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Abstract Radioresistance contributes to metastasis and recurrence in non-small cell lung cancer (NSCLC) patients. However, the underlying mechanism remains unclear. To provide novel clues, a complete multi-omics map of a radioresistant cancer cell line has been profiled. In this article, a lung adenocarcinoma cell line, radioresistant A549 (RA549), was generated by exposure to a series of irradiation. Subsequently, we adopted transcriptome, quantitative proteome and lysine 2-hydroxyisobutyrylome to construct a differential profile on the transcriptional to post-tanslational levels on A549 and RA549 cell lines, respectively. Our analysis revealed 920 significantly differentially expressed genes and 699 proteins. Furthermore, 2-hydroxyisobutyrylome identified 30,089 Khib modified sites on 4635 proteins, indicating that Khib modifications play vital role in regulating NSCLC radioresistance. Multi-omics combined analysis identified 19 significantly differentially expressed genes/proteins in total. Meanwhile, we found that EGFR, a well-known lung cancer-related receptor, was upregulated at both the protein and Khib modification levels in RA549. Further gain/loss of function experiments showed that Khib modified EGFR level positively correlates with NSCLC cell radioresistance. Taken together, our findings report that Khib-modified proteins enhanced resistance to radiation and represent promising therapeutic targets.

Abstract The Omicron subvariants of SARS-CoV-2, especially for BA.2.86 and JN.1, have rapidly spread across multiple countries, posing a significant threat in the ongoing COVID-19 pandemic. Distinguished by 34 additional mutations on the Spike (S) protein compared to its BA.2 predecessor, the implications of BA.2.86 and its evolved descendant, JN.1 with additional L455S mutation in receptor-binding domains (RBDs), are of paramount concern. In this work, we systematically examine the neutralization susceptibilities of SARS-CoV-2 Omicron subvariants and reveal the enhanced antibody evasion of BA.2.86 and JN.1. We also determine the cryo-EM structures of the trimeric S proteins from BA.2.86 and JN.1 in complex with the host receptor ACE2, respectively. The mutations within the RBDs of BA.2.86 and JN.1 induce a remodeling of the interaction network between the RBD and ACE2. The L455S mutation of JN.1 further induces a notable shift of the RBD–ACE2 interface, suggesting the notably reduced binding affinity of JN.1 than BA.2.86. An analysis of the broadly neutralizing antibodies possessing core neutralizing epitopes reveals the antibody evasion mechanism underlying the evolution of Omicron BA.2.86 subvariant. In general, we construct a landscape of evolution in virus-receptor of the circulating Omicron subvariants.

Introduction Deep brain stimulation (DBS) and vagus nerve stimulation (VNS) can improve motor function in patients with poststroke hemiplegia. No comparison study exists.Methods and analysis This is a randomised, double-blind, controlled clinical trial involving 64 patients who had their first stroke at least 6 months ago and are experiencing poststroke limb dysfunction. These patients must receive necessary support at home and consent to participate. The aim is to evaluate the effectiveness and safety of DBS and VNS therapies. Patients are excluded if they have implantable devices that are sensitive to electrical currents, severe abnormalities in their lower limbs or are unable to comply with the trial procedures. The study has two parallel, distinct treatment arms: the Stimulation Group and the Sham Group. Initially, the Stimulation Group will undergo immediate electrical stimulation postsurgery, while the Sham Group will receive non-stimulation 1 month later. After 3 months, these groups will swap treatments, with the Stimulation Group discontinuing stimulation and the Sham Group initiating stimulation. Six months later, both groups will resume active stimulation. Our primary outcomes will meticulously assess motor function improvements, using the Fugl-Meyer Assessment, and safety, monitored by tracking adverse reaction rates. Furthermore, we will gain a comprehensive view of patient outcomes by evaluating secondary measures, including clinical improvement (National Institutes of Health Stroke Scale), surgical complications/side effects, quality of life (36-item Short Form Questionnaire) and mental health status (Hamilton Anxiety Rating Scale/Hamilton Depression Rating Scale). To ensure a thorough understanding of the long-term effects, we will conduct follow-ups at 9 and 12 months postsurgery, with additional long-term assessments at 15 and 18 months. These follow-ups will assess the sustained performance and durability of the treatment effects. The statistical analysis will uncover the optimal treatment strategy for poststroke hemiplegia, providing valuable insights for clinicians and patients alike.Ethics and dissemination This study was reviewed and approved by the Ethical Committee of Chinese PLA General Hospital (S2022-789-01). The findings will be submitted for publication in peer-reviewed journals with online accessibility, ensuring adherence to the conventional scientific publishing process while clarifying how the research outcomes will be disseminated and accessed.Trial registration number NCT06121947.

