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The evolution of critical care medicine is inextricably linked to the development of critical care procedures. These procedures not only facilitate diagnosis and treatment of critically ill patients, but also provide valuable insights into disease pathophysiology. While critical care interventions offer undeniable benefits, the potential for iatrogenic complications necessitates careful consideration. The recent surge in critical care ultrasound (US) utilization is a testament to its unique advantages: non-invasiveness, real-time bedside availability, direct visualization of internal structures, elimination of ionizing radiation exposure, repeatability, and relative ease of learning. Recognizing the need to optimize procedures and minimize complications, critical care utrasound study group of Beijing critical care ultrasound research assocition convened a panel of critical care experts to generate this consensus statement. This document serves as a guide for healthcare providers, aiming to ensure patient safety and best practices in critical care.

Acute respiratory and circulatory disorders are the most common critical syndromes, the essence of which is damage to the organs/systems of the heart and lungs. These comprise the essential manifestation of disease and injury progression to the severe stage. Its development involves the following components: individual specificity, primary disease strike, dysregulation of the host's response, and systemic disorders. Admission for acute respiratory and circulatory disorders is a clinical challenge. Based on a previously proposed flow, a critical care ultrasound-based stepwise approach (PIEPEAR) as a standard procedure to manage patients with acute cardiorespiratory compromise and practical experience in recent years, a modified seven-step analysis and treatment process has been developed to help guide clinicians with rational thinking and standardized treatment when faced with acute respiratory and circulatory disorders. The process consists of seven steps: problem-based clinical analysis, intentional information acquisition, evaluation of core disorder based on critical care ultrasound, pathophysiology and host response phenotype identification, etiology diagnosis, act treatment through pathophysiology-host response and etiology, and re-check. The modified seven-step approach is guided by a "modular analysis" style of thinking and visual monitoring. This approach can strengthen the identification of clinical problems and facilitate a three-in-one analysis. It focuses on pathophysiological disorders, body reactions, and primary causes to more accurately understand the condition's key points, and make treatment more straight forward, to finally achieve the aim of "comprehensive cognition and refined treatment".

Objectives To learn the echocardiography skills of intensivists after receiving a basic critical care echocardiography training course, and investigate factors that may influence their performance. Methods We completed a web-based questionnaire that assessed the skills in ultrasound scanning techniques of intensivists who took a training course on basic critical care echocardiography held in 2019 and 2020. Mann-Whitney test was used to analyze the factors which might affect their performance on image acquisition, recognizing clinical syndrome, and measuring the diameter of inferior vena cava, left ventricular ejection fraction and left ventricular outflow tract velocity-time integral.Results We enrolled 554 physicians from 412 intensive care units across China. Among them, 185 (33.4%) reported that they had 10%-30% chance of being misled by critical care echocardiography when making therapeutic decision, and 34 (6.1%) reported that the chance was greater than 30%. Intensivists who performed echocardiography under the guidance of a mentor and finished ultrasound scanning more than 10 times per week reported significant higher scores in image acquisition, clinical syndrome recognition, and quantitative measurement of inferior vena cava diameter, left ventricular ejection fraction and left ventricular outflow tract velocity-time integral than those without mentor and performing echocardiography 10 times or less per week respectively (all P < 0.05).Conclusion The skills in diagnostic medical echocardiography of Chinese intensivists after a basic echocardiographic training course remain low, and further quality assurance training program is clearly warranted.

We wished to establish an expert consensus on late stage of critical care (CC) management. The panel comprised 13 experts in CC medicine. Each statement was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principle. Then, the Delphi method was adopted by 17 experts to reassess the following 28 statements. (1) ESCAPE has evolved from a strategy of delirium management to a strategy of late stage of CC management. (2) The new version of ESCAPE is a strategy for optimizing treatment and comprehensive care of critically ill patients (CIPs) after the rescue period, including early mobilization, early rehabilitation, nutritional support, sleep management, mental assessment, cognitive-function training, emotional support, and optimizing sedation and analgesia. (3) Disease assessment to determine the starting point of early mobilization, early rehabilitation, and early enteral nutrition. (4) Early mobilization has synergistic effects upon the recovery of organ function. (5) Early functional exercise and rehabilitation are important means to promote CIP recovery, and gives them a sense of future prospects. (6) Timely start of enteral nutrition is conducive to early mobilization and early rehabilitation. (7) The spontaneous breathing test should be started as soon as possible, and a weaning plan should be selected step-by-step. (8) The waking process of CIPs should be realized in a planned and purposeful way. (9) Establishment of a sleep-wake rhythm is the key to sleep management in post-CC management. (10) The spontaneous awakening trial, spontaneous breathing trial, and sleep management should be carried out together. (11) The depth of sedation should be adjusted dynamically in the late stage of CC period. (12) Standardized sedation assessment is the premise of rational sedation. (13) Appropriate sedative drugs should be selected according to the objectives of sedation and drug characteristics. (14) A goal-directed minimization strategy for sedation should be implemented. (15) The principle of analgesia must be mastered first. (16) Subjective assessment is preferred for analgesia assessment. (17) Opioid-based analgesic strategies should be selected step-by-step according to the characteristics of different drugs. (18) There must be rational use of non-opioid analgesics and non-drug-based analgesic measures. (19) Pay attention to evaluation of the psychological status of CIPs. (20) Cognitive function in CIPs cannot be ignored. (21) Delirium management should be based on non-drug-based measures and rational use of drugs. (22) Reset treatment can be considered for severe delirium. (23) Psychological assessment should be conducted as early as possible to screen-out high-risk groups with post-traumatic stress disorder. (24) Emotional support, flexible visiting, and environment management are important components of humanistic management in the intensive care unit (ICU). (25) Emotional support from medical teams and families should be promoted through"ICU diaries"and other forms. (26) Environmental management should be carried out by enriching environmental content, limiting environmental interference, and optimizing the environmental atmosphere. (27) Reasonable promotion of flexible visitation should be done on the basis of prevention of nosocomial infection. (28) ESCAPE is an excellent project for late stage of CC management.

