General Hospital of Guangzhou Military Command

This study combines bioinformatics, network search, and immune infiltration analysis to explore the mechanisms and biomarkers underlying the comorbidity of atrial fibrillation (AF) and ischemic stroke (IS). The Gene Expression Omnibus database acquired 2 microarray datasets each for AF and IS. After removing batch effects and merging the data, potential comorbid targets were identified through differential expression analysis and weighted gene co-expression network analysis. These targets were then explored using a protein-protein interaction network to identify comorbid targets with similar functions, followed by enrichment analysis. Subsequently, hub genes were determined via Lasso regression, and predictive models based on these genes were constructed for both IS and AF to assess the models' predictive capabilities. Finally, immune infiltration analysis was conducted to uncover the comorbid mechanisms of IS and AF from an immunological perspective. From the AF dataset, 2063 differentially expressed genes were identified, along with 4776 genes from the most relevant turquoise module. From the IS gene set, 947 differentially expressed genes were identified, along with 1900 genes from the most pertinent blue module, yielding 31 intersecting genes as potential comorbid targets. Based on the protein-protein interaction network, a restart random walk algorithm focused on these 31 potential targets identified 50 related comorbid targets, primarily enriched in processes such as fatty acid metabolism, peroxisome proliferator-activated receptor signaling pathway, and ErbB signaling pathway. Hub genes cortactin, FOS, JUN, and cathepsin B were identified through Lasso regression and exhibited excellent predictive performance in both AF and IS datasets. Immune infiltration analysis revealed a higher infiltration abundance of monocytes, CD8+ T cells, and neutrophils in AF and IS samples. This study clarifies the comorbidity mechanisms of AF and IS, linking them to lipid metabolism and activated peroxisome proliferator-activated receptor/ErbB signaling pathways. Hub comorbid genes FOS, JUN, cortactin, and cathepsin B were identified, and the AF/IS early prediction models built on these genes show excellent performance, meriting clinical focus. Additionally, neutrophils, monocytes, and CD8+ T cells may participate in the shared pathogenesis of AF and IS, though whether hub genes regulate immune cell infiltration to affect AF/IS requires further experimental validation.

SummaryThe SFMBT2 protein is a Polycomb group protein implicated in transcriptional regulation and cancer biology. Here, we investigated the role of SFMBT2 promoter hypermethylation in colorectal cancer (CRC) development and its clinical relevance. Using CRC cell lines, FFPE tissues, plasma samples, and public datasets, we show that promoter hypermethylation is associated with the transcriptional silencing of SFMBT2. SFMBT2 expression was high in normal intestinal mucosa but progressively reduced in advanced adenoma, primary CRC, and metastatic lesions, accompanied by increased promoter methylation. Elevated plasma SFMBT2 methylation was associated with higher recurrence risk in stage III CRC and poor prognosis in stage IV disease. Bioinformatic analyses further linked high SFMBT2 expression to enhanced immune cell infiltration and activation of immune-related pathways. These findings identify SFMBT2 hypermethylation as a potential noninvasive biomarker for recurrence risk stratification and prognostic assessment in advanced CRC, and suggest a role for SFMBT2 in shaping the tumor immune microenvironment.

<title>Abstract</title> Purpose: This study aimed to improve the first pass success (FPS) rate of endotracheal intubation (ETI) performed by residency physicians in the emergency department using the PDCA cycle management approach. It also sought to increase the difficult airway identification success rate while reducing the multiple-attempts rate and overall complications. Methods: We compared data collected before (January 2021 - December 2022, control group, n=36) and after (January 2023 - December 2023, experimental group, n=44) implementing the PDCA cycle. The PDCA plan included: Plan: Set goals for standardized operations, skill advancement, and refined complication prevention; establish key indicators including FPS rate, multiple-attempts rate, difficult airway identification success rate, and overall complication rate. Do: Implement a tiered training system (admission system + graded practice), standardized operating procedures (SOP), and comprehensive quality control (use of video laryngoscopy, difficult airway protocols). Check: Monitor how well the procedures were followed in real-time (completeness of steps, correctness of equipment use). Act: Keep improving training based on feedback from the data. Results: Compared to before PDCA implementation, the FPS rate of the experimental group increased significantly from 55.6% (control group, 20/36) to 86.4% (38/44) ( <italic>P</italic> &lt;0.01). The rate of complications included esophageal intubation (6.8% vs. 27.8%) and laryngeal edema/vocal cord injury (4.5% vs. 30.5%), both of which decreased significantly compared to the control group, which was statistically significant ( <italic>P</italic> &lt;0.01). The ifficult airway identification success rate between these two groups were 30.8% and 92.9%, respectively, with statistical significance ( <italic>P</italic> &lt;0.01). Results by experience level showed that the FPS rate for third-year STRs increased from 50.0% to 85.2%, while the FPS rate for second-year STRs increased from 62.5% to 88.2%. Conclusion: The PDCA cycle management significantly improves the FPS rate of ETI and enhances operational safety through a tiered training system, standardized procedures, and dynamic quality control.. This approach provides a repeatable training framework for developing technical talent in emergency medicine and plays a vital role in managing airways of critically ill patients.

