Science Progress最新文献

ObjectiveTo validate a serial multimodal ultrasound (MMUS) protocol for assessing dynamic tibialis anterior changes in detecting intensive care unit-acquired weakness (ICUAW) and to develop a diagnostic algorithm.MethodsIn a prospective cohort of 97 high-risk adults (mean age 60.7±13.7 years; 73.2% male; SOFA score ≥8 for ≥3 days), MMUS quantified structural (thickness, echogenicity), hemodynamic (perfusion grade, peak systolic velocity [PSV]), and mechanical (elastic modulus) parameters of the tibialis anterior at ICU admission (Day 1) and Day 7. ICUAW was diagnosed per American Thoracic Society guidelines. Serum biomarkers (IL-6, PCT, CRP) were correlated with sonographic changes. Diagnostic models were constructed using binary logistic regression and evaluated by ROC analysis.Results31 patients (32.0%) developed ICUAW. By Day 7, the ICUAW group showed greater structural deterioration (echogenicity progression: 54.8% vs. 16.7%, P < 0.001), hemodynamic changes (PSV: 7.60 ± 1.72 vs. 6.35 ± 1.78 cm/s, P < 0.001), and faster stiffness increase (elastic modulus rate: 14.1±12.3% vs. 5.4±6.0%, P < 0.001). Day 7 PSV correlated with IL-6 (r = 0.59), PCT (r = 0.50), and CRP (r = 0.68) (all P < 0.05). A 7-parameter model achieved an AUC of 0.917 (95%CI: 0.857-0.978) with an NPV of 92.4%.ConclusionDynamic MMUS captures ICUAW pathophysiology. The proposed algorithm shows potential as a non-invasive bedside tool for early risk stratification, pending multicenter validation.

ObjectiveTo investigate the independent associations, dose-response relationships, and heterogeneity across different populations between eight cholesterol-related indices (WHR, LHR, NHR, MHR, PHR, AIP, CHG, and RCII) and diabetic nephropathy (DN), utilizing data from the National Health and Nutrition Examination Survey (NHANES).MethodsThis cross-sectional analysis included 9421 participants from the NHANES 2015-2020 cycles, including 631 DN patients. Multivariable logistic regression was used to assess associations between each index and DN. Restricted cubic spline (RCS) models were employed to explore nonlinear relationships, and effect modification was assessed across subgroups defined by gender, BMI, glycemic control, and other characteristics.ResultsAfter adjusting for multiple confounders, WHR, LHR, NHR, AIP, CHG, and RCII were all significantly positively associated with DN risk (all P < 0.001), with RCS analyses indicating nonlinear "threshold effects" for most indices. Subgroup analyses revealed significant heterogeneity in associations: WHR and LHR showed stronger associations in females; AIP and CHG remained robust across BMI and glycemic control subgroups; RCII showed stronger associations among non-hypertensive and non-smoking individuals.ConclusionIn this cross-sectional study, six cholesterol-inflammation composite indices were independently associated with DN, predominantly exhibiting non-linear dose-response relationships. The variation in association strength across sex, metabolic status, and lifestyle factors suggests a potential pattern of "pathway heterogeneity" in DN risk. These indices warrant further investigation in future studies to explore their value as early clues for risk identification.

ObjectiveSepsis remains a primary contributor to mortality among critically ill individuals, and the assessment of vascular stiffness, indicated by estimated pulse wave velocity (ePWV), could offer insights into patient outcomes. This retrospective cohort study examines the correlation between ePWV levels and all-cause mortality in individuals with sepsis.MethodsA total of 22,166 sepsis patients from the MIMIC-IV database were included. Cox regression analysis, restricted cubic spline (RCS) analysis, and subgroup analyses were conducted to evaluate the association between ePWV and 30-day and 365-day mortality.ResultsThe 30-day and 365-day mortality rates were 18.28% and 32.93%, respectively. Compared to the first quartile (Q1), patients in the highest ePWV quartile (Q4) had a 92% higher risk of 30-day mortality (HR: 1.92, 95% CI: 1.73-2.13, p < 0.001) and an 75% higher risk of 365-day mortality (HR: 1.75, 95% CI: 1.62-1.89, p < 0.001) in adjusted models. RCS analysis identified a nonlinear association between ePWV and mortality (p for non-linearity < 0.001) with inflection points at 9.04 m/s for 30-day mortality and 10.81 m/s for 365-day mortality. The nomogram model demonstrated good performance in predicting both 30-day and 365-day mortality, with area under the curve values of 0.736 and 0.775 in the training set, respectively.ConclusionsThis study demonstrates that higher ePWV is significantly associated with increased short- and long-term mortality risk in critically ill sepsis patients, with evidence of a nonlinear relationship. ePWV may serve as a valuable prognostic marker to identify sepsis patients at higher risk of mortality in the ICU.

