatomical structure of the facial muscles and their evolution in dogs,the analogy between dog and human facial expressions,and the expression of various parts of the dog's face under different emotions.These studies demonstrate that dog's facial expressions can be used as a potential indicator of animal welfare,and that dogs can be used as a model animal for studying interspecies facial emotional communication.The use of dog's facial expressions to assess emotions will aid multidisciplinary research,including in the fields of neuroscience,psychopharmacology,animal behavior,and animal welfare.

In recent years，the incidence and prevalence of non-tuberculous mycobacterial（NTM）infections have been on the rise，posing a serious threat to public health and presenting significant challenges for disease management. Currently，the treatment outcomes for NTM disease are poor，one of the main reasons being the high resistance of NTM pathogens to various anti-mycobacterial drugs. Novel therapeutic strategies targeting the host rather than the NTM pathogens themselves may help improve cure rates and reduce mortality. This article summarizes the latest research findings on host factors related to the incidence of NTM disease，including age，pulmonary diseases，immune function，genetic factors and lifestyle，which aids in the early identification of high-risk populations and provides a theoretical basis for developing targeted prevention and treatment strategies and optimizing treatment plans.