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LiF-BeF2-ZrF4-UF4 and LiF-BeF2 have been employed as fuel salt and coolant in liquid fueled molten salt reactor, respectively. A heat exchanger containing both fuel salt and cooling salt is placed inside the reactor vessel to dissipate the heat produced by the reactor. A molten salttoair heat exchanger outside the reactor vessel is used to cool the molten salt, and a molten salt pump is used to drive the circulation of the entire circuit of coolant system. As of the molten salt, LiF-BeF2 coolant, flows through the molten salt heat exchanger located inside the reactor vessel, nuclides in the coolant are activated by 19F(n, α)16N, 19F(n, γ)20F, and 19F(n, p)19O reactions with neutrons in the reactor core, and thus radionuclides such as 16N, 20F and 19O are produced. These radionuclides have radiation impact on the surrounding environment and equipment if they enter the rooms where equipment for molten salt coolant circuit locate. According to the flow process and distribution law of the cooling salt, theoretical calculation formulas to calculate the amount of radionuclide were given. Using theoretical formulas, calculated radioactivities of the three most important radionuclides 16N, 20F and 19O per unit volume of cooling salt are 9.05×106, 8.33×106 and 2.69×105 Bq/cm3 at the outlet of the molten salt heat exchanger, while the radioactivities of the three radionuclides at the same location calculated by ORIGENS program are 8.98×106, 8.58×106 and 2.76×105 Bq/cm3, respectively. The results calculated by the formulas are in good agreement with the data of the ORIGENS program, and the maximum relative deviation between the results of the two methods is 292%, indicating that applying the derived formulas to carry out cooling salt activation analysis is reasonable and feasible. These radionuclides, 16N, 20F and 19O, produced in the cooling salt of molten salt reactor release highenergy gamma rays as they decay. The total gamma emissivities of the cooling salt in equipment and pipelines located in the cooling salt storage tank room, in the molten salt-to-air heat exchanger room and in the cooling salt pump room are 8.71×1011, 9.51×1011 and 1.93×1012 s-1, respectively, and the most radioactive area is in the cooling salt pump room. The maximum absorbed dose rate at the location of the cooling salt auxiliary equipment is 45.7 mGy/h without shielding, which cannot meet the requirement of the radiation dose, and which should be less than 50 Gy for the entire life of the equipment (300 full power days). By setting a 30 cm thick concrete shielding wall between the cooling salt auxiliary equipment and the cooling salt pump, the absorbed dose rate at the location of the auxiliary equipment can be reduced to less than 7 mGy/h, thereby the radiation protection requirements for the cooling salt auxiliary equipment can be met.

Background: A critical parameter of extracorporeal CO2 removal (ECCO2R) applications is the CO2 removal rate (VCO2). Low‐flow venovenous extracorporeal support with large‐size membrane lung remains undefined. This study aimed to evaluate the VCO2 of a low‐flow ECCO2R with large‐size membrane lung using a renal replacement therapy platform in an experimental animal model. Methods: Twelve healthy pigs were placed under mechanical ventilation and connected to an ECCO2R‐CRRT system (surface area = 1.8 m2; OMNIset®, BBraun, Germany). Respiratory settings were reduced to induce two degrees of hypercapnia. VCO2 was recorded under different combinations of PaCO2 (50–69 or 70–89 mm Hg), extracorporeal blood flow (ECBF; 200 or 350 mL/min), and gas flow (4, 6, or 10 L/min). Results: VCO2 increased with ECBF at all three gas flow rates. In severe hypercapnia, the increase in sweep gas flow from 4 to 10 L/min increased VCO2 from 86.38 ± 7.08 to 96.50 ± 8.71 mL/min at an ECBF of 350 mL/min, whereas at ECBF of 200 mL/min, any increase was less effective. But in mild hypercapnia, the increase in sweep gas flow result in significantly increased VCO2 at two ECBF. VCO2 increased with PaCO2 from 50–69 to 70–89 mm Hg at an ECBF of 350 mL/min, but not at ECBF of 200 mL/min. Post‐membrane lung PCO2 levels were similar for different levels of premembrane lung PCO2 (p = 0.08), highlighting the gas exchange diffusion efficacy of the membrane lung in gas exchange diffusion. In severe hypercapnia, the reduction of PaCO2 elevated from 11.5% to 19.6% with ECBF increase only at a high gas flow of 10 L/min (p < 0.05) and increase of gas flow significantly reduced PaCO2 only at a high ECBF of 350 mL/min (p < 0.05). Conclusions: Low‐flow venovenous extracorporeal ECCO2R‐CRRT with large‐size membrane lung is more efficient with the increase of ECBF, sweep gas flow rate, and the degree of hypercapnia. The influence of sweep gas flow on VCO2 depends on the ECBF and degree of hypercapnia. Higher ECBF and gas flow should be chosen to reverse severe hypercapnia. [ABSTRACT FROM AUTHOR]