Abstract Series multivariable coupled system is a typical controlled object in process control industry. The interaction of various state variables between multiple inputs and outputs in the system forms a complex series multivariable coupled structure. This coupled structure makes the control of a controlled object in the system affect the controlled object in the upper and lower control loop. As a result, it is difficult to control one or more control loops in the system without changing the state of other links in the system. In this paper, a cooperative control method for series multivariable coupled system is proposed. A decoupling controller is designed to remove the coupling effect caused by the interaction between stages, and the system is decoupled into several independent control loops. Differential leading PI (proportional-integral) error compensation method is introduced to ensure the following performance of the controller without static error. The proposed cooperative control method satisfies the Lyapunov stability, and has been successfully applied in the simulation experiment of cascade pumping station system of Beijing East-to-West water transfer project. The proposed method reduces the difficulty to controlling the water level of forebay of each pumping station and ensures the efficient operation of the cascade pumping station system.

Abstract Background Tumor-associated macrophages (TAMs) play a pivotal role in reshaping the tumor microenvironment following radiotherapy. The mechanisms underlying this reprogramming process remain to be elucidated. Methods Subcutaneous Lewis lung carcinoma (LLC) murine model was treated with hypofrationated radiotherapy (8 Gy × 3F). Single-cell RNA sequencing was utilized to identify subclusters and functions of TAMs. Multiplex assay and enzyme-linked immunosorbent assay (ELISA) were employed to measure serum chemokine levels. Bindarit was used to inhibit CCL8, CCL7, and CCL2. The infiltration of TAMs after combination treatment with hypofractionated radiotherapy and Bindarit was quantified with flow cytometry, while the influx of CD206 and CCL8 was assessed by immunostaining. Results Transcriptome analysis identified a distinct subset of M2-like macrophages characterized by elevated Ccl8 expression level following hypofractionated radiotherapy in LLC-bearing mice. Remarkbly, hypofractionated radiotherapy not only promoted CCL8high macrophages infiltration but also reprogrammed them by upregulating immunosuppressive genes, thereby fostering an immunosuppressive tumor microenvironment. Additioinally, hypofractionated radiotherapy enhanced the CCL signaling pathway, augmenting the pro-tumorigenic functions of CCL8high macrophages and boosting TAMs recruitment. The adjunctive treatment combining hypofractionated radiotherapy with Bindarit effectively reduced M2 macrophages infiltration and prolonged the duration of local tumor control. Conclusions Hypofractionated radiotherapy enhances the infiltration of CCL8high macrophages and amplifies their roles in macrophage recruitment through the CCL signaling pathway, leading to an immunosuppressive tumor microenvironment. These findings highlight the potential of targeting TAMs and introduces a novel combination to improve the efficacy of hypofractionated radiotherapy.

