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Four new lactones, including hypomonacid A (1) and hypomonone A–C (4–6), as well as nine known polyketide analogues (2–3 and 7–13) were obtained from endophytic fungus Hypomontagnella sp. TX-09 derived from Santalum album. Their planar structures were extensively established by analysing HRESIMS and NMR spectroscopic data. Stereochemistry of new compounds was determined by X-ray diffraction analysis and modified Mosher’s method in combination with quantum-chemical ECD calculation. In addition, compounds 1 and 2 showed anti-inflammatory activity by inhibition of lipopolysaccharide (LPS)-induced NO production in RAW264.7 cells at 50 μmol/L without cytotoxicity. Among them, compound 1 inhibited the production of LPS-stimulated inflammation in mouse macrophage RAW264.7 cells by suppressing the expression of iNOS, TNF-α, IL-1β, and IL-6.

Abstract Objective Efgartigimod, a neonatal Fc receptor antagonist, facilitates antibody degradation including pathogenic IgGs. The ADAPT study demonstrated the tolerability and efficacy of efgartigimod in the treatment of generalized myasthenia gravis (gMG). However, very limited evidence is available for the Chinese population, and it remains inconclusive about which kind of patients are selected to preferentially receive efgartigimod in real‐world settings. Methods This multicenter cohort study included gMG patients treated at 14 neuromuscular reference centers in China. The Myasthenia Gravis Activities of Daily Living (MG‐ADL) score, immunosuppressants, and the incidence of treatment‐emergent adverse events (TEAEs) were prospectively collected. Results Of the 1640 gMG admitted between September and December 2023, 61 (3.7%) received efgartigimod for at least one treatment cycle. Among them, 56 cases (92%) were anti‐AChR antibody‐positive, 4 were anti‐MuSK antibody‐positive, and 1 was seronegative. Thymoma‐associated myasthenia gravis accounted for most cases (44%, 27 out of 61). The principal causes of efgartigimod initiation included MG acute exacerbation (MGAE) (48%, 29 out of 61) and myasthenic crisis (MC) (15%, 9 out of 61). Clinically meaningful improvement was rapidly achieved in 97% (58 out of 61) of patients at 1.3 ± 0.7 weeks. By week 12, the MG‐ADL score reduced to 3.8 ± 4.1 (baseline:10.5 ± 5.2) for all participants, while it reduced to 4.0 ± 4.7 for MGAE and 3.8 ± 4.2 for MC, respectively. All but one TMG patient required no additional rescue therapies after efgartigimod initiation. 11.5% (7 out of 61) reported ≥1 TEAEs. Interpretation This multicenter cohort study demonstrated the efficacy of efgartigimod in rapid control of gMG. Patients with MGAE or MC would benefit from efgartigimod treatment.

ObjectiveThis study aimed to systematically evaluate the safety of cyclosporine (CsA) and tacrolimus (TAC) in pediatric nephrotic syndrome (NS) patients using real-world data from the FDA Adverse Event Reporting System (FAERS).MethodsWe analyzed adverse event (AE) reports from the FAERS database between Q4 2003 and Q2 2024, focusing on AEs associated with CsA and TAC in NS patients aged 18 years and younger. We employed three signal detection methods—Proportional Reporting Ratio (PRR), Relative Reporting Ratio (RRR), and Reporting Odds Ratio (ROR)—to assess the risk of drug-related AEs. Sensitivity analyses were conducted to explore the influence of gender on AE occurrence.ResultsA total of 207 CsA-related and 145 TAC-related AE reports were included. CsA was significantly associated with nephropathy toxic (ROR = 8.26, 95% CI: 4.21–16.20), urine output decreased (ROR = 29.93, 95% CI: 3.66–244.61), and posterior reversible encephalopathy syndrome (ROR = 6.70, 95% CI: 3.17–14.14). TAC was associated with an increased risk of dystonia (ROR = 67.93, 95% CI: 8.63–534.86), kidney fibrosis (ROR = 22.65, 95% CI: 8.16–62.87), and diabetic ketoacidosis (ROR = 46.51, 95% CI: 5.68–380.97). Sensitivity analysis indicated that gender influenced the occurrence of AEs, with CsA showing higher nephrotoxicity in male patients, while TAC was more strongly associated with metabolic disorders and neurological AEs in female patients.ConclusionIn pediatric NS patients, CsA primarily induces nephrotoxicity and neurological complications, whereas TAC is more likely to cause kidney fibrosis and metabolic disorders. Enhanced monitoring of these AEs and individualized drug adjustments based on patient characteristics are recommended to optimize treatment outcomes and reduce AE incidence.