The PandaX-4T liquid xenon detector at the China Jinping Underground Laboratory is used to measure the solar ^{8}B neutrino flux by detecting neutrinos through coherent scattering with xenon nuclei. Data samples requiring the coincidence of scintillation and ionization signals (paired), as well as unpaired ionization-only signals (US2), are selected with energy threshold of approximately 1.1 keV (0.33 keV) nuclear recoil energy. Combining the commissioning run and the first science run of PandaX-4T, a total exposure of 1.20 and 1.04  tonne·year are collected for the paired and US2, respectively. After unblinding, 3 and 332 events are observed with an expectation of 2.8±0.5 and 251±32 background events, for the paired and US2 data, respectively. A combined analysis yields a best-fit ^{8}B neutrino signal of 3.5 (75) events from the paired (US2) data sample, with ∼37% uncertainty, and the background-only hypothesis is disfavored at 2.64σ significance. This gives a solar ^{8}B neutrino flux of (8.4±3.1)×10^{6}  cm^{-2} s^{-1}, consistent with the standard solar model prediction. It is also the first indication of solar ^{8}B neutrino "fog" in a dark matter direct detection experiment.

We report the first search for the elastic scatterings between cosmic-ray boosted sub-MeV dark matter (DM) and electrons in the PandaX-4T liquid xenon experiment. Sub-MeV DM particles can be accelerated by scattering with electrons in the cosmic rays and produce detectable electron recoil signals in the detector. Using the commissioning data from PandaX-4T of 0.63  tonne·year exposure, we set new constraints on DM-electron scattering cross sections for DM masses ranging from 10  eV/c^{2} to 3  keV/c^{2}.

^{134}Xe is a candidate isotope for neutrinoless double beta decay (0νββ) search. In addition, the two-neutrino case (2νββ) allowed by the standard model of particle physics has not yet been observed. With the 656-kg natural xenon in the fiducial volume of the PandaX-4T detector, which contains 10.4% of ^{134}Xe, and its initial 94.9-day exposure, we have established the most stringent constraints on 2νββ and 0νββ of ^{134}Xe half-lives, with limits of 2.8×10^{22}  yr and 3.0×10^{23}  yr at 90% confidence level, respectively. The 2νββ (0νββ) limit surpasses the previously reported best result by a factor of 32 (2.7), highlighting the potential of large monolithic natural xenon detectors for double beta decay searches.

We report results of a search for dark-matter-nucleon interactions via a dark mediator using optimized low-energy data from the PandaX-4T liquid xenon experiment. With the ionization-signal-only data and utilizing the Migdal effect, we set the most stringent limits on the cross section for dark matter masses ranging from 30  MeV/c^{2} to 2  GeV/c^{2}. Under the assumption that the dark mediator is a dark photon that decays into scalar dark matter pairs in the early Universe, we rule out significant parameter space of such thermal relic dark-matter model.

We report a search for light dark matter produced through the cascading decay of η mesons, which are created as a result of inelastic collisions between cosmic rays and Earth's atmosphere. We introduce a new and general framework, publicly accessible, designed to address boosted dark matter specifically, with which a full and dedicated simulation including both elastic and quasielastic processes of Earth attenuation effect on the dark matter particles arriving at the detector is performed. In the PandaX-4T commissioning data of 0.63  tonne·year exposure, no significant excess over background is observed. The first constraints on the interaction between light dark matter generated in the atmosphere and nucleus through a light scalar mediator are obtained. The lowest excluded cross section is set at 5.9×10^{-37}  cm^{2} for a dark matter mass of 0.1  MeV/c^{2} and mediator mass of 300  MeV/c^{2}. The lowest upper limit of η to the dark matter decay branching ratio is 1.6×10^{-7}.