Epilepsy patients face significantly elevated cardiovascular risks, with cardiac arrhythmias occurring 2-3 times more frequently than in the general population. Current knowledge of brain-heart functional coupling abnormalities in epilepsy, particularly during interictal periods, remains limited. We investigated brain-heart interplay characteristics in temporal lobe epilepsy through synchronized electroencephalographic-electrocardiographic analysis using a synthetic data generation model and microstate analysis. We enrolled 52 patients with temporal lobe epilepsy (mean age = 33.4 ± 12.7 years) and 42 age-matched healthy controls (mean age = 31.95 ± 11.03 years). Twenty-minute artifact-free electroencephalographic segments were analyzed during resting states. Four directional brain-heart coupling sequences were extracted: CBrain→HF, CBrain→LF, CHF→Brain, and CLF→Brain, representing bidirectional interactions between brain activity and cardiac components. Six microstate topologies were consistently identified across all brain-heart interplay sequences, with temporal lobe epilepsy patients demonstrating significantly more complex and unstable topological characteristics compared to healthy controls. For CBrain→HF coupling, patients exhibited significantly reduced mean duration of microstate 3 (.34 ± .09 s vs. .38 ± .07 s, p = .02), increased occurrence rates of microstates 3 and 4 (both p < .001), and altered temporal coverage patterns. Similar abnormalities were observed across all sequences, with patients showing shortened microstate durations, altered occurrence rates, and disrupted temporal coverage. Spatial dissimilarity analysis revealed significant topological abnormalities across all microstates. A logistic regression model incorporating microstate parameters achieved 94.7% diagnostic accuracy for temporal lobe epilepsy, with an F1 score of .952 and an area under the curve of .932. Temporal lobe epilepsy is characterized by profound disruptions in brain-heart functional coupling during interictal periods, manifesting as altered microstate topographies and temporal dynamics. These findings establish microstate-based analysis as a promising framework for characterizing brain-heart axis dysfunction in epilepsy.

Compared to Classical Test Theory, Rasch analysis could provide more precise and specific estimates for the quality of measures. This study aimed to conduct Rasch analysis to examine the psychometric properties of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) in Chinese patients with major depressive disorder (MDD). The sample was comprised of 136 participants (66.9% females). Severity of depression was assessed through the Hamilton Depression Rating Scale 17-item and resilience through the CD-RISC-10. Rasch analysis was employed to evaluate unidimensionality, local independence, item fit, reliability, differential item functioning (DIF), ordering of response category and targeting. Rasch analysis confirmed the unidimensionality of the CD-RISC-10. All items demonstrated adequate fit, and all items were locally independent. No evidence of disordered category or threshold of rating scale was observed, indicating reasonable response category setting. There was no significant DIF except for item 1 and item 6 concerning sex. Moreover, all items were well-targeted and patients with moderate levels of resilience were better targeted. The CD-RISC-10 demonstrated acceptable psychometric properties among Chinese patients with MDD, providing more precise estimations for patients with moderate levels of resilience than those with high and low levels.

Enhanced external counterpulsation (EECP) is a safe, non-invasive, economic and effective assisted circulation technique. It not only can improves multisystem disorders, but also reduces adverse event rates. EECP utilizes electrocardiogram-gated sequential inflation of cuffs wrapped around patient's lower extremities to increase blood flow perfusion of heart, which can improve myocardial ischemia of patients with coronary heart disease (CHD). Patients with CHD or heart failure or sleep disorder are suitable to receive EECP. But there are few reports on super elderly people. This is the first reported case of a 98-year-old patient with CHD, who accepted EECP. Patient was presented to hospital with complaints of “intermittent chest tightness for 12 years, worsening for 20 days.” His medical history included lacunar infarction, as well as type 2 diabetes mellitus and hypertension. For the elderly patients reported in this case, the efficacy of medicine was limited and the surgical risk was high. After performing a course of EECP, The patient's symptoms of CHD adverse psychological conditions and sleep quality were improved. This report proved the effectiveness and safety of EECP to treat such super elderly patients with CHD, which provided evidence for the clinical application of EECP in such patients.