Background: Thymoma-associated myasthenia gravis (TAMG) is a subtype of myasthenia gravis (MG) that is associated with more severe symptoms and a relatively poor prognosis. Eculizumab, an inhibitor to target human C5 component of the complement cascade, is considered a treatment option for refractory generalized MG (gMG). Objectives: To explore the safety and efficacy of eculizumab in patients with TAMG. Design: This is an observational multicenter real-world cohort study to assess TAMG who were treated with eculizumab from June 2023 to June 2024. Data sources and methods: Clinical features associated with thymoma-associated multi-organ autoimmunity (TAMA), Myasthenia Gravis Activities of Daily Living (MG-ADL) score, and the incidence of treatment-emergent adverse events (TEAEs) were prospectively collected. Results: Overall, 42 patients with gMG were treated with eculizumab at 5 research centers, of whom 22 patients with TAMG were finally included. This cohort had a mean age of 51.5 ± 12.1 years and an average disease duration of 4.0 ± 4.3 years. Regarding thymomas, the World Health Organization (WHO) histological classification was primarily B2 and B3 (63.7%), and Masaoka staging was predominantly IV (45.5%). Nine participants (40.9%) switched from efgartigimod to eculizumab aiming at a better clinical improvement and reducing steroid use. By week 12, the MG-ADL score decreased to 4.8 ± 4.7 (baseline: 11.7 ± 6.0), and the corticosteroid dose reduced to 23.2 ± 26.5 mg (baseline: 41.8 ± 63.9 mg). Two patients with TAMA showed significant improvement in skin lesions and thrombocytopenia. Two TEAEs were recorded including COVID-19 and herpes labialis infection. Four patients (18.2%) died of respiratory or circulatory failure owing to thymoma metastasis. Conclusion: This real-world study demonstrates the efficacy of eculizumab in achieving symptom control and corticosteroid reduction for TAMG. It may also be a therapeutic option for refractory TAMG and TAMA. Trial registration: NCT04535843.

Abstract BackgroundElectronic medical records store extensive patient data and serve as a comprehensive repository, including textual medical records like surgical and imaging reports. Their utility in clinical decision support systems is substantial, but the widespread use of ambiguous and unstandardized abbreviations in clinical documents poses challenges for natural language processing in clinical decision support systems. Efficient abbreviation disambiguation methods are needed for effective information extraction. ObjectiveThis study aims to enhance the one-to-all (OTA) framework for clinical abbreviation expansion, which uses a single model to predict multiple abbreviation meanings. The objective is to improve OTA by developing context-candidate pairs and optimizing word embeddings in Bidirectional Encoder Representations From Transformers (BERT), evaluating the model’s efficacy in expanding clinical abbreviations using real data. MethodsThree datasets were used: Medical Subject Headings Word Sense Disambiguation, University of Minnesota, and Chia-Yi Christian Hospital from Ditmanson Medical Foundation Chia-Yi Christian Hospital. Texts containing polysemous abbreviations were preprocessed and formatted for BERT. The study involved fine-tuning pretrained models, ClinicalBERT and BlueBERT, generating dataset pairs for training and testing based on Huang et al’s method. ResultsBlueBERT achieved macro- and microaccuracies of 95.41% and 95.16%, respectively, on the Medical Subject Headings Word Sense Disambiguation dataset. It improved macroaccuracy by 0.54%‐1.53% compared to two baselines, long short-term memory and deepBioWSD with random embedding. On the University of Minnesota dataset, BlueBERT recorded macro- and microaccuracies of 98.40% and 98.22%, respectively. Against the baselines of Word2Vec + support vector machine and BioWordVec + support vector machine, BlueBERT demonstrated a macroaccuracy improvement of 2.61%‐4.13%. ConclusionsThis research preliminarily validated the effectiveness of the OTA method for abbreviation disambiguation in medical texts, demonstrating the potential to enhance both clinical staff efficiency and research effectiveness.

