Science Progress最新文献

ObjectivesTo investigate the risk factors associated with thrombocytopenia in patients undergoing extracorporeal membrane oxygenation (ECMO) support.MethodsThis retrospective cohort study included 230 patients who received ECMO support during January 2018 to December 2024. Clinical data collected included age, gender, causes of ECMO, medical history, vital signs, laboratory test results, complications and outcomes. The patients were divided into the thrombocytopenia group and the control group based on whether the patient's platelet count was less than 150*10⁹/L. The differences in clinical data between the two groups were compared. Moreover, risk factors associated with thrombocytopenia were identified using univariate and multivariate regression analyses.ResultsIn this study, a total of 230 patients undergoing ECMO were involved. The mean age of patients was 52 ± 8 years with 119 (51.7%) males and 111 (48.3%) females. The age, sex distribution, reasons for ECMO, previous medical history, temperature, respiration rate, heart rate, mean arterial pressure, white blood cells, hemoglobin, C-reactive protein, platelets, total bilirubin, alanine aminotransferase, aspartate aminotransferase, prothrombin time, activated partial thromboplastin time, blood lactate between two groups showed no statistically significant differences (P > 0.05) while the APACHE II score (24(20,28) vs 21(17,24)) was higher in thrombocytopenia group (P < 0.05). The bleeding events were significantly higher (62.4% vs 15.7%), in-hospital survival (49.7% vs 62.9%) was lower, the duration of ICU stay (19(16,23) vs 18 (14,22)) was longer, and more platelet (30(10,40) vs 15 (10,20)) and plasma transfusions (600(400,800) vs 450 (200,600)) in thrombocytopenia group (P < 0.05). Logistic regression analysis showed that APACHE II score, rotational speed over the first 48 h, with sepsis, the heparin doseage before ECMO, use of continuous renal replacement therapy (CRRT) and intra-aortic balloon pump (IABP) during ECMO were risk factors associated with thrombocytopenia.ConclusionsThe incidence of thrombocytopenia in patients receiving ECMO is high and may be associated with poor prognosis. Patients with higher APACHE II score, higher rotational speed during the first 48 h, sepsis, higher heparin doseage before ECMO initiation, and the use of CRRT or IABP may at an increased risk of developing thrombocytopenia.

ObjectivesGrassland net primary productivity (NPP) in the Ili River Basin Grasslands, as Earth's largest terrestrial ecosystem, are crucial for global carbon cycling and ecological stability. Clarifying the spatiotemporal patterns and driving factors of grassland NPP is key to optimizing conservation strategies and enhancing productivity.MethodsUsing MODIS data (2000-2022) and the CASA model, this study estimated grassland NPP in the Ili River Basin, and explored its dynamic characteristics and responses to climate and human activities through trend analysis, correlation analysis, and the Hurst index.Results(1) NPP increased annually by 0.14% from 2000 to 2020, but decreased by 15.4% from 2020 to 2022, with an overall 12.95% decline over 23 years; extreme climates in 2008, 2014, and 2021 caused NPP to drop by 27.24%, 28.01%, and 21.31%, respectively, compared to the previous years. (2) High-NPP areas were concentrated in eastern mountainous regions (Nileke, Zhaosu, Tekes, etc.), while low-NPP areas were distributed in central urban zones and high-altitude regions, showing an "east-high-west-low" pattern. (3) Temperature was the main climatic driver (affecting 91,253 km²); human activities led to NPP decline in 55.94% of the area (far exceeding the 2.81% where NPP increased). (4) The Hurst index projected that 79.5% of the area would shift from decline to increase, 8% would continue to decline, and 9.81% would reverse from increase to decline.ConclusionsNPP showed a downward trend from 2000 to 2022 but is expected to rise significantly in the future, providing references for conservation efforts.

Background: Sudden sensorineural hearing loss is a prevalent ear disorder requiring acute intervention, characterized by unclear etiology and challenging therapeutic interventions. This study aims to identify potential biomarkers for sudden sensorineural hearing loss through metabolomic profiling.

Methods: We analyzed metabolomic data samples from a database associated with sensorineural hearing loss. Metabolomic analysis identified significantly differential metabolites in reversed-phase liquid chromatography and hydrophilic interaction liquid chromatography modes. We further validated abnormal metabolites using plasma samples from 51 sudden sensorineural hearing loss patients and 26 healthy controls in the case-control study.