Critical ultrasonography is widely used in ICU and has become an indispensable tool for clinicians. However, besides operator-dependency of critical ultrasonography, lack of standardized training mainly result in the physicians' heterogenous ultrasonic skill. Therefore, standardized training as well as strict quality control plays the key role in the development of critical ultrasonography. We present this quality control standards to promote better development of critical ultrasonography.

Objective Focused cardiac ultrasound (FCU) and lung ultrasound (LU) are increasingly being used in critically ill patients. This study aimed to investigate the effect of FCU in combination with LU on these patients and to determine if the timing of ultrasound examination was associated with treatment change. Methods This is a multicenter cross-sectional observational study. Consecutive patients admitted to the intensive care unit (ICU) were screened for enrollment. FCU and LU were performed within the first 24 h, and treatment change was proposed by the performer based on the ultrasound results and other clinical conditions. Results Among the 992 patients included, 502 were examined within 6 h of ICU admission (early phase group), and 490 were examined after 6 h of admission (later phase group). The early phase group and the later phase group had similar proportions of treatment change (48.8% vs . 49.0%, χ 2 =0.003, P =0.956). In the multivariable analysis, admission for respiratory failure was an independent variable associated with treatment change, with an odds ratio ( OR ) of 2.357 [95% confidence interval ( CI ): 1.284-4.326, P =0.006]; the timing of examination was not associated with treatment change ( OR =0.725, 95% CI : 0.407-1.291, P =0.275). Conclusions FCU in combination with LU, whether performed during the early phase or later phase, had a significant impact on the treatment of critically ill patients. Patients with respiratory failure were more likely to experience treatment change after the ultrasound examination.

Purpose: The primary objective was to demonstrate the relationship between lung ultrasound (LUS) manifestations and the outcomes of intensive care unit (ICU) patients. The secondary objective was to determine the characteristics of LUS manifestations in different subgroups of ICU patients., Methods: This prospective multi-center cohort study was conducted in 17 ICUs. A total of 1702 patients admitted between August 31, 2017 and February 16, 2019 were included. LUS was performed according to the bedside lung ultrasound in emergency (BLUE)-plus protocol, and LUS scores were calculated. Data on the outcomes and oxygenation indices were analyzed and compared between different primary indication groups., Results: The LUS scores were significantly higher for non-survivors than for survivors and were significantly different between the oxygenation index groups, with higher scores in the lower oxygenation index groups. The LUS score was an independent risk factor for the 28-day mortality. The area under the receiver operating characteristic curve was 0.663 for prediction of the 28-day mortality and 0.748 for prediction of an oxygenation index ≤100., Conclusions: The LUS score based on the BLUE-plus protocol was an independent risk factor for the 28-day mortality and was important for the prediction of an oxygenation index ≤100. An early LUS score within 24 hours of ICU admission helps predicting the outcome of ICU patients., (© 2021 Wiley Periodicals LLC.)