We report the search results of light dark matter through its interactions with shell electrons and nuclei, using the commissioning data from the PandaX-4T liquid xenon detector. Low energy events are selected to have an ionization-only signal between 60 to 200 photoelectrons, corresponding to a mean nuclear recoil energy from 0.77 to 2.54 keV and electronic recoil energy from 0.07 to 0.23 keV. With an effective exposure of 0.55  tonne·year, we set the most stringent limits within a mass range from 40  MeV/c^{2} to 10  GeV/c^{2} for pointlike dark matter-electron interaction, 100  MeV/c^{2} to 10  GeV/c^{2} for dark matter-electron interaction via a light mediator, and 3.2 to 4  GeV/c^{2} for dark matter-nucleon spin-independent interaction. For DM interaction with electrons, our limits are closing in on the parameter space predicted by the freeze-in and freeze-out mechanisms in the early Universe.

A search for interactions from solar ^{8}B neutrinos elastically scattering off xenon nuclei using PandaX-4T commissioning data is reported. The energy threshold of this search is further lowered compared with the previous search for dark matter, with various techniques utilized to suppress the background that emerges from data with the lowered threshold. A blind analysis is performed on the data with an effective exposure of 0.48  tonne year, and no significant excess of events is observed. Among the results obtained using the neutrino-nucleus coherent scattering, our results give the best constraint on the solar ^{8}B neutrino flux. We further provide a more stringent limit on the cross section between dark matter and nucleon in the mass range from 3 to 9  GeV/c^{2}.

Precise measurement of two-neutrino double beta decay (DBD) half-life is an important step for the searches of Majorana neutrinos with neutrinoless double beta decay. We report the measurement of DBD half-life of 136 Xe using the PandaX-4T dual-phase Time Projection Chamber (TPC) with 3.7-tonne natural xenon and the first 94.9-day physics data release. The background model in the fiducial volume is well constrained in situ by events in the outer active region. With a 136 Xe exposure of 15.5 kg-year, we establish the half-life as 2.27 ± 0.03( stat. ) ± 0.10( syst. ) × 10 21 years. This is the first DBD half-life measurement with natural xenon and demonstrates the physics capability of a large-scale liquid xenon TPC in the field of rare event searches., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this article., (Copyright © 2022 Lin Si et al.)

Compared with the signature of dark matter elastic scattering off nuclei, the absorption of fermionic dark matter by nuclei opens up a new searching channel for light dark matter with a characteristic monoenergetic signal. In this Letter, we explore the 95.0-day data from the PandaX-4T commissioning run and report the first dedicated searching results of the fermionic dark matter absorption signal through a neutral current process. No significant signal was found, and the lowest limit on the dark matter-nucleon interaction cross section is set to be 1.5×10^{-50}  cm^{2} for a fermionic dark matter mass of 40  MeV/c^{2} with 90% confidence level.

We report a novel search for the cosmic-ray boosted dark matter using the 100  tonne·day full dataset of the PandaX-II detector located at the China Jinping Underground Laboratory. With the extra energy gained from the cosmic rays, sub-GeV dark matter particles can produce visible recoil signals in the detector. The diurnal modulations in rate and energy spectrum are utilized to further enhance the signal sensitivity. Our result excludes the dark matter-nucleon elastic scattering cross section between 10^{-31} and 10^{-28}  cm^{2} for dark matter masses from 0.1  MeV/c^{2} to 0.1  GeV/c^{2}, with a large parameter space previously unexplored by experimental collaborations.

