Current state of research on exercise for the treatment of myasthenia gravis: A scoping review.

OBJECTIVE: To provide a comprehensive overview of existing evidence, research gaps, and future research priorities concerning the treatment of myasthenia gravis (MG) using exercise therapies. METHOD: Clinical studies on exercise treatment for MG were searched in nine databases to conduct a scoping review. Two independent researchers screened the literature and comprehensively analyzed the characteristics and limitations of the included articles. RESULTS: A total of 5725 studies were retrieved, of which 24 were included. The included studies were conducted in 16 different countries/regions and 456 patients were enrolled. Study designs included both interventional and observational studies. Exercise interventions included aerobic exercise, resistance exercise, balance training, and stretch training, and are typically administered in conjunction with medication, usual care, or some other interventions. The intensity, frequency, and duration of exercise interventions varied hugely among studies. Six-minute walk test, adverse events, muscle strength, MG quality of life-15 scale, forced vital capacity, quantitative MG scale, and MG activities of daily living scale were the most frequently used outcomes. All studies reported results in favor of the efficacy and safety of exercise in MG, and exercise-related adverse events were reported in two studies. CONCLUSION: This scoping review provides an overview of the evidence concerning exercise treatment for MG. Key gaps in evidence include a limited number of participants, complex interventions, variability in outcome selection, and insufficient reporting in publications. The promotion of exercise treatment for MG still encounters several obstacles. A larger population, rigorous study design and conduction, standardized interventions and outcomes, and standardized reporting are essential.

Mapping current trends and hotspots in myasthenia gravis from 2003 to 2022: a bibliometric analysis.

Introduction: Research on myasthenia gravis (MG) has undergone rapid development in recent years. This article aimed to elucidate the characteristics of MG publications over the past 20 years and analyze emerging trends using bibliometric methods. Methods: Information on MG articles was obtained from the Web of Science Core Collection and stored in Excel for quantitative analyses. Bibliometric analyses were performed using CiteSpace and VOSviewer to visualize publications according to countries/regions, institutions, journals, and authors. Results: A total of 3,610 publications were included in the analysis. The USA had the highest number of publications (NP) and H-index. Among the institutions, the University of Oxford had the highest NP, followed by the University of Toronto and Duke University. Close cooperation was observed among countries and institutions. The most productive author was Renato Mantegazza, followed by Jan J. Verschuuren, and Amelia Evoli. Muscle & Nerve published the most articles on MG, followed by the Journal of Neuroimmunology and Neuromuscular Disorders. The keyword with the highest strength is "neuromuscular transmission," followed by "safety" and "rituximab." Co-citation analysis includes 103 publications cited at least 65 times, categorized into four clusters. Additionally, 123 keywords cited more than 40 times were analyzed and divided into five clusters. Conclusion: This bibliometric analysis shows the framework of research over the past 20 years by mapping the scholarly contributions of various countries or regions, institutions, journals, and authors in MG. The analysis also explores future trends and prospective directions, emphasizing individualized treatment based on subtypes, novel immunotherapeutic approaches, and thymectomy.

Current state of research on acupuncture for the treatment of amyotrophic lateral sclerosis: A scoping review.

Objective: To provide an overview of the range and characteristics of existing evidence, research gaps, and future research priorities in treating amyotrophic lateral sclerosis (ALS) with acupuncture. Method: Clinical studies on acupuncture treatment for ALS were searched in 9 databases and two websites. Two independent researchers screened the literature according to the inclusion and exclusion criteria; extracted the demographic data, interventions, and significant findings of the studies; and comprehensively analyzed the characteristics and limitations of the included articles. Results: A total of 2,326 studies were retrieved, of which 92 were included. Most of the studies were conducted in China, with the number increasing over time. Study designs included case reports, case series, randomized controlled trials (RCTs), and before-and-after studies, among which case reports were the most frequently used. A total of 1,388 patients were enrolled, of whom 1,031 had ALS, 274 had progressive bulbar palsy (PBP), 60 had progressive muscle atrophy (PMA), and 23 had primary lateral sclerosis (PLS). Acupuncture interventions included body acupuncture, electroacupuncture, acupoint injection, scalp acupuncture, acupoint massage, Sa-am acupuncture, needle-embedding therapy, auricular acupuncture, venom pharmacopuncture therapy, plum blossom needling, acupoint paste, electroacupuncture, and needle warming through moxibustion. The most frequently used acupoints were ST36, LI4, SP6, and LI11. Acupuncture is often applied in combination with other treatments, such as herbal or Western medicine. The frequency of treatment ranged from once a month to three times a day, and the duration of treatment ranged from 5 days to 3 years. Clinical symptoms, muscle strength, and effective rates were the most frequently used outcomes. Most studies reported significant efficacy, and only a few studies reported adverse events explicitly. Conclusion: Evidence gaps include poor study design, complex interventions, limited significance of the selected outcomes, and limited study reporting. The promotion of acupuncture treatment for ALS still faces several obstacles. Rigorous study design and conduct, standardized intervention and outcome measurements, and normative reporting are needed to investigate the efficacy and safety of acupuncture treatment for ALS.

