Clinical features of myasthenia gravis with neurological and systemic autoimmune diseases

Multiple reports on the co-existence of autoimmune diseases and myasthenia gravis (MG) have raised considerable concern. Therefore, we reviewed autoimmune diseases in MG to explore their clinical presentations and determine whether the presence of autoimmune diseases affects the disease severity and treatment strategies for MG. We reviewed all the major immune-mediated coexisting autoimmune conditions associated with MG. PubMed, Embase and Web of Science were searched for relevant studies from their inception to January 2023. There is a higher frequency of concomitant autoimmune diseases in patients with MG than in the general population with a marked risk in women. Most autoimmune comorbidities are linked to AChR-MG; however, there are few reports of MuSK-MG. Thyroid disorders, systemic lupus erythematosus, and vitiligo are the most common system autoimmune diseases associated with MG. In addition, MG can coexist with neurological autoimmune diseases, such as neuromyelitis optica (NMO), inflammatory myopathy (IM), multiple sclerosis (MS), and autoimmune encephalitis (AE), with NMO being the most common. Autoimmune diseases appear to develop more often in early-onset MG (EOMG). MS coexists more commonly with EOMG, while IM coexists with LOMG. In addition, MG complicated by autoimmune diseases tends to have mild clinical manifestations, and the coexistence of autoimmune diseases does not influence the clinical course of MG. The clinical course of neurological autoimmune diseases is typically severe. Autoimmune diseases occur most often after MG or as a combined abnormality; therefore, timely thymectomy followed by immunotherapy could be effective. In addition, thymoma-associated AChR MG is associated with an increased risk of AE and IM, whereas NMO and MS are associated with thymic hyperplasia. The co-occurrence of MG and autoimmune diseases could be attributed to similar immunological mechanisms with different targets and common genetic factor predisposition. This review provides evidence of the association between MG and several comorbid autoimmune diseases

Five newly recorded species of angiosperms from Shanxi Province

Abstract [Objective] The aim is to enrich the angiosperm germplasm resources in Shanxi Province, and promote research on biodiversity and forest ecosystems in Zhongtiao Mountain area. [Methods] Photoes of plant specimens and their typical features from Zhongtiao Mountains were collected through specimen identification, data access, and expert consultation, by conducting an extensive field survey of vegetation. [Results] Five species of angiosperms were newly recorded in Shanxi Province, including viz. Rumex acetosella L., Anemone narcissiflora subsp. protracta (Ulbrich) Ziman & Fedoronczuk, Cardamine flexuosa With., Impatiens lushiensis Y. L. Chen, and Physalis minima L.. [Conclusion] These plants belong to 5 families and 5 genera, which are newly recorded species of angiosperms from Shanxi Province. These discoveries enrich the angiosperms germplasm resources and provide a basis for the study of plant diversity and florogenesis in Zhongtiao Mountain Area

Service Differentiated and Adaptive CSMA/CA over IEEE 802.15.4 for Cyber-Physical Systems

Cyber-Physical Systems (CPS) that collect, exchange, manage information, and coordinate actions are an integral part of the Smart Grid. In addition, Quality of Service (QoS) provisioning in CPS, especially in the wireless sensor/actuator networks, plays an essential role in Smart Grid applications. IEEE 802.15.4, which is one of the most widely used communication protocols in this area, still needs to be improved to meet multiple QoS requirements. This is because IEEE 802.15.4 slotted Carrier Sense Multiple Access/Collision Avoidance (CSMA/CA) employs static parameter configuration without supporting differentiated services and network self-adaptivity. To address this issue, this paper proposes a priority-based Service Differentiated and Adaptive CSMA/CA (SDA-CSMA/CA) algorithm to provide differentiated QoS for various Smart Grid applications as well as dynamically initialize backoff exponent according to traffic conditions. Simulation results demonstrate that the proposed SDA-CSMA/CA scheme significantly outperforms the IEEE 802.15.4 slotted CSMA/CA in terms of effective data rate, packet loss rate, and average delay