This study proposes a battery thermal management system based on L-shaped heat pipes coupled with liquid cooling. Experimental and computational fluid dynamics (CFD) numerical simulation studies have been conducted on the performance of the thermal management system. The thermal performance of three heat dissipation methods including forced air cooling, bottom liquid cooling and heat pipe coupled liquid cooling were compared. The results demonstrate that the coupling system can control the maximum temperature and temperature difference of the module at 30.12°C and 2.02°C at a 3C discharge rate. Compared with forced air cooling and bottom liquid cooling, the maximum temperature was decreased by 30.16% and 17.01% and the temperature difference was decreased by 72.14% and 77.20%, respectively. Studied the impact of factors such as coolant flow rate, the number of liquid-cooled plate channels, and the coolant inlet temperature under different ambient temperatures on the thermal management performance of the coupled system. By monitoring the maximum temperature of the module and the ambient temperature, a method for controlling the flow rate and the inlet temperature of the cooling water has been developed to implement an intermittent liquid cooling strategy for the battery module. Intermittent liquid cooling at various ambient temperatures can obtain similar thermal management performance to continuous liquid cooling, while significantly reducing liquid cooling energy consumption. Compared to continuous liquid cooling, intermittent liquid cooling can reduce energy consumption by a maximum of 97.05% and a minimum of 30.00%.

BackgroundDeep brain stimulation (DBS) is a potential treatment for improving movement disorder. However, few large-sample studies can reveal its efficacy and safety. This study aims to initially explore the efficacy and safety of DBS in the mesencephalic locomotor region (MLR) on motor function in patients with post-stroke hemiplegia.Methods/designThis multicenter, prospective, double-blind, randomized crossover clinical trial aims to assess the safety and effectiveness of Deep Brain Stimulation (DBS) in the mesencephalic locomotor region (MLR) for patients with moderate to severe post-stroke hemiplegia. Sixty-two patients with stable disease after a year of conservative treatment will be enrolled and implanted with deep brain electrodes. Post-surgery, patients will be randomly assigned to either the DBS group or the control group, with 31 patients in each. The DBS group will receive electrical stimulation 1 month later, while the control group will undergo sham stimulation. Stimulation will be discontinued after 3 and 6 months, followed by a 2-week washout period. Subsequently, the control group will receive electrical stimulation, while the DBS group will undergo sham stimulation. Both groups will resume electrical stimulation at the 9th and 12th-month follow-ups. Post-12-month follow-up, motor-related scores will be collected for analysis, with the Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE) as the primary metric. Secondary outcomes include balance function, neuropsychiatric behavior, fall risk, daily living activities, and quality of life. This study aims to provide insights into the therapeutic benefits of DBS for post-stroke hemiplegia patients.Result/conclusionWe proposed this study for the first time to comprehensively explore the effectiveness and safety of DBS in improving motor function for post-stroke hemiplegia, and provide evidence for DBS in the treatment of post-stroke hemiplegia. Study limitations are related to the small sample size and short study period.Clinical Trial RegistrationClinicaltrials.gov, identifier NCT05968248.

Abstract Langya Henipavirus (LayV) infection is an emerging zoonotic disease that has been causing respiratory symptoms in China since 2019. For virus entry, LayV’s genome encodes the fusion protein F and the attachment glycoprotein G. However, the structural and functional information regarding LayV-G remains unclear. In this study, we revealed that LayV-G cannot bind to the receptors found in other HNVs, such as ephrin B2/B3, and it shows different antigenicity from HeV-G and NiV-G. Furthermore, we determined the near full-length structure of LayV-G, which displays a distinct mushroom-shaped configuration, distinguishing it from other attachment glycoproteins of HNV. The stalk and transmembrane regions resemble the stem and root of mushroom and four downward-tilted head domains as mushroom cap potentially interact with the F protein and influence membrane fusion process. Our findings enhance the understanding of emerging HNVs that cause human diseases through zoonotic transmission and provide implication for LayV related vaccine development.

Abstract Using the CRITIC method, comprehensive index evaluation method, VAR model, coupling coordination model and other methods, this paper evaluates the comprehensive development of the population economy and eco-geological environment composite system in the twin-city economic circle of Chengdu–Chongqing region from 2000 to 2020, verifies the dynamic coupling relationship between subsystems and measures the coupling coordination degree of complex system. Meanwhile, the differences in the development process of each subsystem are discussed and the spatial–temporal evolution characteristics and laws of coupling coordination of the composite system during the research period are analyzed. The results reveal the following: (1) There is a long-term coordinated relationship between population, economy and eco-geological environment in Chengdu–Chongqing region, which have the conditions for emergence and generation. (2) The subsystems of population, economy and eco-geological environment in Chengdu–Chongqing region show an overall upward trend, among which the Sichuan part obviously outperforms the Chongqing part. Besides, the growth rate of the economy subsystem is significantly higher than that of the population, eco-geological environment subsystem. (3) The coupling coordinated development of the composite system has shown a benign upward development trend, gradually changing from “composite spiral structure” to “two cores outstanding, peripheral collapse, the west superior to the east”, while the main coordination state has developed from “Basic synergy—Economic lag” in 2000 to “Basic synergy—Population lag” in 2022. In addition, Cheng-De-Mian and Yuzhong districts with the better level of economic development have shown “Advanced synergy—Ecological lag”.