BackgroundMaternal microbiota during pregnancy plays a crucial role in establishing the neonatal gut microbiota, which is essential for infant health. This study aimed to trace maternal microbial sources contributing to early neonatal gut colonization and assess the effect of prenatal probiotic supplementation on maternal–to–neonatal microbial transmission.MethodsA total of 26 mother–neonate pairs undergoing full-term vaginal delivery were enrolled. From gestational week 32 until delivery, the intervention group received a probiotic supplement containing Bifidobacterium longum, Lactobacillus delbrueckii bulgaricus, and Streptococcus thermophilus twice daily, while the control group received no supplementation. Maternal fecal, vaginal, and placental samples were collected at full term, and neonatal fecal samples were collected longitudinally at Days 1, 3, 14, and 6 months postpartum. Microbial community profiling was performed using 16 S rRNA gene sequencing. Microbial source attribution was conducted using the FEAST algorithm.ResultsAlpha and beta diversity analyses showed that prenatal probiotics transiently altered the composition of neonatal meconium microbiota, with no significant differences observed at later time points. Volatility analysis revealed enhanced microbial stability in the probiotic group during Days 1 to 3 (P < 0.001). FEAST source-tracking indicated that maternal gut and placenta were the major contributors to neonatal meconium colonization, with gut-derived input increasing over time and vaginal contributions remaining minimal throughout. Probiotic supplementation significantly increased the placental contribution to meconium microbiota (P = 0.02), with a sustained but non-significant elevation observed through later stages. Meanwhile, gut-derived and vaginal-derived inputs were consistently reduced in the probiotic group, though these differences did not reach statistical significance.ConclusionThis study highlights the dynamic nature of maternal-to-neonatal microbial transmission and demonstrates that prenatal probiotic supplementation can transiently reshape early colonization patterns by modulating source contributions.Trial registrationClinicalTrials.gov, NCT06241222 (https://clinicaltrials.gov/study/NCT06241222); retrospectively registered on 2024-01-17 (study start 2018-01-01; completion 2021-12-31; first posted 2024-02-05).Supplementary InformationThe online version contains supplementary material available at 10.1186/s12967-025-07293-6.

BackgroundAlthough pembrolizumab has been shown to be effective, its high price has prevented it from being widely used. Especially in the real world, the application situation is still uncertain. The purpose of this study was to evaluate the cost-effectiveness of pembrolizumab on the basis of real-world studies, from the perspective of the health care system.MethodsRetrospectively, 630 patients with advanced NSCLC treated with pembrolizumab (monotherapy or combination chemotherapy) versus chemotherapy alone from January 2020 to December 2022 at a large 3 A hospital in China were included. Confounders between groups were eliminated using propensity score matching analysis. A partitioned survival model was developed to evaluate the cost-effectiveness of pembrolizumab versus chemotherapy for the treatment of advanced NSCLC based on progression-free survival, overall survival, and the incidence of adverse effects in the two matched groups (n = 450 patients). The incremental cost-effectiveness ratio was calculated. The impact of a drug donation program on the cost-effectiveness of pembrolizumab was also evaluated.ResultsPembrolizumab significantly improved median PFS in patients (15.5 months vs. 8.8 months). The median OS in the Pembrolizumab group has not been reached, while it was 26.2 months in the chemotherapy group. When the drug donation program is not considered, the ICER of pembrolizumab is $146,409.07/QALY. Regardless of whether the willingness-to-pay threshold is set at three times the per capita GDP of China ($36,070.2) or three times the per capita GDP of Guangdong Province ($64,523.8), the use of pembrolizumab is not cost-effective. However, after considering the drug donation program, the ICER decreased to $56,127.74/QALY. Under the willingness-to-pay threshold of three times the per capita GDP of Guangzhou in 2022 ($64,523.8), pembrolizumab became a cost-effective choice.ConclusionIn the treatment of advanced NSCLC in China, pembrolizumab, particularly when considering the drug donation program, offers better survival outcomes and becomes cost-effective. This highlights the importance of such programs in making high-cost treatments accessible in real-world clinical settings.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00432-025-06242-6.