Severe patients with coronaviras disease 2019 (COVID-19) are characterized by persistent lung damage, causing respiratory failure, secondary circulatory changes and multiple organ dysfunction after virus invasion. Because of its dynamic, real-time, non-invasive, repeatable and other advantages, critical ultrasonography can be widely used in the diagnosis, assessment and guidance of treatment for severe patients. Based on the recommendations of critical care experts from all over the country who fight against the epidemic in Wuhan, this article summarizes the guidelines for the treatment of COVID-19 based on critical ultrasonography, hoping to provide help for the treatment of severe patients. The recommendations mainly cover the following aspects: (1) lung ultrasound in patients with COVID-19 is mainly manifested by thickened and irregular pleural lines, different types of B-lines, shred signs, and other consolidation like dynamic air bronchogram; (2) Echocardiography may show right heart dysfunction, diffuse cardiac function enhancement, stress cardiomyopathy, diffuse cardiac depression and other multiple abnormalities; (3) Critical ultrasonography helps with initiating early treatment in the suspect patient, screening confirmed patients after intensive care unit admission, early assessment of sudden critical events, rapid grading assessment and treatment based on it; (4) Critical ultrasonography helps to quickly screen for the etiology of respiratory failure in patients with COVID-19, make oxygen therapeutic strategy, guide the implementation of lung protective ventilation, graded management and precise off-ventilator; (5) Critical ultrasonography is helpful for assessing the circulatory status of patients with COVID-19, finding chronic cardiopulmonary diseases and guiding extracorporeal membrane oxygenation management; (6) Critical ultrasonography contributes to the management of organs besides based on cardiopulmonary oxygen transport; (7) Critical ultrasonography can help to improve the success of operation; (8) Critical ultrasonography can help to improve the safety and quality of nursing; (9) When performing critical ultrasonography for patients with COVID-19, it needs to implement three-level protection standard, pay attention to disinfect the machine and strictly obey the rules from nosocomial infection. (10) Telemedicine and artificial intelligence centered on critical ultrasonography may help to improve the efficiency of treatment for the patients with COVID-19. In the face of the global spread of the epidemic, all we can do is to share experience, build a defense line, We hope this recommendations can help COVID-19 patients therapy.

Objective: To explore whether ultrasound abnormalities in the non-gravity dependent areas (area 1-2) of the lungs are associated with poor prognosis in patients with shock and on mechanical ventilation., Methods: We retrospectively analyzed the data of lung ultrasound from 181 patients with shock from Apr. 2016 to Nov. 2017. The patients were divided into the survival group and the non-survival group according to the 28 d outcome. Single factor and multivariate Cox regression were used to analyze the relationship between lung ultrasound score of the overall and each area and the 28 d mortality.Kaplan-Meier curve was used to analyze the relationship between the severity of ultrasound lesions in area 1-2 and the prognosis at 28 d., Results: 169 patients were included.There were 106 males (62.7%) and 63 females (37.3%).There were 90 patients in the survivel group and 79 patients in the non-survival group.Single factor Cox regression analysis found that adjusting the age, acute physiology and chronic health evaluation (APACHE) Ⅱ score, lactate level, urine output per hour, application of vasoactive agent, oxygenation index, lungs ultrasound score of area 1-6, area 1-2 and area 3-4 were associated with 28 d mortality. Multivariate Cox regression revealed that lung ultrasound score of area 1-2 was the independent risk factor of 28 d mortality, as well as APACHE Ⅱ score and lactate level. The Kaplan-Meier curve found that the more severe the lesion in area 1-2, the lower the survival rate at 28 d., Conclusion: Lung ultrasound score of area 1-2 in patients with shock and on mechanical ventilation may be a predictor of poor prognosis at 28 d., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).)

Transesophageal echocardiography(TEE) is valuable in intensive care unit (ICU) because its application meets the requirements of diagnosis and treatment of critically ill patients.However, the current application has not fully adapted to the specialty of critical care. TEE could be more valuablein ICU when used with a new way that under the guidance of the theory of critical care and embedded into the treatment workflow. We have expanded and improved the application of traditional TEE and integrated the concept of critical care, established the concept of transesophageal echocardiography for critical care (TEECC). Chinese Critical Ultrasound Study Group (CCUSG) organized experts in the area to form the consensus based the previous studiesand the long term practice of critical care ultrasound and TEE, aiming at clarifying the nature and characteristics of TEECC, promoting the rational and standardized clinical application and the coming researches.The consensus of Chinese experts on clinical application of TEECC (2019) were 33 in total, of whichthe main items were as follows: (1) TEECC is a significant means, which is expanded and improved from the traditional transesophageal echocardiography according to characteristics of critically ill patients and is applied in ICU based on critically clinical scenarios and requirements by the critical care physician, to promote visualized, refined and precisely management of critically ill patients.(2) TEE possesses distinctive superiority in implementation in ICU. It has characteristics of images with good quality, operations with good stability and low-dependent of operators, monitoring with continuity, and visualization with all-dimensional and detail of heart and blood vessels.(3)As a means of refined monitoring that could resulted in precise diagnosis and treatment, TEECC expands the dimension of intensive monitoring and improves the performance of critical care. (4) Indications of TEECC application include clinical etiological searching and invasive procedures guiding when it acted as a traditional role; and also refined hemodynamic monitoring based on critical care rationale and over-all management under specific critical clinical scenarios. (5) TEE and TTE assessments are complementary; they are not alternative. Integrated assessment of TTE and TEE is required under many critical clinical scenarios.(6) TEE should be a necessary configuration in ICU. (7) All-round and significant information regarding to the mechanism of acute circulatory disorders can be provided by TEECC; it is a non-substitutable means of identifying the causes of shock under some special clinical scenarios. (8) Focal extracardiac hematoma can be accurately and rapidly detected by TEE in patients with open-thoracic cardiac surgery or severe chest trauma when highly suspected pericardial tamponade.(9) The priority of pathophysiologic mechanism of septic shock can be rapidly and accurately identified by TEE; even if its pathophysiological changes are complex, including hypovolemia and/or vasospasm and/or left and right heart dysfunction. (10) Causes of hemodynamic disorders can be rapidly and qualitatively evaluated so that the orientation of treatment can be clarified by TEECC. (11) A full range of quantitative indicators for refined hemodynamic management in critically ill patients can be provided by TEECC. (12) TEECC helps to accurately assess volume status and predict fluid responsiveness.(13) TEECC is specially suitable for accurate quantitative assessment of cardiac function.(14) Mini TEE provides long-term continuous hemodynamic monitoring. (15) Standard views are easy to be acquired by TEECC, which is a premise for accurate and repeatable measurements, and a guarantee for assessment of effect and risk of therapy. (16) Compared with invasive hemodynamic monitoring, TEECC is minimally invasive, with low infection risk and high safety.(17) In patients with acute cor pulmonale (ACP) under condition of right ventricular dysfunction and low cardiac output, TEECC is a key tool for assessment. (18) TEECC should be implemented actively when suspicious of left to right shunt in critically ill patients who occurred hypotension that hard to explain the cause. (19) TEECC should be implemented actively when suspicious of right to left shunt in critically ill patients who occurred hypoxemia that hard to explain the cause. (20) TEECC is preferred in hemodynamics monitoring under prone position of ventilated patients.(21) TEECC is an imperative means to achieve over-all management of extracorporeal membrane oxygenation (ECMO) therapy, especially for all-round hemodynamic monitoring. (22) Three basic views is recommended to be used to simplify TEE assessment during cardiac arrest so that reversible causes could be identified, and resuscitation could be guided. (23) The flow related echodynamic evaluation (TEECC-FREE) workflow is preferred in refined hemodynamics monitoring and therapy. (24) Simple workflow of TEECC could be implemented in special critical clinical scenarios. (25) Application of TEECC is highly secure; however, impairments of procedure should also be alert by operators. (26) Pitfalls in application of TEE should be paid attention to by the critical care physician. (27) Timely and rationally application of TEECC is in favor of diagnosis and treatment of critically ill patients and may improve the prognosis.