Results: Metabolomic analysis revealed 75 and 76 significantly differential metabolites in reversed-phase liquid chromatography and hydrophilic interaction liquid chromatography modes, respectively. Integrating metabolomic and transcriptomic analyses, we validated four abnormal metabolites-triglyceride, lipase, S-adenosyl methionine, and cholesterol-in our cohort. In the serum of patients with sudden sensorineural hearing loss, the contents of triglyceride, lipase, S-adenosyl methionine, and cholesterol were significantly increased. These metabolites demonstrated significant discriminatory potential in distinguishing sudden sensorineural hearing loss patients from healthy controls.

Conclusions: Our findings underscore the promising utility of metabolomic profiling as a valuable approach for identifying potential biomarkers and unraveling the underlying mechanisms of sudden sensorineural hearing loss.

There are several factors that influence the mechanisms underlying human injuries in vehicle-to-pedestrian crashes (VTPCs). Traditional multibody system (MBS) models can simulate the entire VTPC process; however, they cannot fully and accurately assess the degree of injury to each part of the head. Therefore, a finite element (FE) model of the head with a complete brain structure is developed based on the 50th-percentile Chinese male data. First, the complete kinematic response of pedestrians in a VTPC is simulated using the MBS model, and the head kinematic response parameters that are most related to pedestrian injury are explored. An FE of the head model is subsequently established based on computed tomography (CT) and magnetic resonance imaging (MRI) data from a 50th-percentile Chinese male. Head-injury-related parameters are input into the head FE model, and orthogonal experiments are designed to analyze the head-to-windshield impact. The results show that impact velocity, position, and angle strongly affect the biological injury parameters of the head. These findings reveal the mechanisms of head injuries in pedestrians in VTPCs and the biomechanical dynamic response characteristics of the main parts of the head.

Currently, purely deep learning-based agents struggle to make optimal decisions within a short timeframe in problems with a vast decision-making space. Human planning knowledge is required to assist agents in making better decisions. This manuscript proposes a novel knowledge-guided and data-driven decision-making framework, utilizing hierarchical task network as the carrier of knowledge, deep learning as the trainer for data, and the Monte Carlo Tree Search as the connector between hierarchical task network and deep learning. The experiments on the MiniRTS environment validated that the proposed framework in this manuscript can replace humans in collecting high-quality data, and it can train neural networks that perform equally well as the compared network even with only 20% of the available data, which provide a new direction for future research.

Urological stones are the common urological diseases in clinical practice. So far, the mechanisms of kidney stone formation still remain unclear. Among all of the mechanisms, the supersaturated crystallization theory focuses on the microcrystal size of stones. However, there are few researches on the formation mechanism of stones in nanoscale. This narrative review summarizes the current mainstream mechanisms of kidney stone formation. It also discusses the relationship between calcium oxalate (CaOx) nanocrystals and the formation of kidney stones from the perspective of the physicochemical properties of the nanocrystals. To further explore the role of CaOx nanocrystals in the formation of CaOx, this review lists some convenient and reliable methods for tracking nanocrystals. Currently, in addition to mainstream treatments like potassium sodium hydrogen citrate and thiazide diuretics, some researches indicate that polysaccharide drugs, selenium nanoparticles, and dietary can inhibit the formation of nanocrystals, ultimately preventing the formation of CaOx stones.

ObjectiveThe aim is to enhance clinician awareness of the disease, reduce the risk of misdiagnosis, and analyze the risk factors for the progression of Chlamydia psittaci infection to severe pneumonia.MethodsWe conducted a retrospective analysis of the clinical data from patients infected with Chlamydia psittaci at our hospital.ResultsThirty-three patients diagnosed with Chlamydia psittaci pneumonia were included in this study. Among them, 23 (72.2%) were male and 10 (27.8%) were female, with a mean age of 59.1 ± 11.1 years. Twenty-four patients (72.7%) had a clear history of poultry exposure. The main clinical manifestations were high fever (n = 30, 90.9%), cough (n = 28, 84.8%), chill (n = 24, 72.7%), expectoration (n = 22, 66.7%), fatigue (n = 20, 60.6%), poor appetite (n = 20, 60.6%), dyspnea (n = 13, 39.4%), and myalgia (n = 10, 30.3%). The lymphocyte count in severe pneumonia group was significantly lower than that in non-severe pneumonia group. C-reactive protein, erythrocyte sedimentation rate, and lactate dehydrogenase levels in the severe group were remarkably higher than those in the non-severe group. The common imaging findings included flake high-density shadows (n = 29, 87.9%), consolidation (n = 20, 60.6%), pleural effusion (n = 17, 51.5%), bronchial inflation signs (n = 15, 45.5%), and ground-glass exudation (n = 20, 60.6%). The majority of patients received treatment with either doxycycline alone, quinolones alone, or a combination of doxycycline and quinolones.ConclusionHistory of contact with birds or poultry, repeated high fever, and flake high-density shadows with consolidation in Chest computed tomography can serve as important indicators for diagnosing C. psittaci pneumonia. Lower lymphocyte counts were identified as the sole risk factor associated with severe C. psittaci pneumonia. Quinolones and doxycycline are effective treatments for C. psittaci pneumonia.

