Objective To investigate the correlation between platelet-to-albumin ratio(PAR)and occurrence of cerebral infarction after left atrial appendage closure(LAAC)in patients with non-valvular atrial fibrillation(NVAF).Methods A retrospective study was conducted on 259 NVAF patients undergoing LAAC in our department between 2019 and 2023.According to occurrence of cerebral infarction after LAAC or not,they were divided into a control group(241 cases)and a study group(18 cases).Their general data were collected,and Cox proportional hazards regression model was used to identify the risk factors for cerebral infarction.ROC curve was plotted to assess the predictive value of PAR for cerebral infarction in NVAF patients after LAAC,and the AUC value was calculated.Kaplan-Meier survival curve was drawn to analyze the incidence of cerebral infarction after LAAC in NVAF patients with different PAR values.Results The study group had significantly advanced age,higher SBP at admission,increased WBC,neutrophil,monocyte and platelet counts,longer thrombin time,elevated international normalized ratio(INR)and high-sensitivity C-reactive protein(hs-CRP)level,and higher PAR than the control group(P＜0.05,P＜0.01).Multivariate Cox regression analysis showed that PAR(HR=2.286,95％CI:1.182-4.420,P＜0.05)was an independent risk factor for cerebral infarction in NVAF patients after LAAC.ROC curve indicated that the AUC value of PAR in predicting cerebral infarction after LAAC in NVAF patients was 0.721(95％CI:0.586-0.856,P＜0.01),with an optimal cut-off value of 4.137,a sensitivity of 66.39％,and a specificity of 77.78％.Kaplan-Meier survival curve revealed that the higher the PAR value was,the higher the risk of cerebral infarction was(P＜0.01).Conclusion PAR is significantly correlated with cerebral infarction in NVAF patients after LAAC.The higher the PAR,the higher the risk of cerebral infarction,demonstrating its predictive value and being worthy of clinical promotion.

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.

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.

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.

Proteolysis-targeting chimeras(PROTACs)represent a promising class of drugs that can target disease-causing proteins more effectively than traditional small molecule inhibitors can,potentially revolu-tionizing drug discovery and treatment strategies.However,the links between in vitro and in vivo data are poorly understood,hindering a comprehensive understanding of the absorption,distribution,metabolism,and excretion(ADME)of PROTACs.In this work,14C-labeled vepdegestrant(ARV-471),which is currently in phase Ⅲ clinical trials for breast cancer,was synthesized as a model PROTAC to characterize its preclinical ADME properties and simulate its clinical pharmacokinetics(PK)by estab-lishing a physiologically based pharmacokinetics(PBPK)model.For in vitro-in vivo extrapolation(IVIVE),hepatocyte clearance correlated more closely with in vivo rat PK data than liver microsomal clearance did.PBPK models,which were initially developed and validated in rats,accurately simulate ARV-471's PK across fed and fasted states,with parameters within 1.75-fold of the observed values.Human models,informed by in vitro ADME data,closely mirrored postoral dose plasma profiles at 30 mg.Furthermore,no human-specific metabolites were identified in vitro and the metabolic profile of rats could overlap that of humans.This work presents a roadmap for developing future PROTAC medications by elucidating the correlation between in vitro and in vivo characteristics.

Objective:To evaluate preoperative high-resolution thin-layer cervical enhanced CT used to predict the venous route of the submental flap reflux vein and its relationship with adjacent structures in order to guide the anatomical understanding and protection of submental flap in pharyngeal cancer surgery.Methods:Sixty consecutive patients with pharyngeal cancer who underwent submental flap repair surgery in our department from March 2022 to December 2024, as well as 60 patients who were accepted neck dissection suffering other cancers, were selected. Before surgery, high-resolution cervical enhanced CT scans were performed, and the position of the transverse section of the facial vein in the venous phase horizontal image gradually variation tendency was focused layer by layer. The direction and adjacent relationship of the submental flap reflux veins were determined and recorded. Combined with 60 patients with other head and neck tumors who underwent neck dissection in our department during the same period (a total of 120 cases, 240 sides), the classification and management of the draining veins of Fang′s mental flap were conducted. Type Ⅰ mainly drains into the internal jugular vein; Type Ⅱ mainly drains into the external jugular vein and Type Ⅲ mainly drains into the anterior jugular vein (often accompanied by an external jugular draining branch). The status and proportion of venous drainage were analyzed.Results:Vascular predictive coincidence rate was 98.3% (59/60) among the 60 patients with pharyngeal cancer. Only one patient was predicted to have a simple return to the external jugular vein. However, during the operation, in addition to the main return to the external jugular vein, a small portion also returned to the internal jugular vein. Submental flap reflux vessels were classified into three types based on intraoperative submental flap venous return in 60 cases of laryngopharyngeal cancer, in conjunction with the analysis of venous return patterns from 240 cervical CT scans. Type Ⅰ mainly refluxed to the internal jugular vein, accounting for 42.1%. Type Ⅱ mainly refluxed to the external jugular vein (47.9%). Type Ⅲ mainly refluxed to the anterior jugular vein (10.0%). The total detection rate of CT reading of 240 venous reflux was 98.7% (237/240). Vascular predictive coincidence rate was 97.9%(235/240).Conclusion:The detailed analysis of submental venous return vessels can accurately predict the direction of reflux veins and its surrounding areas by preoperative high-resolution enhanced CT scan. This provides reliable guidance for the anatomy and protection of the submental flap reflux veins during surgery.

