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The 2023 (1st Edition) NCCN guideline changed the negative margin criteria for cervical conization from ≥ 3 mm to ≥ 1 mm. To explore the clinical safety of this up-dation in the real world, we performed a retrospective study to validate the rationality of the negative margin criteria for conization in patients with early-stage cervical cancer. We retrospectively collected the clinical and pathological data of 986 patients with early-stage cervical cancer from June 2011 to June 2023. All of the patients underwent conization and secondary (radical) hysterectomy at Tianjin Central Hospital of Gynecology Obstetrics. Patients were divided into four groups based on the status of the conization margins: margin < 1 mm ( n  = 132), margin < 3 mm ( n  = 147), margin involved ( n  = 443), and margin not involved ( n  = 264). The safety of the negative margin criteria for conization (< 1 mm) was evaluated by comparing the residual disease rates in different groups after secondary (radical) hysterectomy. Additionally, univariate and logistic multivariate analyses were conducted to identify the risk factors for residual disease after hysterectomy. A total of 986 patients with cervical cancer at stages IA1-IB1 were included. Among these patients, 382 had residual diseases (HSIL or higher) after hysterectomy, resulting in a residual disease rate of approximately 38.7%. Patients were categorized based on margin status (< 1 mm, <3 mm, margin involved, and, margin not involved). There were statistically significant differences in residual disease rates among the four groups ( P  < 0.05). There is no significant difference in residual disease rates between patients with the margin < 1 mm and margin < 3 mm, nor between these two groups and the margin not involved group. However, the residual disease rates in cases with margins < 1 mm and margins < 3 mm were significantly lower compared to those with margin involvement. Univariate analysis indicated that multiple factors, including age, were associated with residual disease. However, multivariate analysis revealed that age ( P  = 0.002, OR = 1.041, 95% CI 1.014–1.069), involvement of the margin by the lesion ( P  < 0.001, OR = 7.655, 95% CI 4.745–12.349), and cervical biopsy pathology showing cancer ( P  = 0.020, OR = 1.571, 95% CI 1.074–2.298) were independent risk factors for residual disease after hysterectomy in early-stage cervical cancer patients. Our findings suggest that a ≥ 1 mm negative margin criterion appears to be a safe threshold for early-stage cervical cancer, yet prospective validation is still required.

represents a group of bacteria that exhibit significant value in industrial and agricultural applications, while also posing pathogenic risks to humans. 704A1 was isolated from a patient with tuberculous pleurisy. Its 16S rRNA sequence showed the highest homology (99.72%) with a strain without defined species classification. It is necessary to clarify the species 704A1 belonging to and its potential pathogenicity to humans. Systematical evaluations including phenotypic and biochemical characteristics, antibiotic susceptibility, genomic sequencing were conducted. The pathogenicity and immunological characteristics were tested by intranasally inoculated C57BL/6J mice. 704A1 is Gram negative rod-shaped bacterium with flagella at single extreme. Showing highly similar with , 704A1 also displayed distinct characteristic peaks in fatty acid profiling and MALDI-TOF analysis. 704A1 was resistance to 21 antibiotics, including four anti-tuberculosis drugs: rifampicin, streptomycin, rifabutin, and cycloserine. The average nucleotide identity (ANI) values of 704A1 compared to defined species ranged from 80.03% to 89.6%, below than both the commonly accepted 95%-96% ANI threshold for prokaryote species and the 95% threshold suggested for . Though no mortality was observed, 704A1 could cause severe consolidation in murine lung tissue and has the ability of hematogenous dissemination. Results supported the classification of 704A1 (=GDMCC 1.4133 ) as a novel species within the genus , for which the name sp. nov. is proposed. 704A1 is a multi-antibiotic resistance strain with potentially stronger pathogenicity than and requires more clinical attention. The isolation of 704A1 underscored the importance of sustained surveillance and taxonomic clarity of species emerging from clinical environments.