In this paper, a double-focused conical inlet axisymmetric structure with double acceleration is proposed and the evolution of composite core-shell droplets is calculated using the volume of fluid (VOF) method, focusing on the size and droplet formation frequency of composite core-shell droplets as well as the quality control method. The results show that dripping and jetting regimes occur in the channel, and the generation period and flow distribution under the two mechanisms are investigated accordingly. The effect of local geometry on the evolution of composite droplets in the core-shell is investigated and analyzed using the composite droplet size, frequency, maximum extended length, and core droplet relative offset rate at the initial stage. It is found that changing the entrance angle can achieve the regulation of droplet size to a certain extent. With the increase of dimensionless width of the collection channel, the core-shell composite droplets size shows an overall increasing trend and is inversely proportional to the outer phase capillary number. Finally, a quality control method for composite droplet formation based on the maximum relative offset rate of core droplets is proposed for the purpose of controlling the integrity of composite droplets.

ABSTRACTObjectives The study's aim was to enhance awareness of acquired hemophagocytic syndrome (HPS) in adults by analyzing clinical features, and investigating the relationship between factors such as the Systemic Inflammation Index (SII) and the prognosis of HPS.Methods Clinical characteristics, survival data, and prognostic factors of 75 HPS patients admitted to our hospital between January 2012 and October 2022 were analyzed.Results In the high SII group, red blood cells, white blood cells, platelets, neutrophils, fibrinogen, and CD4 + cell activity were higher, and survival time was longer compared to the low SII group. Conversely, total bilirubin and direct bilirubin were higher in the low SII group (P ≤ 0.05). After applying the log-Rank or Breslow tests, HPS patients in the high SII group and those following the HLH-2004 protocol experienced a notably longer survival time. (χ2 = 4.291, P

Abstract Low-carbon city construction is one of the key issues that must be addressed for China to achieve high-quality economic development and meet the Sustainable Development Goals. This study creates a comprehensive evaluation index system of low-carbon city multivariate system based on carbon emission data from 30 typical Chinese cities from 2006 to 2017 and evaluates and analyzes the trend of city low-carbon levels using the CRITIC-TOPSIS technique and MK method. Meanwhile, the influence mechanism of the multi-coupled system is investigated using the coupling coordination degree model and random forest algorithm.The results show that there are 8 cities with a significant increasing trend of low-carbon level, 19 cities with no significant monotonic change trend, and 3 cities with a decreasing trend of low-carbon level. By analyzing the coupling coordination degree, we found that the coupling coordination degree between low-carbon level and economic development in most cities tends to increase year by year, from the initial antagonistic effect to a good coordination development trend, which confirms the “inverted U-shaped” relationship between economy and carbon emission. In addition, industrial pollutant emissions, foreign direct investment, and economic output are the core drivers of low-carbon levels in cities.