To establish the experts consensus on the management of delirium in critically ill patients. A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group. Each statement was assessed based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) principle. Then the Delphi method was adopted by 36 experts to reassess all the statements. (1) Delirium is not only a mental change, but also a clinical syndrome with multiple pathophysiological changes. (2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function. (3) Pain is a common cause of delirium in critically ill patients. Analgesia can reduce the occurrence and development of delirium. (4) Anxiety or depression are important factors for delirium in critically ill patients. (5) The correlation between sedative and analgesic drugs and delirium is uncertain. (6) Pay attention to the relationship between delirium and withdrawal reactions. (7) Pay attention to the relationship between delirium and drug dependence/withdrawal reactions. (8) Sleep disruption can induce delirium. (9) We should be vigilant against potential risk factors for persistent or recurrent delirium. (10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases, and can also be alleviated with the improvement of primary diseases. (11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis. (12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium, especially subclinical delirium. (13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium. (14) Daily assessment is helpful for early detection of delirium. (15) Hopoactive delirium and mixed delirium are common and should be emphasized. (16) Delirium may be accompanied by changes in electroencephalogram. Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant. (17) Pay attention to differential diagnosis of delirium and dementia/depression. (18) Pay attention to the role of rapid delirium screening method in delirium management. (19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium. (20) The key to the management of delirium is etiological treatment. (21) Improving environmental factors and making patient comfort can help reduce delirium. (22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium. (23) Communication with patients should be emphasized and strengthened. Family members participation can help reduce the incidence of delirium and promote the recovery of delirium. (24) Pay attention to the role of sleep management in the prevention and treatment of delirium. (25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium. (26) When using antipsychotics to treat delirium, we should be alert to its effect on the heart rhythm. (27) Delirium management should pay attention to brain functional exercise. (28) Compared with non-critically illness related delirium, the relief of critically illness related delirium will not accomplished at one stroke. (29) Multiple management strategies such as ABCDEF, eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients. (30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment. (31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management. Consensus can promote delirium management in critically ill patients, optimize analgesia and sedation therapy, and even affect prognosis.

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound, the examiner and interpreter of the image are critical care medicine physicians. The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes. With the idea of critical care medicine as the soul, it can integrate the above information and clinical information, bedside real-time diagnosis and titration treatment, and evaluate the therapeutic effect so as to improve the outcome. CUS is a traditional technique which is applied as a new application method. The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept, implementation and application of CUS. It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure. At the same time, the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications, and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS. Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group, based on the rich experience of clinical practice in critical care and research, combined with the essence of CUS, to learn the traditional ultrasonic essence, established the clinical application technical specifications of CUS, including in five parts: basic view and relevant indicators to obtain in CUS; basic norms for viscera organ assessment and special assessment; standardized processes and systematic inspection programs; examples of CUS applications; CUS training and the application of qualification certification. The establishment of applied technology standard is helpful for standardized training and clinical correct implementation. It is helpful for clinical evaluation and correct guidance treatment, and is also helpful for quality control and continuous improvement of CUS application.