ObjectivePseudogenes are often referred to as "junk DNA." Although they have been well characterized in mammals, pseudogenes have been identified in only a few plant species. As an important traditional Chinese medicinal plant, the genome of Strobilanthes cusia (Nees) Kuntze has recently been released, providing a valuable opportunity to explore pseudogenes in S. cusia.MethodsBased on the S. cusia genome, pseudogenes were identified using the Soft PseudoPipe tool, and their evolutionary patterns and expression profiles across different tissues and developmental stages were analyzed.ResultsA total of 3156 pseudogenes were identified. DUP-type pseudogenes exhibited more insertion and frameshift mutations than PSSD-type pseudogenes; furthermore, a recent expansion of DUP-type pseudogenes was observed. Expression analysis detected 802 pseudogenes expressed in various tissues, primarily associated with plant defense functions according to Gene Ontology enrichment analysis. Among these, DUP-type pseudogenes were the most prevalent, with most arising recently. Additionally, 45 pseudogenes corresponding to gene family members involved in the biosynthesis of the medicinal compounds (indigo and indirubin) in S. cusia were identified, of which 27 were expressed in different tissues.ConclusionsIn this study, we successfully identified and characterized 3156 pseudogenes in S. cusia. Additionally, we analyzed the expression patterns of these pseudogenes. Our findings contribute to a better understanding of pseudogenes in S. cusia.

ObjectiveTo evaluate the clinical efficacy of the direct posterior approach (DPA) with seagull-shaped plate fixation for treating posterior wall acetabular fractures.MethodsA retrospective cohort study of 17 patients (8 male, 9 female) with posterior wall acetabular fractures treated with DPA seagull-shaped plate fixation was conducted. Postoperative pelvic X-ray imaging and computed tomography were performed, and the quality of acetabular reduction was evaluated using the Matta score. The Merle d'Aubigné & Bone score, as modified by Matta, was used to assess hip joint function.ResultsThe mean ± standard deviation surgical incision length, operating time, and intraoperative blood loss were 9.7 ± 0.6 cm, 48.7 ± 9.1 min, and 235.3 ± 65.6 mL, respectively. According to the Matta score, 11 patients achieved excellent reduction quality, and six had good reduction quality, resulting in a 100% combined excellent or good reduction rate. All patients had good fracture healing, with a healing time of 9.7 ± 1.6 weeks. The modified Merle d'Aubigné & Bone score was 17.0 ± 1.6, with 11, 4, 2, and 0 patients rated as excellent, good, fair, and poor, respectively, yielding an 88.2% excellent or good outcome rate. Postoperative complications included fat liquefaction in one patient and deep vein thrombosis in the lower limbs of two patients, with an overall complication rate of 17.6%.ConclusionsDPA with seagull-shaped plate fixation provides satisfactory clinical outcomes for posterior wall acetabular fractures, improving patients' living ability and quality of life.

ObjectiveThe use of aspirin in patients undergoing open tracheostomy is an issue for which there is still no clear conclusion. This uncertainty leads surgeons to make decisions based on the risks and benefits of continuing versus discontinuing aspirin. Therefore, this study aims to investigate complications related to aspirin use. The primary outcome was bleeding complications, while other complications were secondary outcomes.MethodsThis was a retrospective study compiling data from patients who underwent open tracheostomy at the Department of Otolaryngology, Faculty of Medicine, Chulalongkorn university and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, between January 2019 and December 2023. Demographic data, medical conditions, indications for tracheostomy, surgeon characteristics, operative time, aspirin use status, and complications were reviewed.ResultsThere were 47 patients in total in this study: 15 patients in the aspirin continuation group and 32 patients in the aspirin discontinuation group. In the aspirin continuation group, there were no major or minor bleeding events. In the discontinuation group, there were two cases of major bleeding and two cases of minor bleeding (an incidence of 6.3% for each), although the differences observed were not statistically significant. There were no other complications that showed statistically significant differences between the two groups.ConclusionThis study has shown that low-dose aspirin (81 mg) does not increase the risk of bleeding or other complications in patients who undergo open tracheostomy. These results support that the continuation of aspirin may be safe in patients undergoing this procedure.