BackgroundAs targeted drug development in myasthenia gravis (MG) continues to advance, it is important to compare the efficacy of these drugs for better clinical decision-making. However, due to the varied regimens and dosages used in clinical trials for different drugs, a standardized comparison between them is necessary.MethodsThis study enrolled participants in phase II and III trials of innovative targeted drugs for MG. The primary outcome was the change in Quantitative Myasthenia Gravis score (MG-QMG) from baseline. The efficacy of all drugs at four time points was separately analyzed at four time points: initiation 1 week, initiation 4 weeks, maximized response, and post last dose 4 weeks. A network meta-analysis was conducted to compare the results of the different drugs.ResultsA total of 9 drugs, including Efgartigimod, Rozanolixizumab, Batoclimab, Eculizumab, Belimumab, Zilucoplan, Ravulizumab, Nipocalimab, Rituximab, derived from 12 studies were analyzed. At the initiation 1-week time point, three drugs exhibited significant improvement compared to the placebo effect: Efgartigimod, Zilucoplan, Rozanolixizumab. At the initiation 4-week time point, four drugs showed significant improvement compared to the placebo effect: Efgartigimod, Rozanolixizumab, Batoclimab, Zilucoplan. At the maximized response time point, six drugs achieved significant improvement compared to the placebo effect: Efgartigimod, Rozanolixizumab, Batoclimab, Eculizumab, Zilucoplan, Ravulizumab. At the post last dose 4-week point, all drugs statistically showed no significant difference from the placebo.ConclusionAlthough the MG subtypes were not consistent across trials, within the regimen design of each trial, neonatal Fc receptor inhibitors—represented by Efgartigimod, Rozanolixizumab, and Batoclimab—exhibited the most effective response rates when compared to complement and B-cell inhibitor drugs.

In this paper, the GSP655060Fe soft pack lithium-ion battery with a capacity of 1600 mAh is utilized, employing lithium iron phosphate as the positive electrode and graphite as the negative electrode. In order to comprehensively evaluate the performance of lithium batteries under the conditions of multi-application scenarios, the operating conditions of the battery were simulated under various external confinement pressures of 300 N, 400 N, 500 N, and 600 N, respectively, and the ambient temperatures of 10 ℃, 25 ℃, and 40 ℃, respectively, were controlled to thoroughly test the battery. One charge/discharge test was conducted on six batteries of the same model at multiplicities of 0.5 C, 1 C, 1.5 C, and 2 C, respectively. To ensure the accuracy and reliability of the experimental data, a Battery comprehensive tester Neware BTS-5V12A was utilized, which possesses high-precision voltage and current measurement capabilities with an error rate of only 0.05 %. This data plays an important role in battery research and development, new energy vehicles, electronic products, and other fields.

Interstitial oxygen embrittles titanium, particularly at cryogenic temperatures, which necessitates a stringent control of oxygen content in fabricating titanium and its alloys. Here, we propose a structural strategy, via grain refinement, to alleviate this problem. Compared to a coarse-grained counterpart that is extremely brittle at 77 K, the uniform elongation of an ultrafine-grained (UFG) microstructure (grain size ~ 2.0 µm) in Ti-0.3wt.%O is successfully increased by an order of magnitude, maintaining an ultrahigh yield strength inherent to the UFG microstructure. This unique strength-ductility synergy in UFG Ti-0.3wt.%O is achieved via the combined effects of diluted grain boundary segregation of oxygen that helps to improve the grain boundary cohesive energy and enhanced dislocation activities that contribute to the excellent strain hardening ability. The present strategy will not only boost the potential applications of high strength Ti-O alloys at low temperatures, but can also be applied to other alloy systems, where interstitial solution hardening results into an undesirable loss of ductility.

This study investigated the mechanism by which A-type oligomeric proanthocyanidins (A-OPC) from abscising litchi fruits inhibit proinflammation induced by litchi thaumatin-like protein (LcTLP). A-OPC were prepared by sequential ethanol extraction and purification by macroporous adsorption resin and preparative liquid chromatography. Structural analysis showed that A-OPC were mainly composed of proanthocyanidin A2, two A-type proanthocyanidin trimers and one A-type tetramer, with a purity of 88.69%. At 120 μg/mL concentration, A-OPC inhibited the secretion of nitric oxide (NO), interleukin (IL)-6 and tumor necrosis factor-α (TNF-α) by 58.38%, 39.80% and 86.31% in RAW264.7 cells treated with LcTLP, respectively (P < 0.01). Western blot showed that 120 μg/mL A-OPC reduced the expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2), and significantly decreased the phosphorylation levels of p65, inhibitor of NF-κB (IκBα), c-Jun N-terminal kinase (JNK), extracellular signal-regulated kinase (ERK) and p38. Therefore, A-OPC down-regulated the phosphorylation levels of downstream proteins in the nuclear transcription factor-κB (NF-κB) and mitogen-activated protein kinase (MAPK) signaling pathways, thereby suppressing LcTLP-induced inflammatory response.