As the critical component of capturing wind energy, the performance and reliability of blade are directly related to the safe, stable operation and service life of wind turbines. The performance of the blade is mainly determined by the ply parameters, so it has important valueto study the optimization method of ply parameters and the analysis method of strength reliability of wind turbine blade.In this paper, the load of a 1.5MW wind turbine bladeunder the DLC1.5g-2 working condition is calculated and its finite element model is established. Combined with engineering practice, the investigation range of ply parameters is determined, the test scheme is designed by using the mixed level uniform experiment method, and the blade strength is analyzed. Based on the polynomial regression analysis method and simulation results, the quadratic mathematical model between the ply parameters and the Tsai-Wu failure factors is established, and the range of ply parameters is optimized by mean value analysis method and interaction analysis method. On this basis, the ply parameters are regarded as random variables, and the structural performance function of blade failure is constructed. The reliability of the blade is predicted by the first-order second-moment method. The results show that the blade is reliable in the range of optimized ply parameters. The work provides the method and technical support for the laminate structure design and optimization of wind turbine blade.

is a prominent genus owing to its dual nature. Species of this genus have many applications in industry and agriculture as plant growth-promoting rhizobacteria and microbial biological control agents, whereas species such as are considered one of the leading gram-negative multi-drug-resistant bacterial pathogens because of their high contribution to the increase in crude mortality and significant clinical challenge. Pathogenic species and most clinical isolates belong to the complex (SMc). However, a strain highly homologous to was isolated from a patient with pulmonary tuberculosis (TB), which aroused our interest, as belongs to a relatively distant clade from SMc and there have been no human association reports. The pathogenicity, immunological and biochemical characteristics of 610A2 were systematically evaluated. 610A2 is a new species of genus , which is named as sp. nov. for its obvious brown water-soluble pigment. 610A2 is pathogenic and caused significant weight loss, pulmonary congestion, and blood transmission in mice because it has multiple virulence factors, haemolysis, and strong biofilm formation abilities. In addition, the cytokine response induced by this strain was similar to that observed in patients with TB, and the strain was resistant to half of the anti-TB drugs. The pathogenicity of 610A2 may not be weaker than that of . Its isolation extended the opportunistic pathogenic species to all 3 major clades of the genus , indicating that the clinical importance of species of other than and potential risks to biological safety associated with the use of require more attention.

Acupuncture has been increasingly applied as an adjunctive treatment for major depressive disorder (MDD), yet its central neurobiological mechanisms remain insufficiently understood. Cerebral blood flow (CBF) and functional connectivity strength (FCS) provide complementary perspectives on regional metabolic activity and large-scale functional integration, and their coupling may reflect neurovascular coordination relevant to depression. Twenty patients with MDD and twenty matched healthy controls (HC) underwent resting-state MRI. Patients received intradermal acupuncture (IA) and were scanned before and immediately after stimulation, while healthy controls were scanned once. Voxel-wise analyses of CBF, FCS, and their ratio (CBF/FCS) were performed to characterize acupuncture-related changes in neurovascular coupling. Group comparisons and pre-post acupuncture effects were assessed at the whole gray matter level. Acupuncture induced significant alterations in CBF/FCS coupling across widespread brain regions, including the bilateral precuneus, postcentral gyrus, superior temporal pole, superior frontal gyrus, occipital cortex, and cerebellum. These regions are primarily involved in sensorimotor processing, cognitive control, and emotional regulation. Overall, IA was associated with an immediate increase in CBF/FCS coupling, suggesting enhanced coordination between cerebral perfusion and functional network integration. This study provides evidence that intradermal acupuncture modulates neurovascular coupling in patients with MDD, offering neuroimaging-based insights into its antidepressant mechanisms. The findings support the notion that acupuncture may facilitate more efficient brain function by optimizing the balance between neural activity and metabolic supply.