To establish the experts consensus on the right heart function management in critically ill patients. The panel of consensus was composed of 30 experts in critical care medicine who are all members of Critical Hemodynamic Therapy Collaboration Group (CHTC Group). Each statement was assessed based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) principle. Then the Delphi method was adopted by 52 experts to reassess all the statements. (1) Right heart function is prone to be affected in critically illness, which will result in a auto-exaggerated vicious cycle. (2) Right heart function management is a key step of the hemodynamic therapy in critically ill patients. (3) Fluid resuscitation means the process of fluid therapy through rapid adjustment of intravascular volume aiming to improve tissue perfusion. Reversed fluid resuscitation means reducing volume. (4) The right ventricle afterload should be taken into consideration when using stroke volume variation (SVV) or pulse pressure variation (PPV) to assess fluid responsiveness.(5)Volume overload alone could lead to septal displacement and damage the diastolic function of the left ventricle. (6) The Starling curve of the right ventricle is not the same as the one applied to the left ventricle,the judgement of the different states for the right ventricle is the key of volume management. (7) The alteration of right heart function has its own characteristics, volume assessment and adjustment is an important part of the treatment of right ventricular dysfunction (8) Right ventricular enlargement is the prerequisite for increased cardiac output during reversed fluid resuscitation; Nonetheless, right heart enlargement does not mandate reversed fluid resuscitation.(9)Increased pulmonary vascular resistance induced by a variety of factors could affect right heart function by obstructing the blood flow. (10) When pulmonary hypertension was detected in clinical scenario, the differentiation of critical care-related pulmonary hypertension should be a priority. (11) Attention should be paid to the change of right heart function before and after implementation of mechanical ventilation and adjustment of ventilator parameter. (12) The pulmonary arterial pressure should be monitored timingly when dealing with critical care-related pulmonary hypertension accompanied with circulatory failure.(13) The elevation of pulmonary aterial pressure should be taken into account in critical patients with acute right heart dysfunction. (14) Prone position ventilation is an important measure to reduce pulmonary vascular resistance when treating acute respiratory distress syndrome patients accompanied with acute cor pulmonale. (15) Attention should be paid to right ventricle-pulmonary artery coupling during the management of right heart function. (16) Right ventricular diastolic function is more prone to be affected in critically ill patients, the application of critical ultrasound is more conducive to quantitative assessment of right ventricular diastolic function. (17) As one of the parameters to assess the filling pressure of right heart, central venous pressure can be used to assess right heart diastolic function. (18). The early and prominent manifestation of non-focal cardiac tamponade is right ventricular diastolic involvement, the elevated right atrial pressure should be noticed. (19) The effect of increased intrathoracic pressure on right heart diastolic function should be valued. (20) Ttricuspid annular plane systolic excursion (TAPSE) is an important parameter that reflects right ventricular systolic function, and it is recommended as a general indicator of critically ill patient. (21) Circulation management with right heart protection as the core strategy is the key point of the treatment of acute respiratory distress syndrome. (22) Right heart function involvement after cardiac surgery is very common and should be highly valued. (23) Right ventricular dysfunction should not be considered as a routine excuse for maintaining higher central venous pressure. (24) When left ventricular dilation, attention should be paid to the effect of left ventricle on right ventricular diastolic function. (25) The impact of left ventricular function should be excluded when the contractility of the right ventricle is decreased. (26) When the right heart load increases acutely, the shunt between the left and right heart should be monitored. (27) Attention should be paid to the increase of central venous pressure caused by right ventricular dysfunction and its influence on microcirculation blood flow. (28) When the vasoactive drugs was used to reduce the pressure of pulmonary circulation, different effects on pulmonary and systemic circulation should be evaluated. (29) Right atrial pressure is an important factor affecting venous return. Attention should be paid to the influence of the pressure composition of the right atrium on the venous return. (30) Attention should be paid to the role of the right ventricle in the acute pulmonary edema. (31) Monitoring the difference between the mean systemic filling pressure and the right atrial pressure is helpful to determine whether the infusion increases the venous return. (32) Venous return resistance is often considered to be a insignificant factor that affects venous return, but attention should be paid to the effect of the specific pathophysiological status, such as intrathoracic hypertension, intra-abdominal hypertension and so on. Consensus can promote right heart function management in critically ill patients, optimize hemodynamic therapy, and even affect prognosis.