Introduction Deep brain stimulation (DBS) has been validated as a safe and effective treatment for refractory cervical dystonia (CD). Globus pallidus internus (GPi) and subthalamic nucleus (STN) are the two main stimulating targets. However, there has been no prospective study to clarify which target is the better DBS candidate for CD. The objective of this trial is to compare directly the efficacy and safety of GPi-DBS and STN-DBS, thereby instructing the selection of DBS target in clinical practice.Methods and analysis This multicentre, prospective, randomised, controlled study plans to enrol 98 refractory CD patients. Eligible CD patients will be randomly allocated to GPi-DBS group or STN-DBS group, with the DBS electrodes implanted into the posteroventral portion of GPi or the dorsolateral portion of STN, respectively. The primary outcome will be the improvement of symptomatic severity, measured by the changes in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity subscale and the Tsui scale at 3 months, 6 months and 12 months after surgery. The secondary outcomes include the improvement of the TWSTRS-disability subscale, TWSTRS-pain subscale, quality of life, mental and cognitive condition, as well as the differences in stimulation parameters and adverse effects. In addition, this study intends to identify certain predictors of DBS efficacy for CD.Ethics and dissemination The trial has been approved by the Medical Ethics Committee of Chinese PLA General Hospital (S2022-613-01). The results of this study will be published in international peer-reviewed journals and shared in professional medical conferences.Trial registration number NCT05715138.

Objective: To investigate the effect of MALAT1 on the modulating the radiosensitivity of lung adenocarcinoma, through regulation of the expression of the miR-140/PD-L1 axis. Methods: The online databases UALCAN and dbDEMC were searched for the MALAT1 and miR-140 expressions in patients with lung adenocarcinoma (LUAD), respectively. Then analyze their relationship with overall survival rates separately in the UALCAN and ONCOMIR databases. A functional analysis was performed for A549 cells by transfecting small-interfering RNAs or corresponding plasmids after radiotherapy. Xenograft models of LUAD exposed to radiation were established to further observe the effects of MALAT1 on the radiosensitivity of LUAD. The luciferase assay and reverse transcription–polymerase chain reaction were performed to assess the interaction between miR-140 and MALAT1 or PD-L1. Results: MALAT1 were overexpressed in human LUAD tumor tissues and cell lines, while miR-140 were inhibited. MALAT1 knockdown or miR-140 increase suppressed cell proliferation and promoted cell apoptosis in LUAD after irradiation. LUAD xenograft tumor growth was also inhibited by MALAT1 knockdown combined with irradiation. miR-140 could directly bind with MALAT1 or PD-L1. Furthermore, MALAT1 knockdown inhibited PD-L1 mRNA and protein expressions by upregulating miR-140 in LUAD cells. Conclusion: MALAT1 may function as a sponge for miR-140a-3p to enhance the PD-L1 expression and decrease the radiosensitivity of LUAD. Our results suggest that MALAT1 might be a promising therapeutic target for the radiotherapy sensitization of LUAD.

Abstract Catastrophic landslides characterized by runaway slope failures remain difficult to predict. Here, we develop a physics‐based framework to prospectively assess slope failure potential. Our method builds upon the physics of extreme events in natural systems: the extremes so‐called “dragon‐kings” (e.g., slope tertiary creeps prior to failure) exhibit statistically different properties than other smaller‐sized events (e.g., slope secondary creeps). We develop statistical tools to detect the emergence of dragon‐kings during landslide evolution, with the secondary‐to‐tertiary creep transition quantitatively captured. We construct a phase diagram characterizing the detectability of dragon‐kings against “black‐swans” and informing on whether the slope evolves toward a catastrophic or slow landslide. We test our method on synthetic and real data sets, demonstrating how it might have been used to forecast three representative historical landslides. Our method can in principle considerably reduce the number of false alarms and identify with high confidence the presence of true hazards of catastrophic landslides.

To continue directing global sustainable development efforts from 2015 to 2030, the United Nations adopted 17 global development goals known as the Sustainable Development Goals (SDGs) when the Millennium Development Goals (MDGs) from 2000 to 2015 expired. Sustainable development of World Natural Heritage Sites is one of these 17 MDGs and a crucial step toward achieving global sustainability. A scientific and systematic indicator system that can measure the sustainable development of natural World Heritage Sites more objectively and fairly is urgently needed to support the establishment of SDG11.4 on a Chinese scale and to help with the subsequent promotion of the development of natural World Heritage Sites. This study proposes a comprehensive assessment indicator system for the sustainable development of natural heritage sites based on the theoretical framework of “value contribution-environmental effect” to quantify the sustainable development of natural heritage sites. The study is based on the ecological environment and regional economic and social data of Jiuzhaigou World Natural Heritage Site from 2010 to 2020. Finally, the degree of coupling and coordination between the natural environment and economic development is assessed and studied. The results show that tourism to the World Heritage Site drove rapid economic development in Jiuzhaigou County between 2010 and 2020. As the fame of the World Heritage Site Jiuzhaigou has grown, so has the per capita income of local locals, making them unduly reliant on tourists for a living. Meanwhile, both the 2017 earthquake and the COVID-19 epidemic in 2019 have had substantial detrimental effects on the local economy. Furthermore, the Jiuzhaigou sustainable development trend from 2010 to 2020 exhibits a “W-shaped” curve, and there is a high level of positive coupling between the Jiuzhaigou sustainable development trend and economic development, and the two are mutually reinforcing.