Multidrug-resistant (MDR-AB) poses a critical threat in neonatal intensive care units (NICUs), however few studies have reported the molecular characterization of isolates from the NICU in China. This study aims to describe the molecular, biofilm and motility characteristics related to carbapenem resistance genes in isolates from the NICU. Following an outbreak in March-April 2024, 21 A isolates from neonatal and environmental sources were collected. These isolates underwent antimicrobial susceptibility testing, whole-genome sequencing (WGS) for resistance gene profiling and multi-locus sequence typing (MLST). Biofilm formation and twitching motility were measured in representative strains exposed to subinhibitory concentrations of gentamicin, levofloxacin, and meropenem. All 21 A isolates were carbapenem-resistant (CRAB), showing resistance to cephalosporins, aminoglycosides, and quinolones. WGS identified 25 resistance genes, including the universal , , and , aminoglycoside resistance genes ( , ), macrolide resistance genes ( , ), and tetracycline ( ) resistance genes. Efflux pumps ( , , ) were ubiquitous. Two sequence types emerged: ST195 (20 isolates) and ST1959 (1 isolate), with high genetic similarity suggesting nosocomial transmission. ST1959 exhibited stronger biofilm formation than ST195. Biofilm formation of ST1959 was significantly enhanced by gentamicin but inhibited by levofloxacin. Meropenem suppressed only the ST195 biofilms. Twitching motility was markedly reduced in ST1959 and also decreased after levofloxacin exposure. This NICU outbreak was driven by CRAB ST195 harboring a conserved resistome. Strain-specific differences in biofilm formation and motility under antibiotic stress highlight the interplay between genetic lineage and phenotypic adaptability. Levofloxacin demonstrates dual anti-biofilm and anti-motility effects, which could guide targeted infection control strategies against high-risk clones.

The role of thyroid hormones and their interaction with sex hormones in adolescent major depressive disorder (MDD), particularly regarding sex differences, remains poorly understood. This cross-sectional study included first-episode adolescent depression outpatients. All patients were stratified by depression severity into non-major depression disorder (non-MDD) and MDD groups. Serum levels of thyroid and sex hormones (testosterone, estradiol, progesterone) were measured. Group comparisons, correlation analyses, multivariate logistic regression, and moderation analysis were performed. The study included 837 patients (597 females and 240 males), comprising 359 non-MDD and 478 MDD cases. The mean age was 15 years (IQR 14-16). Compared to males, females exhibited higher SDS (Z = -7.34, < 0.001), higher SAS scores (Z = -5.73, < 0.001), alongside lower T3 (Z = -3.81, < 0.001), FT4 (Z = -3.54, < 0.001), and FT3 levels (Z = -6.38, < 0.001), while sex hormones differed as anticipated: testosterone was higher in males (Z = -21.00, < 0.001), whereas estradiol and progesterone were higher in females (Z = -13.02, < 0.001; Z = -5.74, < 0.001, respectively). SDS scores correlated negatively with T4 (ρ = -0.080, = 0.021), T3 (ρ = -0.099, = 0.004), and testosterone (ρ = -0.207, < 0.001), and positively with estradiol (ρ = 0.144, < 0.001) and progesterone (ρ = 0.104, = 0.003). Three multivariate regression models were established, among which Model 3-including age, sex, T3, and testosterone-achieved the highest AUC of 0.80 (95% CI = [0.77-0.83]). Moderation analysis demonstrated that testosterone significantly moderated the T3-depression relationship (interaction β = -0.09, = 0.04). Furthermore, higher T3 was associated with lower depression severity in high-testosterone subgroups (simple slope = -1.39, = 0.003). Thyroid dysfunction is associated with adolescent MDD in a sex-specific manner. A logistic regression model incorporating both thyroid and sex hormones showed improved classification accuracy. Importantly, testosterone was found to moderate the relationship between T3 and depression severity. These findings suggest that assessing thyroid function alongside sex hormone levels may enhance risk stratification in adolescent MDD.