Objective: To observe and explore the effects of different tidal volume (VT) ventilation on right ventricular (RV) function in patients with critical respiratory failure. Methods: Consecutive respiratory failure patients who were treated with invasive ventilator over 24 h in the Department of Critical Care Medicine at the Fourth Hospital of Hebei Medical University from June to December in 2015 were enrolled in this study.Clinical data including patients' vital signs, ventilator parameters and RV echocardiography were collected within 6 h (D0), day1(D1), day2 (D2) and day3 (D3) after ventilation started.According to the VT, patients with acute respiratory distress syndrome (ARDS) were assigned to low VT group [S6, ≤6 ml/kg predicted body weight (PBW)] and high VT group (L6, >6 ml/kg PBW), while non-ARDS patients were also assigned to low VT group (S8, ≤8 ml/kg PBW) and high VT group (L8, >8 ml/kg PBW). Results: A total of 84 patients were enrolled in this study.44.2% ARDS patients and 58.5% non-ARDS patients were in low VT groups.After ventilation, tricuspid annulus plane systolic excursion(TAPSE)decreased progressively in S6 [from 18.30(16.70, 20.70) mm to 17.55(15.70, 19.50) mm, P =0.001], L6 [from 19.50(17.00, 21.00) mm to 16.30(15.00, 18.00) mm P =0.001], S8[from 18.00(16.00, 21.00) mm to 16.50(15.50, 18.00) mm, P =0.001] and L8 [from 19.00(17.50, 21.50) mm to 16.35(15.15, 17.00) mm, P =0.001] groups.However, TAPSE decreased less in small VT groups (S6 and S8) than those of in large VT groups (S8 and L8) without significant differences.There were not statistical differences between different VT groups in terms of ventilation days, including right ventricle area/left ventricle area (RV(area)/LV(area)), TAPSE, peak mitral flow velocity of the early rapid filling wave (E), peak mitral flow velocity of the late rapid filling wave (A), early diastolic velocity of the tricuspid annulus (e'), pulmonary artery systolic pressure, inferior vena cava diameter (all P >0.05). Compared to L6 group, low VT (S6 group) resulted in decreased mortality at 28 days [1/19 vs 37.5%(9/24), P =0.014]. There were not statistical differences between different VT groups in terms of ventilation days, length of intensive care unit stay, length of hospital stay (all P >0.05). Logistic regression analysis showed that VT could be the independent factor of TAPSE ( OR =1.104, 95% CI 0.100-1.003, P =0.049). Conclusions: Positive pressure mechanical ventilation resulted in RV systolic dysfunction .Lower VT may have the protective effect on RV function. Trial registration: Chinese Clinical Trial Registry, ChiCTR-POC-15007563.

To study the value of lung ultrasound score (LUS) in assessing the clinical outcome of patients with ventilator-associated pneumonia(VAP). A total of 99 VAP patients were enrolled in a prospective study. All patients met the diagnostic criterion of VAP based on the 2013 guidelines and admitted into our ICU from Jun 2013 to Jun 2015. All parameters were recorded on the diagnostic day (day 1) and day 5, including LUS, clinical pulmonary infection score (CPIS), chest X ray (CXR), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, Sequential Organ Failure Assessment(SOFA) score, etc. According to the CPIS, patients were divided into 2 groups(CPIS less than 6 and more or equal to 6). CPIS and LUS were similar on day 1 between two groups ( P >0.05). However, on day 5, significant differences of CPIS and LUS were found between groups with CPIS<6 and CPIS≥6 ( P =0.019 and P <0.001 respectively). LUS decreased on day 5 in CPIS<6 group and increased in CPIS≥6 group. In CPIS<6 group, there was a positive correlation between LUS and CPIS on day 1( r =0.375, P =0.003) and day 5 ( r =0.590, P <0.001). CPIS≥6 groupshowed the same trend on day 1 ( r =0.484, P =0.002) and day 5 ( r =0.407, P =0.011). LUS can be used to dynamically evaluate the clinical outcome of VAP.

Objective: To investigate the relationship between optic nerve sheath diameter (ONSD) and volume status of patients after cardiac surgery. Methods: A total of consecutive 56 patients who were treated in Critical Care Unit in Peking Union Medical College Hospital after open heart surgery from January to August 2015 were screened in this study. Central venous pressure (CVP) and 72 h net fluid balance were monitored. ONSD and diameter of inferior vena cava (IVC) were measured by ultrasound. Results: A total of 44 patients were finally included in the study. The postoperative baseline ONSD was (5.31±1.96)mm, compared to (5.07±1.77)mm after 72 h treatment, with ΔONSD(0.22±0.21)mm. Baseline and post-treatment at 72 h CVP were (11.98±4.09)mmHg and (8.95±4.02)mmHg respectively. IVC dropped from (19.75±4.12)mm to (17.11±4.68)mm. ΔONSD and ΔCVP were significantly correlated ( r =0.422, P <0.05), ΔONSD and net fluid balance (NFB) at 72 h were significantly correlated ( r =-0.388, P <0.05). While ΔONSD were significantly correlated with ΔIVC ( r =0.423, P <0.05), ΔCVP and ΔIVC were also significantly correlated ( r =0.391, P <0.05). Conclusion: The change of ONSD in patients after cardiac surgery is related to the change of volume status. Therefore ONSD is helpful to estimate brain edema, not only could be a potential index to evaluate volume status, but also be used to guide improving prognosis after cardiac surgery.