This paper aims to reveal the fatigue damage and instability behaviors of mud-shale under multistage increasing-amplitude fatigue loading. The fatigue loading tests combined with real-time acoustic emission (AE) monitoring technique were employed to investigate the influence of water content on the deformation, damage, and fracture characteristics. Testing results show that rock fatigue life decreases with the increase of water content, and the hysteresis curve changes regularly with time. The failure process can be divided into three stages: initial stage, stable development stage and acceleration stage. The acoustic emission output activities were also influenced by the water content. The acoustic emission ring count and acoustic emission energy both decrease with increasing water ratio and the accumulative count and energy are the least for a sample having high water ratio. The acoustic emission activity shows a sudden increase trend at the amplitude-increasing moment, indicating the occurrence of strong damage within rock sample. The damage propagation within a cyclic loading stage is relatively small compared to the stress-increasing moment. The results are helpful to understand the fatigue mechanical responses of water-sensitive soft rock, as well as the slope stability of the open-pit mine. The research results have important theoretical and practical significance for promoting slope treatment and disaster prevention.

This study aimed to establish a cell-based assay (CBA) for the detection of agrin antibodies (Agrin-Ab) to explore the clinical features of agrin antibody-positive Chinese patients with myasthenia gravis (Agrin-MG). We developed a CBA based on the human full-length agrin protein expressed in HEK293T cells for the reliable and efficient detection of Agrin-Ab. Clinical data and serum samples were collected from 1948 MG patients in 26 provinces in China. The demographic and clinical features of Agrin-MG patients were compared with those of other MG patient subsets. Eighteen Agrin-MG cases were identified from 1948 MG patients. Nine patients were Agrin-Ab positive, and nine were AChR-Ab and Agrin-Ab double-positive (Agrin/AChR-MG). Eleven (61.11%) patients were males older than 40 years of age. The initial symptom in 13 (81.25%) cases was ocular weakness. Occasionally, the initial symptom was limb-girdle weakness (two cases) or bulbar muscle weakness (one case). Agrin-MG patients demonstrated slight improvement following treatment with either acetylcholinesterase inhibitor or prednisone; however, the combination of the two drugs could effectively relieve MG symptoms. In China, Agrin-MG demonstrated seropositivity rates of 0.92%. These patients were commonly middle-aged or elderly men. The patients usually presented weakness in the ocular, bulbar, and limb muscles, which may be combined with thymoma. These patients have more severe diseases, although the combination of pyridostigmine and prednisone was usually effective in relieving symptoms.

AbstractThe preexistence of the geological discontinuities in cold regions is susceptible to freeze-thaw weathering and rock instability, and even the occurrence of geological hazards is strongly impacted by the discontinuities. Knowledge of how natural fracture affects the rock field deformation is crucial to rock stability prediction. This work is aimed at revealing the influences of freeze-thaw on failure process for pyrite-filled marble obtained from an open pit slope. All the tested marbles were selected to roughly have the same initial pyrite band; the full-field displacement and the progressive failure behaviors under uniaxial compression were qualitatively and quantitatively analyzed using 3D digital image correlation (3D DIC) technique. The testing results show that the previous freeze-thaw action weakens the cementation between the rock matrix and pyrite band; the peak stress and strain are obviously impacted by the freeze-thaw treatment. In addition, the stimulation of pyrite bands influences the displacement development and high strain concentration pattern. The stimulation of pyrite band results in the formation of strain concentration zone, and shear sliding occurs until rock failure. Moreover, it is found that the stimulation of pyrite band and its localized strain takes place progressively and develops fast for marble exposed to higher freeze-thaw treatment. It is suggested that the field deformation development depends on the stimulation of the pyrite bands.