We report the first dark matter search results using the commissioning data from PandaX-4T. Using a time projection chamber with 3.7 tonne of liquid xenon target and an exposure of 0.63  tonne·year, 1058 candidate events are identified within an approximate nuclear recoil energy window between 5 and 100 keV. No significant excess over background is observed. Our data set a stringent limit to the dark matter-nucleon spin-independent interactions, with a lowest excluded cross section (90% C.L.) of 3.8×10^{-47}  cm^{2} at a dark matter mass of 40  GeV/c^{2}.

Objective: The aims of this systematic review and meta-analysis were to summarize the current existing evidence on the outcome of critically ill patients with COVID-19 as well as to evaluate the effectiveness of clinical interventions. Data Sources: We searched MEDLINE, the Cochrane library, Web of Science, the China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang Data from their inception to May 15, 2021. The search strings consisted of various search terms related to the concepts of mortality of critically ill patients and clinical interventions. Study Selection: After eliminating duplicates, two reviewers independently screened all titles and abstracts first, and then the full texts of potentially relevant articles were reviewed to identify cohort studies and case series that focus on the mortality of critically ill patients and clinical interventions. Main Outcomes and Measures: The primary outcome was the mortality of critically ill patients with COVID-19. The secondary outcomes included all sorts of supportive care. Results: There were 27 cohort studies and six case series involving 42,219 participants that met our inclusion criteria. All-cause mortality in the intensive care unit (ICU) was 35% and mortality in hospital was 32% in critically ill patients with COVID-19 for the year 2020, with very high between-study heterogeneity ( I 2 = 97%; p < 0.01). In a subgroup analysis, the mortality during ICU hospitalization in China was 39%, in Asia-except for China-it was 48%, in Europe it was 34%, in America it was 15%, and in the Middle East it was 39%. Non-surviving patients who had an older age [-8.10, 95% CI (-9.31 to -6.90)], a higher APACHE II score [-4.90, 95% CI (-6.54 to -3.27)], a higher SOFA score [-2.27, 95% CI (-2.95 to -1.59)], and a lower PaO 2 /FiO 2 ratio [34.77, 95% CI (14.68 to 54.85)] than those who survived. Among clinical interventions, invasive mechanical ventilation [risk ratio (RR) 0.49, 95% CI (0.39-0.61)], kidney replacement therapy [RR 0.34, 95% CI (0.26-0.43)], and vasopressor [RR 0.54, 95% CI (0.34-0.88)] were used more in surviving patients. Conclusions: Mortality was high in critically ill patients with COVID-19 based on low-quality evidence and regional difference that existed. The early identification of critical characteristics and the use of support care help to indicate the outcome of critically ill patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Qian, Lu, Luo, Chen and Liu.)

Background: Position intervention has been shown to improve oxygenation, but its role in non-invasively ventilated patients with severe COVID-19 has not been assessed. The objective of this study was to investigate the efficacy of early position intervention on non-invasively ventilated patients with severe COVID-19., Methods: This was a single-center, prospective observational study in consecutive patients with severe COVID-19 managed in a provisional ICU at Renmin Hospital of Wuhan University from 31 January to 15 February 2020. Patients with chest CT showing exudation or consolidation in bilateral peripheral and posterior parts of the lungs were included. Early position intervention (prone or lateral) was commenced for > 4 hours daily for 10 days in these patients, while others received standard care., Results: The baseline parameters were comparable between the position intervention group ( n  = 17) and the standard care group ( n  = 35). Position intervention was well-tolerated and increased cumulative adjusted mean difference of SpO 2 /FiO 2 (409, 95% CI 86 to 733) and ROX index (26, 95% CI 9 to 43) with decreased Borg scale (-9, 95% CI -15 to -3) during the first 7 days. It also facilitated absorption of lung lesions and reduced the proportion of patients with high National Early Warning Score 2 (≥ 7) on days 7 and 14, with a trend toward faster clinical improvement. Virus shedding and length of hospital stay were comparable between the two groups., Conclusions: This study provides the first evidence for improved oxygenation and lung lesion absorption using early position intervention in non-invasively ventilated patients with severe COVID-19, and warrants further randomized trials., (© The Author(s) 2020. Published by Oxford University Press on behalf West China School of Medicine & West China Hospital of Sichuan University.)