Herbal medicine and acupuncture relieved progressive bulbar palsy for more than 3 years: A case report.

RATIONALE: Progressive bulbar palsy (PBP) is a type of motor neuron disease (MND). The main symptoms include dysarthria, dysphagia, tongue muscle atrophy and fasciculations. This disease is generally severe and develops rapidly. Due to the lack of effective treatment, many patients with MND in China turn to traditional Chinese medicine treatment for help. We successfully relieved dysphagia and sialorrhea in a patient with PBP for 3 years with herbal medicine and acupuncture. PATIENT CONCERNS: The patient was a 68-years-old woman with PBP and suffered from severe dysphagia and sialorrhea. DIAGNOSES: Progressive bulbar palsy. INTERVENTIONS: Chinese herbal medicine and acupuncture. OUTCOMES: After 4 months of herbal medicine and acupuncture treatment, dysphagia and sialorrhea were relieved considerably. The patient's condition has been stable for more than 3 years and continues to be treated with Chinese herbal medicine and acupuncture. LESSONS: Our case suggests that alternative therapies such as herbal medicine and acupuncture may be effective in alleviating the symptoms of MND/PBP. However, standardized clinical studies are still required to verify the effectiveness and safety.

Conjugated Microporous Poly(aniline) Enabled Hierarchical Porous Carbons for Hg(II) Adsorption.

Hierarchical porous carbons equipped with heteroatoms and diffusion pores have a wide application prospect in adsorption. Herein, we report N-autodoped porous carbons (PTPACs), which were derived from rigid N-rich conjugated microporous poly(aniline)s (CMPAs) and show their all-around applicability in heavy metal adsorption. Their molecular structure could be delicately tuned from 3D organic networks to graphitic carbons through simply adjusting the pyrolysis temperature, affording unique hybrid features of hierarchical micro-meso-macroporosity and amount-tunable nitrogen defects, as validated by the enhanced CO2 adsorption capacities reaching 5.0 mmol g-1, a 230% increase compared to the precursor (2.15 mmol g-1). They therefore show promising a Langmuir adsorption capacity of 434.8 mg g-1 toward mercury ions, which could be rapidly achieved within a short 20 min. Based on the comprehensive experimental, characterization, and DFT calculation studies, we rationally reveal these impressive adsorptions arise from the hybrid function of chemisorption contributed by populated nitrogen defects and physical adsorption achieved by synergistic functions in the diffusion and storage pores. Outcomes mark the high merits of PTPACs in addressing recent global challenges in environmental engineering.

Can community health centers improve the self-rated health of migrants? Evidence from China.

Background: Due to the "epidemiological paradox," migrants face the risk of health attrition during their migration. Meanwhile, institutional constraints cause a health gap between migrants and non-migrants. To narrow this gap and maintain equity, scholars have studied the role and impact mechanism of medical insurance participation in improving the health of migrants. However, due to the provision of China's basic medical insurance system, the proportion of migrants participating in employee medical insurance is still relatively low, while the community health center (CHC) is a more accessible medical resource for this group. Therefore, this study attempts to explore the impact of CHCs on the self-rated health (SRH) of migrants and identify the factors and mechanisms associated with such an impact. This study addresses the hypotheses whether (a) CHCs can significantly improve the SRH of migrants in China and (b) CHCs improve the SRH of migrants by promoting both their health knowledge and health behavior. Methods: Data was obtained from the 2017 China Migrants Dynamic Survey (CMDS). From the survey, 127,687 migrants were identified, and a series of logit regressions were conducted to explore the correlation between CHCs and the SRH of migrants. Propensity score matching (PSM) logit was also used for the robustness tests. Results: Logit estimations revealed that CHC is positively related to the SRH of migrants (OR = 1.095, p < 0.001). Compared to others, males (OR = 1.156, p < 0.001), younger people with higher education (OR = 1.027, p < 0.001), more stable employment (OR = 1.544, p < 0.001), and people with a lower proportion of elderly (> 65 years) household family members (OR = 0.842, p < 0.001) tended to have better SRH. The results also showed that the impact of CHCs on migrants' SRH varied by gender, age, and income (p < 0.001). A possible mechanism is that CHCs can improve migrants' SRH by promoting both their health knowledge and health behaviors. Conclusion: Programs that strengthen health knowledge and policies to enhance access to healthcare could be prioritized to improve the SRH of migrants in China.