IntroductionPeritoneal dialysis-associated peritonitis (PDAP) is a serious complication of peritoneal dialysis (PD), contributing significantly to hospitalization rates and mortality. In recent years, infections caused by uncommon pathogens such as Coxiella burnetii have increasingly been identified, posing significant challenges to managing PDAP.Case presentationWe report a 62-year-old male hospitalized for recurrent PDAP unresponsive to empirical antibiotics (meropenem, later meropenem/vancomycin). Metagenomic next-generation sequencing (mNGS) of peritoneal fluid identified C. burnetii . Intravenous omadacycline was initiated as part of a multi-agent regimen (100 mg daily after 200 mg loading dose). Within 48 h, hemodynamic stability was achieved, and inflammatory markers (procalcitonin, C-reactive protein, effluent white blood cell count) normalized progressively over the subsequent week. The patient recovered fully and was discharged, and remained relapse-free during 3 months of follow-up.ConclusionThis case highlights the critical importance of identifying pathogens in patients with PDAP. Despite significant confounders (concurrent broad-spectrum antibiotics, ICU support, and polymicrobial infection) that limit definitive attribution, the use of omadacycline was associated with clinical recovery and suggests a potential role as an alternative therapeutic option for Coxiella burnetii infection. Further studies are warranted to validate its efficacy.

Interictal epileptiform discharges (IEDs) are expressed in epileptic networks and disrupt cognitive functions. It is unclear whether addressing IED-induced dysfunction could improve epilepsy outcomes, as most therapeutic approaches target seizures. We show, in a kindling model of progressive focal epilepsy, that IEDs produce pathological oscillatory coupling associated with prolonged, hypersynchronous neural spiking in synaptically connected cortex and expand the brain territory capable of generating IEDs. A similar relationship between IED-mediated oscillatory coupling and temporal organization of IEDs across brain regions was identified in human participants with refractory focal epilepsy. Spatiotemporally targeted closed-loop electrical stimulation triggered on hippocampal IED occurrence eliminated the abnormal cortical activity patterns, preventing the spread of the epileptic network and ameliorating long-term spatial memory deficits in rodents. These findings suggest that stimulation-based network interventions that normalize interictal dynamics may be an effective treatment of epilepsy and its comorbidities, with a low barrier to clinical translation. Pathological neural communication drives the spread of the epileptic network and contributes to memory impairment in focal epilepsy. The authors show that closed-loop electrical stimulation in rodents can prevent this interaction and preserve long-term memory.

New combinations or alternative therapies for major depressive disorder (MDD) are necessary. Intradermal acupuncture (IA) shows promise but requires further investigation regarding its efficacy, safety, and mechanisms. Conducted across 3 centers from November 2022 to January 2024, our randomized controlled trial included 120 participants with moderate to severe MDD, divided into the selective serotonin reuptake inhibitors (SSRIs), SSRIs plus sham IA (SSRIs + SIA), and SSRIs plus active IA (SSRIs + AIA) groups. Acupuncture groups received 10 sessions over 6 weeks at Shenmen (HT7), Neiguan (PC6), Sanyinjiao (SP6) and Taichong (LR3) bilaterally, followed by a 4-week follow-up. The primary outcome was changes in Hamilton Depression Rating Scale-17 (HAMD-17) scores at week 6. Furthermore, healthy controls (HCs) and MDD patients underwent magnetic resonance imaging (MRI) scans for functional connectivity (FC) analysis. After 6 weeks of treatment, the SSRIs + AIA group showed a greater reduction in HAMD-17 score than the SSRIs + SIA group (MD, −4.9 [CI, −7.6 to −2.2], P  < 0.001) and SSRIs group (MD, −5.1 [CI, −7.8 to −2.3], P  < 0.001). No serious adverse events occurred. SSRIs + AIA resulted in lower incidences of palpitations (vs.SSRIs + SIA: OR, 0.1% [CI, 0.0–1.0%]; vs. SSRIs: OR, 0.1% [CI, 0.0–0.7%]; P  < 0.05), somnolence (vs.SSRIs + SIA: OR, 0.1% [CI, 0.0–0.9%]; vs.SSRIs: OR, 0.1% [CI, 0.0–0.7%]; P  < 0.05), and nausea (vs.SSRIs + SIA: OR, 0.1% [CI, 0.0–1.0%]; vs. SSRIs: OR, 0.1% [CI, 0.0–0.9%]; P  < 0.05). MDD patients showed abnormal FCs, and IA enhanced FCs between striatum and frontal_inf_tri, and striatum and cerebellum in the MRI study. Overall, IA as adjunctive therapy provides clinical efficacy and safety for MDD, and it may exert antidepressant effects by modulating striatal FCs.