ObjectiveTo evaluate the effectiveness of dental guards in preventing incisor injuries during direct laryngoscopy in microlaryngeal surgery (MLS).Study designNonrandomized retrospective comparative study.MethodsBetween 2022 and 2024, 50 patients who underwent elective MLS using a dental guard were consecutively selected as the dental guard group, and another 50 patients who underwent surgery without a dental guard were selected as the control group. A standardized silicone dental guard was applied to the maxillary incisors of the experimental group. An independent dentist conducted postoperative dental evaluations to assess incisor mobility and enamel damage.ResultsThe experimental group demonstrated significantly lower rates of dental injury (2% vs. 20%) compared with those of the control group. No adverse events related to dental guard use were reported.ConclusionDental guards effectively reduced the incidence of incisor injuries during direct laryngoscopy. Routine use is recommended to minimize perioperative dental complications.

ObjectiveIn recent years, the pericapsular nerve group (PENG) block and anterior quadratus lumborum block (aQLB) have emerged as regional anesthesia techniques commonly used for pain control after hip surgery. This study compared their analgesic efficacy during the first 48 hours following surgery under spinal anesthesia.MethodsIn this prospective, randomized, single-blinded study, patients were assigned to either the PENG (n = 43) or the aQLB group (n = 30). The primary outcome of the study was the total tramadol consumption within the first 48 hours postoperatively. Secondary outcomes included time to first rescue analgesia, resting and dynamic NRS pain scores at 2, 12, 24, and 48 hours postoperatively, and the incidence of complications.ResultsIn this study, postoperative tramadol consumption within the first 48 hours was significantly lower in the PENG (96.74 ± 77.36 mg) compared to the aQLB group (196.33 ± 157.43 mg) (p = 0.004). Additionally, the time to first rescue analgesia was significantly longer in the PENG (9.03 ± 7.67 hours) than in the aQLB group (6.81 ± 6.70 hours) (p = 0.048). NRS scores were similar between the groups at all time points. Quadriceps weakness was not observed in any patient.ConclusionThe PENG block provides effective postoperative analgesia without causing motor blockade, making it advantageous for early mobilization in patients undergoing hip surgery. It can be used as a part of multimodal analgesia.

Chronic mountain sickness (CMS), first described by Carlos Monge Medrano in 1925, is characterized by excessive erythrocytosis (EE), hypoxemia, and neurocognitive disturbances in long-term high-altitude residents. This narrative review revisits Monge's contribution in the light of modern research. CMS is now recognized worldwide, where genetic predisposition and environmental stressors jointly shape susceptibility to high-altitude life. Although hypoxia-driven erythropoietin (EPO) stimulation has long been considered the primary mechanism, recent evidence highlights the critical role of sex hormones in modulating erythropoiesis. EE, once the defining feature, is now complemented by symptom-based scoring systems that better capture the syndrome. Testosterone promotes erythroid expansion by stimulating progenitors, enhancing EPO sensitivity, and suppressing hepcidin, whereas estrogens counteract these effects by downregulating GATA1 and modulating hypoxia-inducible pathways. Elevated testosterone or high testosterone-to-estradiol ratios correlate with hemoglobin, hematocrit, and EE in CMS, explaining its greater prevalence and severity in men. Advances in molecular biology have identified the hypoxia-testosterone-EPO axis, with regulators such as SENP1 and GATA1, as central to disease susceptibility. Excessive androgenic signaling also worsens sleep-disordered breathing and cognitive dysfunction, while estrogenic modulation appears protective, opening avenues for prevention and therapy. In conclusion, CMS should be regarded as a multifactorial disorder shaped by hypoxia, hormones, gene-environment interactions, and cellular stress. Despite progress, underdiagnosis and limited healthcare attention in South American highlands remain major challenges, underscoring the relevance of Monge's seminal description.