Objective:To compare the survival outcomes of different subsequent treatment regimens in patients with locally advanced hypopharyngeal squamous cell carcinoma (HPSCC) who achieved partial response (PR) after neoadjuvant chemotherapy based on the gross tumor volume regression rate (GTVRR).Methods:This retrospective study included patients with locally advanced HPSCC treated at the Department of Head and Neck Surgery, Beijing Tongren Hospital, from January 2011 to December 2023. The cohort included 135 males and 3 females, aged from 35 to 77 years. All patients received 2-3 cycles of TPF regimen (paclitaxel+cisplatin+5-fluorouracil) neoadjuvant chemotherapy. Subsequent treatments included concurrent chemoradiotherapy or surgery combined with postoperative adjuvant radiotherapy. The impacts of different subsequent treatment modalities on the survivals and prognoses of patients were compared based on GTVRR thresholds of 50% and 70%. The χ 2 test was used to analyze influencing factors; survival analysis and intergroup comparisons were performed using the Kaplan-Meier method and Log-rank test; prognostic factors were assessed using univariate and multivariate Cox regression analyses. Results:The 5-year OS and PFS rates were 56.5% and 47.9%, respectively, while, the 10-year OS and PFS rates were 25.8% and 21.2%, respectively. The median OS was 75 months, and the median PFS was 48 months. The laryngeal function preservation rate for the entire cohort was 83.3%. The patients who underwent surgery combined with postoperative radiotherapy had significantly better OS and PFS outcomes than those treated with concurrent chemoradiotherapy ( P<0.05). Stratification based on GTVRR revealed that the surgery plus postoperative radiotherapy regimen was particularly effective for PR patients with a GTVRR of 30%-70%, showing significantly better OS and PFS compared to the concurrent chemoradiotherapy group ( P<0.05). Conclusion:The optimal subsequent treatment for PR-HPSCC may be surgery-based comprehensive treatment, particularly for patients with a GTVRR of 30%-70%. This study offers valuable insights for the stratified treatment of HPSCC, which could contribute to improving overall patient prognosis.

As an important strategy in antiviral drug development, nucleoside analogs (NAs) have attracted considerable attention due to their unique mechanisms of action and favorable safety profile. This review systematically summarizes recent advances in the mechanisms of action of NAs, focusing on the following four aspects: (1) Targeting viral polymerases, inhibiting viral replication through mechanisms such as non-absolute termination, delayed chain termination and induction of viral RNA mutations in addition to classical chain termination, which has been newly discovered; (2) Regulating RNA methylation modifications—for instance, competitively inhibiting methyltransferases, which significantly reduces viral replication efficiency; (3) Depleting nucleotide pools—by affecting host cell purine nucleotide synthesis pathways, thereby indirectly inhibiting viral replication; and (4) Immunomodulatory functions—including activation of the STING pathway to promote interferon production. Furthermore, this review systematically discusses the breakthrough progress in prodrug technologies for addressing key clinical challenges such as drug resistance and off-target toxicity of NAs. These advances provide crucial technical support for the clinical translation of NAs. These advances provide key technical support for the clinical translation of NAs. This review clarifies the multi-target action rules of NAs and provides a theoretical framework for the design of next-generation broad-spectrum antiviral agents.

Hematological malignancies are a serious disease with a high risk of mortality and a high tendency to recur. The current mainstream treatment methods mainly include chemotherapy, targeted therapy, supportive therapy, and hematopoietic stem cell transplantation. Immune cell therapy can induce the function of immune cells and accurately kill tumors and pathogens. For those refractory patients who experience relapse or have poor response to traditional treatments, the immune cell therapy has good clinical efficacy. This article reviews the latest advances in immune cell therapy for hematological malignancies.

Acute leukemia is a common hematological malignancy.Conventional chemotherapy,targe-ted drug therapy,hematopoietic stem cell transplantation and other treatment methods have made progress,but the mortality rate of patients after recurrence is still high.Adoptive cell therapy(ACT)has emerged as an effective therapeutic option for acute leukemia,particularly chimeric antigen receptor(CAR)T-cell therapy,which has demonstrated remarkable efficacy in treating B-cell acute lymphoblastic leukemia(B-ALL)and ma-lignant lymphoma.However,CAR-T cell therapy may induce cytokine release syndrome.Recent studies have highlighted the potent anti-leukemia effects of CAR-NK cell therapy.This review summarizeed the research progress of ACT employing various immune cells targeting different antigens in the treatment of acute leukemia.