IntroductionEfgartigimod is effective and well-tolerated in patients with anti-acetylcholine receptor (AChR) antibody-positive generalized myasthenia gravis (MG). However, the therapeutic potential and the safety profile of efgartigimod in myasthenic crisis (MC) remained largely unknown.MethodsThis is an observational, prospective, multicenter, real-world study to follow 2 MC patients who initiated efgartigimod as a first-line rescue therapy and 8 cases who used it as an add-on therapy. Baseline demographic features and immunotherapies were collected, and the MG-activities of daily living (MG-ADL) scale was evaluated every week since efgartigimod treatment for 8 weeks. Additionally, serum IgG and anti-AChR antibody levels and the peripheral CD4+ T lymphocytes were measured before and after one cycle of treatment.ResultsTen patients with MC were enrolled in the study, including 9 anti-AChR antibody positive and 1 anti-muscle-specific kinase (MuSK) positive. All patients were successfully weaned from the ventilation after receiving efgartigimod treatment, with a length of 10.44 ± 4.30 days. After one cycle of infusions, the MG-ADL score reduced from 15.6 ± 4.4 at the baseline to 3.4 ± 2.2, while the corticosteroid dose was tapered from 55.0 ± 20.7 mg to 26.0 ± 14.1 mg. The proportions of regulatory T cells and naïve T cells (% in CD4+ T) significantly decreased post-efgartigimod treatment (5.48 ± 1.23 vs. 6.90 ± 1.80, P=0.0313, and 34.98 ± 6.47 vs. 43.68 ± 6.54, P=0.0313, respectively).ConclusionThese findings validated the rapid action of efgartigimod in facilitating the weaning process with a good safety profile in patients with MC.

Abstract Background Myasthenia gravis (MG) is the most prevalent autoimmune disorder affecting the neuromuscular junction. A rapid deterioration in respiratory muscle can lead to a myasthenic crisis (MC), which represents a life-threatening condition with high mortality in MG. Multiple CD4+ T subsets and hypercytokinemia have been identified in the peripheral pro-inflammatory milieu during the crisis. However, the pathogenesis is complicated due to the many types of cells involved, leaving the underlying mechanism largely unexplored. Methods We conducted single-cell transcriptomic and immune repertoire sequencing on 33,577 peripheral blood mononuclear cells (PBMCs) from two acetylcholine receptor antibody-positive (AChR +) MG patients during MC and again three months post-MC. We followed the Scanpy workflow for quality control, dimension reduction, and clustering of the single-cell data. Subsequently, we annotated high-resolution cell types utilizing transfer-learning models derived from publicly available single-cell immune datasets. RNA velocity calculations from unspliced and spliced mRNAs were applied to infer cellular state progression. We analyzed cell communication and MG-relevant cytokines and chemokines to identify potential inflammation initiators. Results We identified a unique subset of monocytes, termed monocytes 3 (FCGR3B+ monocytes), which exhibited significant differential expression of pro-inflammatory signaling pathways during and after the crisis. In line with the activated innate immune state indicated by MC, a high neutrophil–lymphocyte ratio (NLR) was confirmed in an additional 22 AChR + MC patients in subsequent hemogram analysis and was associated with MG-relevant clinical scores. Furthermore, oligoclonal expansions were identified in age-associated B cells exhibiting high autoimmune activity, and in CD4+ and CD8+ T cells demonstrating persistent T exhaustion. Conclusions In summary, our integrated analysis of single-cell transcriptomics and TCR/BCR sequencing has underscored the role of innate immune activation which is associated with hypercytokinemia in MC. The identification of a specific monocyte cluster that dominates the peripheral immune profile may provide some hints into the etiology and pathology of MC. However, future functional studies are required to explore causality.