Background: The aim of this study was to evaluate the prognosis of the classic variant of papillary thyroid carcinomas with the BRAF(V600E) mutation and 131I treatment failure in those tumors due to lower functional sodium iodide symporter expression., Methods: 109 papillary thyroid carcinomas were associated with clinicopathologic features. The BRAF(V600E) mutation was evaluated by direct sequencing and sodium iodide symporter protein was determined by immunohistochemistry., Results: We found that the BRAF(V600E) mutation was significantly associated with the classic variant of papillary thyroid carcinomas and was independent of tumor size, the presence of extrathyroid invasion and lymph node metastasis, advanced TMN stages, and a high risk of disease recurrence. Moreover, the BRAF(V600E) mutation was associated with a statistically significant lower functional NIS protein expression in the classic variant of papillary thyroid carcinomas. However, those statistically significant relationships were not found in the follicular variant of papillary thyroid carcinomas., Conclusions: The BRAF(V600E) mutation might be associated with a more aggressive phenotype and a poor prognosis, causing less NIS-mediated 131I uptake due to a lower functional NIS protein expression in the classic variant of papillary thyroid carcinomas. Our current study appears to be valuable for predicting prognosis and is of important clinical significance for surgery and 131I treatment in patients with the classic variant of papillary thyroid carcinomas.

Aim: Delirium poses a major challenge to global health care, yet there is currently a dearth of single effective interventions or medications. Particularly, addressing delirium induced by critical illness is a complex process. Occupational therapy is considered to have a high potential for use in the prevention of delirium, as it involves both cognitive training and training in ADL. To comprehensively analyze the effect of occupational therapy on delirium prevention, we evaluated the effects of occupational therapy vs. standard non-pharmacological prevention on incidence and duration of delirium, clinical outcomes and rehabilitation outcomes in critically ill patients. Methods: The data sources, including PubMed/Medline, Web of Science, EMBASE, and Cochrane Library, were comprehensively searched from their inception until 15 October 2023. Following the PICOS principle, a systematic screening of literature was conducted to identify relevant studies. Subsequently, the quality assessment was performed to evaluate the risk of bias in the included literature. Finally, outcome measures from each study were extracted and comprehensive analysis was conducted using Review Manager 5.4. Results: A total of four clinical trials met the selection criteria. The pooled analysis indicated no significant difference in the incidence and duration of delirium between the OT group and standard non-pharmacological interventions. A comprehensive analysis of clinical outcomes revealed that OT did not significantly reduce the length of hospital stay or ICU stay. Meanwhile, there was no significant difference in mortality rates between the two groups. It is noteworthy that although grip strength levels did not exhibit significant improvement following OT intervention, there were obvious enhancements observed in ADL and MMSE scores. Conclusion: Although occupational therapy may not be the most effective in preventing delirium, it has been shown to significantly improve ADL and cognitive function among critically ill patients. Therefore, we contend that occupational therapy is a valuable component of a comprehensive multidisciplinary approach to managing delirium. In the future, high-quality researches are warranted to optimize the implementation of occupational therapy interventions for delirium prevention and further enhance their benefits for patients. [ABSTRACT FROM AUTHOR]

Objective: To examine the RNA of severe acute respiratory syndrome-associated coronavirus (SARS-CoV) in the blood and excretion of convalescent patient with SARS for prevention and treatment of the disease., Methods: A total of 276 samples, including plasma, urine, feces and sputum, obtained from 23 convalescent patients with SARS were studied at 3 time-points at least 21 days after the onset of symptoms. RNA was extracted and nested reverse transcription-polymerase chain reaction (RT-PCR) was carried out using SARS-CoV specific primers., Results: Among the 276 samples, SARS-CoV RNA was detected in 6 cases (38.8%) by nested RT-PCR. The positive rates of SARS-CoV RNA was 5.8% in feces and 2.9% in sputum samples but SARS-CoV RNA was not detectable in plasma and urine of all the cases., Conclusion: The existence of SARS-CoV RNA in the excretion of some convalescent patients with SARS showed that the excretion from these patients should be carefully treated whilthe re-transmission of SARS by which, should be further studied.

Objective: To obtain monoclonal antibodies (McAbs) against severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV) nucleocapsid (N) protein to develop diagnostic test for SARS and study the pathogenesis of the disease., Methods: BALB/c mice were immunized with purified N protein of SARS-CoV. Hybridoma cell lines secreting monoclonal antibodies against SARS-associated coronavirus nucleocapsid were established after cell fusion with mouse splenic cells and SP2/0 cells. The specificity of the McAbs obtained was examined by Western blot and indirect fluorescence assay. Epitopes reacted with the McAbs were preliminarily located through Western blot by expressing truncated N proteins., Results: After cell fusion and three rounds of cell cloning, six hybridoma cell lines secreting monoclonal antibodies specifically against SARS-CoV nucleocapsid were obtained. Western blot and indirect fluorescence assay showed that the McAbs reacted specifically with nucleocapsid protein and SARS-CoV. Among the six McAbs, three recognize the epitopes located in the N-terminus of the protein, whereas the others reacted with those located in the C-terminus., Conclusion: The anti-SARS-CoV nucleocapsid McAbs were developed and these McAbs may be useful in the development of diagnosis assays and basic research of SARS.