ObjectivesPolypharmacy, the concurrent use of multiple medications, presents significant challenges and risks in modern healthcare systems, particularly among older individuals and those with chronic diseases. This study aimed to investigate the prevalence and determinants of potential drug-drug interactions (pDDIs) among older adults at Jerusalem, Gaza Strip, and the West Bank of Palestine. This study serves as a baseline assessment before the October 2023 Palestine crisis, which led to extensive forced displacement.MethodsThis cross-sectional study examined the prescribed medications for 403 participants, conducted between May 2023 and August 2023, 2 months prior to the invasion of Gaza. This study served as a baseline evaluation of the potential pDDIs before the 7 October 2023 of Palestine crisis. Participants recruited using simple random sampling technique from medical records' lists of patients. They were interviewed at various pharmacies and hospitals across Jerusalem, the Gaza Strip, and the West Bank of Palestine using an online questionnaire created via Google Forms. Descriptive, Univariate and multivariate analyses, and Chi-square tests were carried-out by SPSS v21.ResultsThe study revealed a high prevalence of pDDIs among the Palestinian population, with a substantial proportion of participants experiencing moderate to major interactions. Participants receiving a higher number of medications were significantly more likely to experience major pDDIs. Additionally, marital status was a significant factor associated with major pDDIs, with married individuals being more likely to experience major interactions compared to non-married individuals. Regional differences were also observed, with participants residing in the northern region of the West Bank more likely to experience moderate pDDIs. Moreover, participants diagnosed with dyslipidemia and diabetes mellitus were significantly more prone to moderate pDDIs.ConclusionsThese findings emphasize the interaction of clinical and demographic factors in influencing the risk of pDDIs among participant patients in Palestine. Healthcare providers should consider these factors when prescribing medications and designing interventions to reduce the risks associated with polypharmacy.

ObjectiveTo estimate the prevalence of human papillomavirus (HPV) infection among males in Jinshan District, Shanghai, China.MethodsStudy design: single-center, retrospective cross-sectional study.

Setting: Tinglin Hospital, Jinshan District, Shanghai, China.

Participants: 116 males aged 22-71 years from outpatient, inpatient, and routine physical examination settings.

Outcomes: overall HPV prevalence, age-specific prevalence, and genotype distribution (high-risk and low-risk).ResultsWe first describe the overall and age-specific prevalence, followed by genotype distribution and the pattern of single versus multiple infections. A total of 116 males aged 22 to 71 years old were enrolled for investigation. The overall HPV infection rate was 31.90% (37/116). The infection rates of different HPV subtypes in various age groups were listed as follows: 12% (3/25) for the 22-30 age group, 27.59% (8/29) for the 31-40 age group, 50% (18/36) for the 41-50 age group, 16.67% (3/18) for the 51-60 age group, and 62.5% (5/8) for the over 60 age group. Among the infected individuals, 27 out of 116 (23.28%) suffered from single subtype infections, while 8 individuals (6.90%) endured dual infections, and 2 individuals (1.72%) had three or more subtypes detected. High-risk HPVs accounted for 30.17%, with the highest infection rates observed in HPVs including HPV-53, HPV-58, HPV-52, HPV-16, and HPV-31. In comparison, low-risk HPVs accounted for 12.93%, with the highest infection rates seen in HPVs including HPV-6, HPV-81, and HPV-11. Apart from that, HPVs such as HPV-18, HPV-59, HPV-73, HPV-70 and HPV-83 were not detected in any of the specimens.ConclusionMales are predominantly infected with a single-subtype HPV infection. The infection rate is highest in the age group of 60 and above, while the infection rate is the lowest in the age group of 22-30 years. It is essential to formulate corresponding strategies and screening plans for the elderly over 60 years to lower or prevent the risk of HPV infection.

When the demand for public health care increases, governments often prioritize citizens over foreign nationals. In South Africa, limited resources and socio-economic inequalities pose unique challenges to epidemic control. The overcrowding and increasing demand for public healthcare have led to protests by some community groups, which have led to the denial of healthcare to migrants. Denying treatment to some infected individuals has the propensity to lead to an increase in the size of an epidemic. We introduce a novel epidemiological model that incorporates health care denial as a dynamic factor influencing the transmission of COVID-19. It incorporates healthcare denial as a key parameter influencing the progression and recovery rates of infections. The study presents a novel framework for understanding the intersection of healthcare access denial and the transmission dynamics of COVID-19. While much of the existing literature has focused on the direct effects of healthcare interventions on pandemic control, this research uniquely emphasizes the role that restricted access to healthcare services, whether due to policy decisions, resource shortages, or system inefficiencies, can exacerbate the spread of infectious diseases. The treatment class of the model is partitioned to account for individuals denied treatment at public healthcare facilities. Analytical results establish conditions for the existence and stability of both disease-free and endemic equilibria, with the basic reproduction number R₀ explicitly derived to quantify transmission potential under varying healthcare access scenarios. Sensitivity analysis reveals that increasing denial of care can significantly elevate R₀, resulting in higher infection peaks, prolonged epidemic duration and greater cumulative mortality. Numerical simulations further illustrate the non-linear relationship between treatment accessibility and outbreak severity. The findings highlight that equitable healthcare provision is not only a public health necessity but also a critical determinant for reducing the COVID-19 burden. Policy implications stress the integration of inclusive healthcare strategies to ensure epidemic resilience and minimize transmission risks, especially in vulnerable populations. Strategies that will accommodate every infected person who goes to the hospital for treatment should be adopted to reduce the disease burden.