The complete chloroplast genome sequence of Ulmus lanceifolia Roxburgh ex Wallich (Ulmaceae).

Ulmus lanceifolia, which plays an important role in ecology and economy, is one of the main evergreen broad leaved arbor species in southern China. In this study, we assembled its complete chloroplast genome. The total genome size of U. lanceifolia was 158,652bp, containing a large single-copy region of 87,119bp, a small single-copy region of 18,697bp, and a pair of inverted repeat regions of 26,418bp. The overall GC content of U. lanceifolia chloroplast genome is 35.63%. We obtained the 132 genes chloroplast genome, including 86 proteincoding genes, 8 rRNA genes, and 37 tRNA genes. The phylogenetic analysis suggests that U. lanceifolia is a monophyletic taxa and a transitional species between the 2 groups which were combined by Ulmus americana, U. elongate and Zelkova serrate, Z. schneideriana respectively in Ulmaceae.

The safety of COVID-19 vaccines in patients with myasthenia gravis: A scoping review.

Background: COVID-19 vaccines are required for individuals with myasthenia gravis (MG), as these patients are more likely to experience severe pneumonia, myasthenia crises, and higher mortality rate. However, direct data on the safety of COVID-19 vaccines in patients with MG are lacking, which results in hesitation in vaccination. This scoping was conducted to collect and summarize the existing evidence on this issue. Methods: PubMed, Cochrane Library, and Web of Science were searched for studies using inclusion and exclusion criteria. Article titles, authors, study designs, demographics of patients, vaccination information, adverse events (AEs), significant findings, and conclusions of included studies were recorded and summarized. Results: Twenty-nine studies conducted in 16 different countries in 2021 and 2022 were included. Study designs included case report, case series, cohort study, cross-sectional study, survey-based study, chart review, and systemic review. A total of 1347 patients were included. The vaccines used included BNT162b2, mRNA-1273, ChAdOx1 nCoV-19, inactivated vaccines, and recombinant subunit vaccines. Fifteen case studies included 48 patients reported that 23 experienced new-onset, and five patients experienced flare of symptoms. Eleven other types of studies included 1299 patients reported that nine patients experienced new-onset, and 60 participants experienced flare of symptoms. Common AEs included local pain, fatigue, asthenia, cephalalgia, fever, and myalgia. Most patients responded well to treatment without severe sequelae. Evidence gaps include limited strength of study designs, type and dose of vaccines varied, inconsistent window of risk and exacerbation criteria, limited number of participants, and lack of efficacy evaluation. Conclusion: COVID-19 vaccines may cause new-onset or worsening of MG in a small proportion of population. Large-scale, multicenter, prospective, and rigorous studies are required to verify their safety.

The complete chloroplast genome sequence of Xylosma racemosa (Siebold & Zucc.) Miq. (Salicaceae).

Xylosma racemosa (Siebold & Zucc.) Miq. which plays an important role in ecology, medicine and economy, is a deciduous species of Salicaceae. In this paper, we sequenced, assembled, and annotated the chloroplast (cp) genome of X. racemosa (Siebold & Zucc.) Miq. by using the sequencing data from Illumina Novaseq platform. The complete cp genome of X. racemosa is 157,262 bp in length, containing a large single-copy (LSC) region of 84,289 bp, and a small single-copy (SSC) region of 17,817 bp. It contains 131 genes, including 8 rRNA genes, 37 tRNAs genes and 86 protein-coding genes. The GC content of X. racemosa cp genome is 36.74%. The phylogenetic analysis suggests that X. racemosa is a sister species to Xylosma congesta in Salicaceae.

The complete chloroplast genome sequence of Styrax agrestis (Lour.) G. Don (Styracaceae).