Abstract Objective To investigate the correlation between acetylcholine receptor antibodies (AChR‐Ab) concentration levels and individualized clinical symptoms in patients with AChR myasthenia gravis (AChR‐MG) in China. Methods ELISA was used to determine the concentration of AChR‐Ab in patients with MG. The Myasthenia Gravis Foundation of America (MGFA) Clinical Classification, Quantitative Myasthenia Gravis (QMG) score, and MG‐specific activities of daily living (MG‐ADL) scoring systems were used to evaluate the clinical status of patients. Spearman correlation analysis was used to determine the correlation between the AChR‐Ab concentration and clinical score. The changes in the antibody concentration and clinical score are shown in MGFA‐antibody concentration–treatment plots. Results Autoantibody detection tests were performed in 67 patients, and their clinical scores were recorded. Forty‐nine patients received immunosuppressive therapy, 17 patients received pyridostigmine only, and 1 patient under thymectomy without any medication. The AChR‐Ab concentration correlated with the MGFA Classification in 5 (29.4%) patients in the pyridostigmine‐only group and 15 (30.6%) patients in the immunosuppressive drug group. The changes in the MGFA Classification preceded the changes in the AChR‐Ab concentration in 4 (23.5%) patients treated with pyridostigmine and 10 (20.4%) patients on immunosuppressive drugs. In patients on oral non‐steroidal immunosuppressants, the AChR‐Ab concentration changed by more than 50%, whereas the MGFA Classification did not increase. The AChR‐Ab concentration decreased in 17/32 (53.1%) patients after thymectomy, and then increased, whereas the AChR‐Ab concentration increased in 15/32 (46.9%) patients and the MGFA Classification decreased in 27/32 (81.8%) patients after thymectomy. The AChR‐Ab concentration presented a slight correlation with the corresponding MGFA, QMG, and MG‐ADL in patients with thymoma. Discussion In the Chinese AChR‐MG population, the Changes in the AChR‐Ab concentration in individuals with AChR‐MG did not consistently correlate with the severity of clinical symptoms.

Background: The coronary atherosclerotic burden in patients with ST-segment elevation myocardial infarction (STEMI) has been identified as the main predictor of prognosis. However, the association of lipoprotein(a) [Lp(a)], a well-established proatherogenic factor, with atherosclerotic burden in patients with STEMI is unclear.Methods: In total, 1,359 patients who underwent percutaneous coronary intervention (PCI) for STEMI were included in analyses. Three prespecified models with adjustment for demographic parameters and risk factors were evaluated. Generalized additive models and restricted cubic spline analyses were used to assess the relationships of Lp(a) with Gensini scores and the no-reflow phenomenon. Kaplan–Meier curves were generated to explore the predictive value of Lp(a) for long-term all-cause mortality. Furthermore, mRNA expression levels of LPA in different groups were compared using the GEO database.Results: Patients in the highest tertile according to Lp(a) levels had an increased incidence of heart failure during hospitalization. Furthermore, patients with high levels of Lp(a) (>19.1 mg/dL) had sharply increased risks for a higher Gensini score (Pfor trend = 0.03) and no-reflow (Pfor trend = 0.002) after adjustment for demographic parameters and risk factors. During a median follow-up of 930 days, 132 deaths (9.95%) were registered. Patients with high levels of Lp(a) (>19.1 mg/dL) had the worst long-term prognosis (Pfor trend < 0.0001). In a subgroup analysis, patients with higher Lp(a) still had the highest all-cause mortality. Additionally, the mRNA expression levels of LPA in patients with STEMI with lower cardiac function were higher than those in other groups (P = 0.003). A higher coronary atherosclerotic burden was correlated with higher LPA expression (P = 0.01).Conclusion: This study provides the first evidence that Lp(a) (at both the protein and mRNA levels) is independently associated with coronary atherosclerotic lesions and prognosis in patients with STEMI treated with PCI.Clinical Trial Registration:http://www.chictr.org.cn/index.aspx, identifier: ChiCTR1900028516.