Longitudinal Gut Bacterial Colonization and Its Influencing Factors of Low Birth Weight Infants During the First 3 Months of Life

Establishment of low birth weight (LBW) infant gut microbiota may have lifelong implications for the health of individuals. However, no longitudinal cohort studies have been conducted to characterize the gut microbial profiles of LBW infants and their influencing factors. Our objective was to understand how the gut bacterial community structure of LBW and normal birth weight (NBW) infants varies across the first 3 months of life and assess the influencing factors. In this observational cohort study, gut bacterial composition was identified with sequencing of the 16S rRNA gene in fecal samples of 69 LBW infants and 65 NBW controls at 0 day, 3 days, 2 weeks, 6 weeks, and 3 months (defined as stages 1–5) after birth. Alpha-diversity of both groups displayed a decreasing trend followed by slight variations. There were significant differences on the Shannon index of the two groups at stages 1 to 3 (P = 0.041, P = 0.032, and P = 0.014, respectively). The microbiota community structure of LBW infants were significantly different from NBW infants throughout the 3 months (all P < 0.05) but not at stage 2 (P = 0.054). There was a significant increase in abundance in Firmicutes while a decrease in Proteobacteria, and at genus level the abundance of Enterococcus, Klebsiella, and Streptococcus increased while it decreased for Haemophilus in LBW group. Birth weight was the main factor explaining the observed variation at all stages, except at stage 2. Delivery mode (4.78%) and antibiotic usage (3.50%) contributed to explain the observed variation at stage 3, and pregestational BMI (4.61%) partially explained the observed variation at stage 4. In conclusion, gut microbial communities differed in NBW and LBW infants from birth to 3 months of life, and were affected by birth weight, delivery mode, antibiotic treatment, and pregestational BMI

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Optimization Analysis of Intake and Outlet of a Power Plant in Semi-enclosed Waters

Two dimensional hydrodynamic model was used to simulate the hydraulic and thermal characteristics of thermal discharge during spring and neap tides under the combination schemes of three intakes and three outlets of Third Stage project in a power plant in semi-enclosed waters, and to analyze the influence of different schemes on the temperature rise distribution and excess temperature at intake. The results show that: For the semi-enclosed waters, neap tide is unfavorable tidal type, because the heat accumulation is more obvious and the areas of maximum and average temperature rise are larger than that in spring tide. When outlet is closer to bay mouth, the heat transfer is better and the area of temperature rise is greatly reduced. For the drainage schemeⅠwhich is closer to the bay mouth, the average temperature rise area of 1 ℃ is about 36% of the area of scheme Ⅲ. Under the same intake scheme of the Third Stage, the average excess temperature at intake is about 0.3 ℃ lower than that of other drainage schemes. The drainage schemeⅠhas obvious advantages. However, the maximum intake temperature rise of the First and Second Stages is higher because the drainage scheme I is close to the intake, so the diversion dike is considered to optimize the scheme. The diversion dike could reduce the maximum intake temperature rise of the First and Second Stages by about 0.6～0.7 ℃ and the mean by 0.1～0.2 ℃, suggesting that the diversion dike is an effective tool to reduce the heat return. The results are valuable for the layout and optimization of intake and outlet, and the study of thermal characteristics for similar waters

The Application of Combination Forecasting Model in Forecasting the Total Power of Agricultural Machinery in Heilongjiang Province

Agricultural machinery total power is an important index to reflect and evaluate the level of agricultural mechanization. Firstly, we respectively made use of exponential model, grey forecasting and BP neural network to construct models depending on historical data of agricultural machinery total power of Heilongjiang Province; secondly, we constructed the combined forecasting models that respectively based on divergence coefficient method, quadratic programming and weight distribution of Shapley value. Fitting results showed that the various combination forecasting model is superior to the single models. Finally, we applied the combination forecasting model which based on the weight distribution method of Shapley value to forecast Heilongjiang agricultural machinery total power, and it would provide some reference to the development and program for power of agriculture machinery