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• A comprehensive stiffness model of intermediate bearing is presented. • A reduced model of dual rotor-bearing-casing coupling system is developed. • The effects of typical parameters on the vibration of the system are discussed. • The mechanism of the comprehensive stiffness and system vibration is revealed. This paper focuses on the vibrational properties of a dual rotor-casing coupled system with nonlinear clearance in the intermediate bearing, considering both the oil film stiffness and Hertzian contact stiffness between rolling elements and raceways. A comprehensive stiffness model for the intermediate bearing has been developed based on elastohydrodynamic lubrication (EHL) and Hertz contact theory. Subsequently, a dynamical model of the dual rotor-bearing-casing system is established using the finite element method, thereby verifying the feasibility of simulating the casing with beam elements. The dimensionality of the system equation is reduced using the fixed-interface component mode synthesis (CMS) method, and the resulting reduced-dimensionality equation is solved using the improved Newmark- β method. The effects of casing support, rotational speed, and radial clearance on the vibration characteristics of the system are investigated. Then, the comprehensive stiffness and coupled vibration characteristics of the system are analyzed to elucidate its intrinsic mechanism. Finally, the contact characteristics within the intermediate bearing under dynamic load are also studied. The results indicate that the support stiffness of the casing has a more significant impact on the second resonance caused by both the inner and outer rotors. The system is prone to experiencing varying compliance (VC) resonance at low rotational speeds. The excessive bearing clearance leads to complex vibrational characteristics of the system, making it challenging to predict its motion. The impact of minor changes in stiffness on system vibration is small when the comprehensive stiffness is large. At this time, the limited effect of oil film stiffness allows it to be disregarded in terms of comprehensive stiffness. Furthermore, the speed significantly influences the contact characteristics within the intermediate bearing under the unbalanced force of the rotor and gravity. [ABSTRACT FROM AUTHOR]

Whether continuous intraoperative nerve monitoring (C-IONM) can further reduce the incidence of recurrent laryngeal nerve injury compared with intermittent intraoperative nerve monitoring (I-IONM) in high-risk thyroid surgery is still controversial. This observational study aimed to evaluate the incidence of vocal cord paralysis (VCP) in high-risk thyroid surgeries performed with I-IONM and C-IONM. High-risk thyroid surgical patients operated with I-IONM or C-IONM by the same group of surgeons in the thyroid surgery department of our institution between January 2014 and February 2018 were analyzed. Differences in the incidence rates of temporary and permanent VCP between the two groups were compared. A P -value < 0.05 was considered statistically significant. A total of 344 patients who underwent high-risk thyroid surgery (550 nerves at risk [NARs]) were observed, with 238 patients (374 NARs) operated with I-IONM and 106 patients (173 NARs) operated with C-IONM. The incidence of temporary and permanent VCP was 1.9% (7/374) and 0.8% (3/374) in the I-IONM group and 1.2% (2/173) and 0% (0/173) in the C-IONM group, respectively, showing no statistical difference (P = 0.726 and P = 0.555). The incidence rate of impending recurrent laryngeal nerve injuries successfully prevented in the C-IONM group was 5.2% (9/173). Both I-IONM and C-IONM are equally safe and effective in high-risk thyroid surgery. C-IONM can help predict impending recurrent laryngeal nerve injury in real time and has a good warning feature, thereby minimizing critical maneuvers in high-risk thyroid surgery. [ABSTRACT FROM AUTHOR]

Type I interferon pathway is a crucial component of innate immune signaling upon pathogen infection or endogenous instability. An imbalance of type I interferon can lead to many diseases, such as autoimmune diseases and inflammatory diseases. Meanwhile, the side effects of clinical drugs on type I interferon signaling may result in impaired outcomes in clinical treatment, especially in cancer immunotherapy which is associated with type I interferon signaling. Here, we found that sorafenib, an FDA-approved drug for HCC chemotherapy, suppresses both DNA- and RNA-sensing mediated type I interferon pathway. Mechanistically, sorafenib treatment induces the autophagic degradation of MAVS, cGAS, TBK1, and IRF3, and attenuates the signaling transduction. In addition, sorafenib also inhibits the recruiting of STING or MAVS with TBK1 and IRF3. This work reveals the negative role of sorafenib in the regulation of type I interferon pathway. Sorafenib treatment is not only a potential drug for autoimmune disease and inflammation diseases, but also needs to be noticed in HCC chemotherapy. • Sorafenib suppresses DNA-sensing mediated type I interferon pathway. • Sorafenib suppresses RLR mediated type I interferon pathway. • Sorafenib induces the autophagic degradation of MAVS, cGAS, TBK1 and IRF3. • Sorafenib blocks the recruiting of STING or MAVS with TBK1 and IRF3. [ABSTRACT FROM AUTHOR]