Background: Myasthenic crisis (MC) is a life-threatening condition for myasthenia gravis (MG). Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIg) efficaciously treat patients with MC. However, not every MC responds well to rescue therapies, and the determinants for outcome with the evidence from prospective cohorts are still lacking. Objectives: To explore the risk factors for in-hospital outcomes in patients with MC. Methods: Using a national neuromuscular center-based cohort of MG with prospective follow-ups from the crisis to the post-crisis phase, we finally included 90 MC episodes from 76 independent patients who received a standard regimen of rescue therapies. Results: The mean admission age was 52.89 ± 15.72 years. With a female predominance of 63.16% (48/76) and a high proportion of thymoma-associated MG (TMG) of 63.16% (48/76), the overall in-hospital mortality was 2.63% (2/76) and the average duration for mechanical ventilation (MV) use was 17.09 ± 13.36 days (0–53 days). In contrast to the patients with anti-acetylcholine receptor (AChR) antibodies, muscle-specific tyrosine kinase (MuSK)-associated MC exhibited a shorter MV support (5.20 ± 5.07 versus 17.40 ± 13.24 days, p = 0.023), length of intensive care units (ICU) stay (6.00 ± 4.64 versus 19.16 ± 17.54 days, p = 0.046), and hospital stay (16.00 ± 4.12 versus 34.43 ± 20.48 days, p = 0.011). Thymoma [odds ratio (OR): 0.200, 95% confidence interval (CI): 0.058–0.687, p = 0.011], partial pressure of carbon dioxide (PCO 2 ) in blood gas before MV (OR: 1.238, 95% CI: 1.015–1.510, p = 0.035), and pneumonia (OR: 0.204, 95% CI: 0.049–0.841, p = 0.028) were identified as independent risk factors for prolonged MV use. TMG patients with thymoma burden exhibited a notable longer MV use (22.08 ± 17.54 versus 8.88 ± 6.79 days, p = 0.001), a prolonged hospital stay (40.40 ± 26.13 versus 23.67 ± 13.83 days, p = 0.009) compared with non-TMG. Even with complete thymoma resection (R0), TMG exhibited an unfavorable outcome versus non-TMG. Conclusion: With timely rescue therapies and prospective follow-ups, the in-hospital outcome of MCs was substantially improved. Thymoma, PCO 2 in blood gas before MV, and pneumonia were identified as independent risk factors for prolonged MV use.

Individually, increasing the concentration of either oxygen or aluminum has a deleterious effect on the ductility of titanium alloys. For example, extremely small amounts of interstitial oxygen can severely deteriorate the tensile ductility of titanium, particularly at cryogenic temperatures. Likewise, substitutional aluminum will decrease the ductility of titanium at low-oxygen concentrations. Here, we demonstrate that, counter-intuitively, significant additions of both Al and O substantially improves both strength and ductility, with a 6-fold increase in ductility for a Ti-6Al-0.3 O alloy as compared to a Ti-0.3 O alloy. The Al and O solutes act together to increase and sustain a high strain-hardening rate by modifying the planar slip that predominates into a delocalized, three-dimensional dislocation pattern. The mechanism can be attributed to decreasing stacking fault energy by Al, modification of the "shuffle" mechanism of oxygen-dislocation interaction by the repulsive Al-O interaction in Ti, and micro-segregation of Al and O by the same cause.

Objective: A model of chronic infectious mandibular defect (IMD) caused by mixed infection with Staphylococcus aureus and Pseudomonas aeruginosa was established to explore the occurrence and development of IMD and identify key genes by transcriptome sequencing and bioinformatics analysis.Methods:S. aureus and P. aeruginosa were diluted to 3 × 108 CFU/mL, and 6 × 3 × 3 mm defects lateral to the Mandibular Symphysis were induced in 28 New Zealand rabbits. Sodium Morrhuate (0.5%) and 50 μL bacterial solution were injected in turn. The modeling was completed after the bone wax closed; the effects were evaluated through postoperative observations, imaging and histological analyses. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway, and protein‒protein interaction (PPI) network analyses were performed to investigate the function of the differentially expressed genes (DEGs).Results: All rabbits showed characteristics of infection. The bacterial cultures were positive, and polymerase chain reaction (PCR) was used to identify S. aureus and P. aeruginosa. Cone beam CT and histological analyses showed inflammatory cell infiltration, pus formation in the medullary cavity, increased osteoclast activity in the defect area, and blurring at the edge of the bone defect. Bioinformatics analysis showed 1,804 DEGs, 743 were upregulated and 1,061 were downregulated. GO and KEGG analyses showed that the DEGs were enriched in immunity and osteogenesis inhibition, and the core genes identified by the PPI network were enriched in the Hedgehog pathway, which plays a role in inflammation and tissue repair; the MEF2 transcription factor family was predicted by IRegulon.Conclusion: By direct injection of bacterial solution into the rabbit mandible defect area, the rabbit chronic IMD model was successfully established. Based on the bioinformatics analysis, we speculate that the Hedgehog pathway and the MEF2 transcription factor family may be potential intervention targets for repairing IMD.