Objectives: To compare and analyse the recommendations from clinical practice guidelines (CPGs) on gout worldwide, examine the consistency across CPGs, and provide suggestions to develop and update gout guidelines., Methods: We conducted systematic searches in MEDLINE, CBM, GIN, NICE, NGC, WHO, SIGN, DynaMed, UpToDate, and Best Practice databases, from their inception to August 2019 to identify and select CPGs related to gout. We used the search terms "gout", "hyperuricaemia" and "guideline". After two rounds of screening, we included the eligible CPGs of gout according to the pre-defined inclusion and exclusion criteria. Methodological quality of included guidelines was assessed with the AGREE-II instrument. The general characteristics of included guidelines and the recommendations were extracted, and the consistency of recommendations across guidelines was compared and analysed., Results: A total of 15 gout guidelines including 359 recommendations were retrieved. The main topics covered by the recommendations were diagnosis, pharmacologic treatment of gout flares, pharmacologic urate-lowering therapy (ULT) of chronic gouty arthritis, lifestyle interventions, prophylaxis, and management of asymptomatic hyperuricaemia. The results of AGREE-II appraisal showed that only two guidelines achieved high scores (≥50%) in all six domains. There was substantial discrepancy between the guidelines in recommendations covering the value of computed tomography (CT) and x-rays for diagnosis, the use of corticosteroids as a first-line treatment for flare, the use of colchicine, indications for ULT, the use of febuxostat as first-line ULT, the administration of allopurinol, and the timing of ULT initiation., Conlusions: A number of countries are devoting themselves to the development of gout guidelines, but the process of updating guidelines is slower than that suggested by the WHO. Methodological quality is not satisfactory in most guidelines, and recommendations between guidelines are not consistent.

Objective: The aim of this systematic review was to assess the diaphragmatic dysfunction (DD) as a predictor of weaning outcome., Background: Successful weaning depends on several factors: muscle strength, cardiac, respiratory and metabolic. Acquired weakness in mechanical ventilation is a growing important cause of weaning failure. With the development of ultrasonography, DD can be evaluated with ultrasound in weakness patients to predict weaning outcomes., Methods: The Cochrane Library, PubMed, Embase, Ovid Medline, WanFang Data and CNKI were systematically searched from the inception to September 2017. Ultrasound assessment of DD in adult mechanical ventilation patients was included. Two independent investigators assessed study quality in accordance with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The primary outcome was diaphragmatic thickness and excursion in the weaning success and failure group. The secondary outcome was the influence of DD on weaning outcome., Results: Eleven studies involving a total of 436 patients were included. There were eight studies comparing diaphragmatic excursion (DE), five comparing the diaphragmatic thickening fraction (DTF) and two comparing DD between groups with and without successful weaning. Overall, the DE or DTF had a pooled sensitivity of 0.85 (95% CI 0.77 to 0.91) and a pooled specificity of 0.74 (95% CI 0.66 to 0.80) for predicting weaning success. There was high heterogeneity among the included studies (I 2 =80%; p=0.0006). The rate of weaning failure was significantly increased in patients with DD (OR 8.82; 95% CI 3.51 to 22.13; p<0.00001)., Conclusions: Both DE and DTF showed good diagnostic performance to predict weaning outcomes in spite of limitations included high heterogeneity among the studies. DD was found to be a predictor of weaning failure in critically ill patients., Competing Interests: Competing interests: The authors declared no competing interests., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Large-area graphene thin films are prized in flexible and transparent devices. We report on a type of glassy graphene that is in an intermediate state between glassy carbon and graphene and that has high crystallinity but curly lattice planes. A polymer-assisted approach is introduced to grow an ultra-smooth (roughness, <0.7 nm) glassy graphene thin film at the inch scale. Owing to the advantages inherited by the glassy graphene thin film from graphene and glassy carbon, the glassy graphene thin film exhibits conductivity, transparency, and flexibility comparable to those of graphene, as well as glassy carbon-like mechanical and chemical stability. Moreover, glassy graphene-based circuits are fabricated using a laser direct writing approach. The circuits are transferred to flexible substrates and are shown to perform reliably. The glassy graphene thin film should stimulate the application of flexible transparent conductive materials in integrated circuits.