A new strategy for designing low side-lobe level (SLL) antenna array is presented. This strategy utilizes special arrangement of antenna elements rather than direct tapered excitation amplitude to obtain an equivalent desired amplitude distribution in the main planes and thus achieve low SLL and high gain concurrently. To illustrate the strategy, 9-element microstrip antennas are arranged in four manners. An equivalent analysis method is also proposed to predict the SLL of the arrays. Using this method, a fast analysis of the trend of a microstrip array for a low SLL can be performed and thus a proper array-element arrangement is acquired. Both numerical and experimental results demonstrate that the SLLs in E and H planes of the novel array are fairly low. Meanwhile, the main beam of the novel array is almost the same with that of a conventional high-gain array. The antenna arrangement manner and the proposed strategy are particularly suitable for applications when low SLL and high gain are both demanded.

For rock engineering in cold regions, the naturally fractured rock is susceptible to repeated freeze-thaw (F-T) weathering, coupled fatigue conditions of freeze-thaw (F-T), and stress disturbance act on rock mass, which can lead to the instability of rock engineering and even occurrence of geological hazards. Knowledge of how natural fracture affects the overall fracture evolution of freeze-thawed rock is crucial to rock mass stability. Laboratory multilevel cyclic loading tests are conducted to reveal the fatigue behavior and energy evolution for naturally fractured marble, as well as the influence of natural fracture volume on fracture evolution. The test results show that the preexisting natural fracture impacts fatigue strength, lifetime, and energy dissipation. The dissipated energy is correlated to all kinds of natural fracture (i.e., opening-mode, closing-mode, and filling-mode), and it decreases with the increase of the total natural fracture volume. The dissipated energy presents a first slow and then faster pattern as the cycle number grows. Compared with newly formed cracks, the proportion of energy consumed by stimulating natural cracks is smaller.

This work is aimed at investigating the structural deterioration and the frost heaving force evolution characteristics of flawed rocks using a self-developed frost heaving force (FHF) measurement system. Three kinds of preflawed rocks with different flaw geometry parameters were used to conduct the FHF measurement tests. The testing results reveal five distinguished stages from the frost heaving force evolution curve; they are the inoculation stage, explosive stage, decline to steady stage, recovery stage, and sudden drop stage. In addition, a secondary frost heaving phenomenon is found, and the secondary peak value is lower than the initial peak value. Moreover, the FHF decreases with increasing the F-T cycle number, and its decreasing rate becomes faster at a high F-T cycle. The frost heaving force is affected not only by flaw geometry but also by the lithology. For low-pore hard rock, damage propagates quickly after the occurrence of freeze-thaw damage. It is suggested that the mesoscopic structure of rock affects the water migration and water-ice phase transformation, and rock can be fractured by FHF in the preexisting flaws.

The thermoelectric refrigeration system is an application of the Peltier effect, and good refrigeration performance is dependent on effective heat dissipation performance. To enhance the cooling performance of the thermoelectric system, this paper designs a new type of finned heat sink, which does not change the overall size of the thermoelectric system. The performance of the refrigeration system under the new fin is tested by experiments under various conditions. During the experiment, the cooling wind speed, the temperature of the hot and cold side of the TEC, the power consumption of the fan, and other parameters were directly recorded through the measuring instrument. The results show that the use of new finned heat sinks can improve the COP of the thermoelectric refrigeration system. Within the scope of the study, the thermal resistance of the new fins can be reduced by 42.6%, and the system COP value can be increased by 22.8%. In addition, increasing the cooling wind speed can further reduce the cold side temperature. Within the research range, the lowest temperature can reach −8.25 °C, but the power consumed by the fan is 166% of that of the conventional fin heat sink refrigeration device.