One of the most potent examples of interstitial solute strengthening in metal alloys is the extreme sensitivity of titanium to small amounts of oxygen. Unfortunately, these small amounts of oxygen also lead to a markedly decreased ductility, which in turn drives the increased cost to purify titanium to avoid this oxygen poisoning effect. Here, we report a systematic study on the oxygen sensitivity of titanium that provides a clear mechanistic view of how oxygen impurities affect the mechanical properties of titanium. The increased slip planarity of Ti-O alloys is caused by an interstitial shuffling mechanism, which is sensitive to temperature, strain rate, and oxygen content and leads to the subsequent alteration of deformation twinning behavior. The insights from our experimental and computational work provide a rationale for the design of titanium alloys with increased tolerance to variations in interstitial content, with notable implications for more widespread use of titanium alloys.

Traditional metallic alloys are mixtures of elements in which the atoms of minority species tend to be distributed randomly if they are below their solubility limit, or to form secondary phases if they are above it. The concept of multiple-principal-element alloys has recently expanded this view, as these materials are single-phase solid solutions of generally equiatomic mixtures of metallic elements. This group of materials has received much interest owing to their enhanced mechanical properties1-5. They are usually called medium-entropy alloys in ternary systems and high-entropy alloys in quaternary or quinary systems, alluding to their high degree of configurational entropy. However, the question has remained as to how random these solid solutions actually are, with the influence of short-range order being suggested in computational simulations but not seen experimentally6,7. Here we report the observation, using energy-filtered transmission electron microscopy, of structural features attributable to short-range order in the CrCoNi medium-entropy alloy. Increasing amounts of such order give rise to both higher stacking-fault energy and hardness. These findings suggest that the degree of local ordering at the nanometre scale can be tailored through thermomechanical processing, providing a new avenue for tuning the mechanical properties of medium- and high-entropy alloys.

C30H18F4IrN5·1.5[H2O], tetragonal, I41/a (no. 88), a = 37.5562(5) Å, b = 37.5562(5) Å, c = 9.2031(2) Å, V = 12980.7(4) Å3, Z = 16, Rgt(F) = 0.0312, wRref(F2) = 0.1166, T = 300(2) K.

The subzero‐temperature service of lithium (Li) metal anode has been enormously restricted by a large working polarization and a poor reversibility. In this contribution, the overpotential attributions during low‐temperature Li electroplating are deconvolved, and the interplay among the dominating kinetic overpotential, the dynamic solid electrolyte interphase (SEI) chemistry, and the corresponding cycling reversibility of Li metal is established. Specifically, by employing a localized highly concentrated electrolyte as a model system, it is disclosed that ionic concentration gradient plays a predominate role in polarizing the cathodic Li electroplating process at subzero working temperature. Inspired by this, a decoupling electrolyte design strategy is presented to synchronously tame the kinetic polarization and build a dynamically stable anion‐derived SEI, thus boosting a remarkably enhanced Coulombic efficiency of Li with a depressed cell overpotential and a more than three times longer lifespan in practical Li | LiNi0.5Co0.2Mn0.3O2 cells at −20 °C. Herein, the essence to affecting the polarization and reversibility of low‐temperature working Li metal anode is uncovered, affording critical design principles to facilitate a stable dynamic interface for the high‐efficiency cycling of practical Li metal batteries at subzero temperatures.