Styrax agrestis (Lour.) G. Don, is a deciduous species of Styracaceae with beautiful shape, drooping flowers, and blooming like snow. Here, we characterized the complete chloroplast (cp) genome of S. agrestis using next generation sequencing. The circular complete cp genome of S. agrestis is 157,893 bp in length, containing a large single-copy (LSC) region of 87,512 bp, and a small single-copy (SSC) region of 18,285 bp. It comprises 136 genes, including eight rRNA genes, 37 tRNAs genes, 90 protein-coding genes, and one pseudo gene. The GC content of S. agrestis cp genome is 36.96%. The phylogenetic analysis suggests that S. agrestis is a sister species to Styrax faberi in Styracaceae.

The complete chloroplast genome sequence of Huodendron tibeticum (J.Anthony) Rehder (Styracaceae).

Huodendron tibeticum (J.Anthony) Rehder, which plays an important role in ecology and economy, is a deciduous species of Styracaceae. The authors sequenced, assembled, and annotated the chloroplast (cp) genome of Huodendron tibeticum using the sequencing data from Illumina Novaseq platform in this study. The complete cp genome of H. tibeticum is 159,320 bp in length, including a large single-copy (LSC) region of 87,795 bp, and a small single-copy (SSC) region of 18,989 bp. It contains 130 genes, including 37 tRNA genes, 8 rRNA genes, and 85 protein-coding genes. The overall GC content of H. tibeticum chloroplast genome is 36.66%. The phylogenetic analysis suggests that H. tibeticum is a sister species to H. biaristatum in Styracaceae.

Shape and margin-aware lung nodule classification in low-dose CT images via soft activation mapping.

A number of studies on lung nodule classification lack clinical/biological interpretations of the features extracted by convolutional neural network (CNN). The methods like class activation mapping (CAM) and gradient-based CAM (Grad-CAM) are tailored for interpreting localization and classification tasks while they ignored fine-grained features. Therefore, CAM and Grad-CAM cannot provide optimal interpretation for lung nodule categorization task in low-dose CT images, in that fine-grained pathological clues like discrete and irregular shape and margins of nodules are capable of enhancing sensitivity and specificity of nodule classification with regards to CNN. In this paper, we first develop a soft activation mapping (SAM) to enable fine-grained lung nodule shape & margin (LNSM) feature analysis with a CNN so that it can access rich discrete features. Secondly, by combining high-level convolutional features with SAM, we further propose a high-level feature enhancement scheme (HESAM) to localize LNSM features. Experiments on the LIDC-IDRI dataset indicate that 1) SAM captures more fine-grained and discrete attention regions than existing methods, 2) HESAM localizes more accurately on LNSM features and obtains the state-of-the-art predictive performance, reducing the false positive rate, and 3) we design and conduct a visually matching experiment which incorporates radiologists study to increase the confidence level of applying our method to clinical diagnosis.

The complete chloroplast genome sequence of Styrax chinensis Hu et S.Y. Liang (Styracaceae).

Styrax chinensis Hu et S.Y. Liang, is one of the few evergreen species of Styracaceae with fragrant flowers. Here, we characterized the complete chloroplast (cp) genome of S. chinensis using next-generation sequencing. The circular complete cp genome of S. chinensis is 158,502 bp in length, containing a large single-copy (LSC) region of 87,817 bp, and a small single-copy (SSC) region of 18,001 bp. It comprises 132 genes, including 8 rRNA genes, 37 tRNAs genes, and 87 protein-coding genes. The GC content of S. chinensis cp genome is 36.93%. The phylogenetic analysis suggests that S. chinensis is a sister species to Styrax suberifolius in Styracaceae.

PaDNet: Pan-Density Crowd Counting.

Crowd counting is a highly challenging problem in computer vision and machine learning. Most previous methods have focused on consistent density crowds, i.e., either a sparse or a dense crowd, meaning they performed well in global estimation while neglecting local accuracy. To make crowd counting more useful in the real world, we propose a new perspective, named pan-density crowd counting, which aims to count people in varying density crowds. Specifically, we propose the Pan-Density Network (PaDNet) which is composed of the following critical components. First, the Density-Aware Network (DAN) contains multiple subnetworks pretrained on scenarios with different densities. This module is capable of capturing pandensity information. Second, the Feature Enhancement Layer (FEL) effectively captures the global and local contextual features and generates a weight for each density-specific feature. Third, the Feature Fusion Network (FFN) embeds spatial context and fuses these density-specific features. Further, the metrics Patch MAE (PMAE) and Patch RMSE (PRMSE) are proposed to better evaluate the performance on the global and local estimations. Extensive experiments on four crowd counting benchmark datasets, the ShanghaiTech, the UCF-CC-50, the UCSD, and the UCFQNRF, indicate that PaDNet achieves state-of-the-art recognition performance and high robustness in pan-density crowd counting.