Abstract Background Myasthenia gravis (MG) is an autoimmune disorder affecting neuromuscular junctions. Cytokines play important roles in facilitating the immune response and augmenting the pathogenic antibody production. The current study aims to sensitively characterize the serum levels of cytokines with very low concentration in generalized MG (gMG). Methods Using ultrasensitive single-molecule arrays (SIMOA), we measured serum IL-2, IL-4, IL-5 and IL-12p70 in 228 participants including 152 immunotherapy-naïve anti-acetylcholine receptor (AChR) subtype gMG from Huashan MG registry and 76 age-matched healthy controls. Subgroup analysis was then performed by stratifying patients according to the onset ages, MGFA classification, disease duration at baseline. Results Serum IL-2, IL-4, IL-5 and IL-12p70 levels were significantly elevated in gMG compared to controls (0.179 pg/mL versus 0.011 pg/mL, P

Reduced generation of multiple motile cilia (RGMC) represents a rare variant of Primary Ciliary Dyskinesia (PCD), associated with CYCLIN‐O (CCNO) mutations. We report a novel compound mutation in the CCNO gene in an adult Chinese Singaporean exhibiting chronic productive cough since childhood and recurrent sino‐pulmonary infections. Low nasal nitric oxide and bronchiectasis suggests PCD. Bronchoscopy for epithelial and nasal brushings for ciliary studies were repeated after adequate treatment of lower respiratory tract infections. Demonstration of oligo‐cilia via transmission electron microscopy, and detection of CCNO mutation through genetic analysis were utilized to diagnose RGMC. Repeated courses of antibiotics including nebulised antibiotics were used to treat recurrent infections and exacerbations. Airway clearance techniques, immunizations and collaboration with otorhinolaryngologist form part of the long‐term management. Heightened clinical suspicion and adherence to established diagnostic algorithms are essential for timely recognition of this entity. [ABSTRACT FROM AUTHOR]

Dendrite growth of lithium (Li) metal anode severely hinders its practical application, while the situation becomes more serious at low temperatures due to the sluggish kinetics of Li-ion diffusion. This perspective is intended to clearly understand the energy chemistry of low-temperature Li metal batteries (LMBs). The low-temperature chemistries between LMBs and traditional Li-ion batteries are firstly compared to figure out the features of the low-temperature LMBs. Li deposition behaviors at low temperatures are then discussed concerning the variation in Li-ion diffusion behaviors and solid electrolyte interphase (SEI) features. Subsequently, the strategies to enhance the diffusion kinetics of Li ions and suppress dendrite growth including designing electrolytes and electrode/electrolyte interfaces are analyzed. Finally, conclusions and outlooks are drawn to shed lights on the future design of high-performance low-temperature LMBs.

Background: Myasthenia gravis (MG) is an autoimmune disease characterized by muscle weakness and fatigability. The fluctuating nature of the disease course impedes the clinical management. Objective: The purpose of the study was to establish and validate a machine learning (ML)–based model for predicting the short-term clinical outcome in MG patients with different antibody types. Methods: We studied 890 MG patients who had regular follow-ups at 11 tertiary centers in China from 1 January 2015 to 31 July 2021 (653 patients for derivation and 237 for validation). The short-term outcome was the modified post-intervention status (PIS) at a 6-month visit. A two-step variable screening was used to determine the factors for model construction and 14 ML algorithms were used for model optimisation. Results: The derivation cohort included 653 patients from Huashan hospital [age 44.24 (17.22) years, female 57.6%, generalized MG 73.5%], and the validation cohort included 237 patients from 10 independent centers [age 44.24 (17.22) years, female 55.0%, generalized MG 81.2%]. The ML model identified patients who were improved with an area under the receiver operating characteristic curve (AUC) of 0.91 [0.89–0.93], ‘Unchanged’ 0.89 [0.87–0.91], and ‘Worse’ 0.89 [0.85–0.92] in the derivation cohort, whereas identified patients who were improved with an AUC of 0.84 [0.79–0.89], ‘Unchanged’ 0.74 [0.67–0.82], and ‘Worse’ 0.79 [0.70–0.88] in the validation cohort. Both datasets presented a good calibration ability by fitting the expectation slopes. The model is finally explained by 25 simple predictors and transferred to a feasible web tool for an initial assessment. Conclusion: The explainable, ML-based predictive model can aid in forecasting the short-term outcome for MG with good accuracy in clinical practice.