Objective: The study aimed to explore the effectiveness of bedside lung ultrasound (LUS) combined with the PaO2/FiO2 (P/F) ratio in evaluating the outcomes of high-flow nasal cannula (HFNC) therapy in infants with severe pneumonia. Methods: This retrospective study analyzed the clinical data of 150 infants diagnosed with severe pneumonia and treated with HFNC therapy at our hospital from January 2021 to December 2021. These patients were divided into two groups based on their treatment outcomes: the HFNC success group (n = 112) and the HFNC failure group (n = 38). LUS was utilized to evaluate the patients’ lung conditions, and blood gas results were recorded for both groups upon admission and after 12 h of HFNC therapy. Results: At admission, no significant differences were observed between the two groups in terms of age, gender, respiratory rate, partial pressure of oxygen, and partial pressure of carbon dioxide. However, the P/F ratios at admission and after 12 h of HFNC therapy were significantly lower in the HFNC failure group (193.08 ± 49.14, 228.63 ± 80.17, respectively) compared to the HFNC success group (248.51 ± 64.44, 288.93 ± 57.17, respectively) (p < 0.05). Likewise, LUS scores at admission and after 12 h were significantly higher in the failure group (18.42 ± 5.3, 18.03 ± 5.36, respectively) than in the success group (15.09 ± 4.66, 10.71 ± 3.78, respectively) (p < 0.05). Notably, in the success group, both P/F ratios and LUS scores showed significant improvement after 12 h of HFNC therapy, a trend not observed in the failure group. Multivariate regression analysis indicated that lower P/F ratios and higher LUS scores at admission and after 12 h were predictive of a greater risk of HFNC failure. ROC analysis demonstrated that an LUS score > 20.5 at admission predicted HFNC therapy failure with an AUC of 0.695, a sensitivity of 44.7%, and a specificity of 91.1%. A LUS score > 15.5 after 12 h of HFNC therapy had an AUC of 0.874, with 65.8% sensitivity and 89.3% specificity. An admission P/F ratio < 225.5 predicted HFNC therapy failure with an AUC of 0.739, 60.7% sensitivity, and 71.1% specificity, while a P/F ratio < 256.5 after 12 h of HFNC therapy had an AUC of 0.811, 74.1% sensitivity, and 73.7% specificity. Conclusion: Decreased LUS scores and increased P/F ratio demonstrate a strong correlation with successful HFNC treatment outcomes in infants with severe pneumonia. These findings may provide valuable support for clinicians in managing such cases. [ABSTRACT FROM AUTHOR]

The multiple etiological characteristics of acute kidney injury (AKI) have brought great challenges to its clinical diagnosis and treatment. Renal injury in critically ill patients always indicates hemodynamic injury. The Critical Care UltraSound Guided (CC USG)-A(KI)BCDE protocol developed by the Chinese Critical Ultrasound Study Group (CC USG), respectively, includes A(KI) diagnosis and risk assessment and uses B-mode ultrasound, Color doppler ultrasound, spectral Doppler ultrasound, and contrast Enhanced ultrasound to obtain the hemodynamic characteristics of the kidney so that the pathophysiological mechanism of the occurrence and progression of AKI can be captured and the prognosis of AKI can be predicted combined with other clinical information; therefore, the corresponding intervention and treatment strategies can be formulated to achieve targeted, protocolized, and individualized therapy. [ABSTRACT FROM AUTHOR]

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Electrochemical carbon dioxide reduction reaction (CO2RR) provides an attractive approach to carbon capture and utilization for the production high-value-added products. However, CO2RR still suffers from poor selectivity and low current density due to its sluggish kinetics and multitudinous reaction pathways. Single-atom catalysts (SACs) demonstrate outstanding activity, excellent selectivity, and remarkable atom utilization efficiency, which give impetus to the search for electrocatalytic processes aiming at high selectivity. There appears significant activity in the development of efficient SACs for CO2RR, while the density of the atomic sites remains a considerable barrier to be overcome. To construct high-metal-loading SACs, aggregation must be prevented, and thus novel strategies are required. The key to creating high-density atomically dispersed sites is designing enough anchoring sites, normally defects, to stabilize the highly mobile separated metal atoms. In this review, we summarized the advances in developing high-loading SACs through defect engineering, with a focus on the synthesis strategies to achieve high atomic site loading. Finally, the future opportunities and challenges for CO2RR in the area of high-loading single-atom electrocatalysts are also discussed. [ABSTRACT FROM AUTHOR]

Introduction: Prone positioning has been shown to improve ventilation status for patients with severe COVID-19 who are receiving mechanical ventilation. This case report describes the nursing care of a patient with severe COVID-19 who underwent prone ventilation for 72 hours. Relevant nursing management and operational considerations are also discussed. Clinical Findings: An 83-year-old woman was admitted to the hospital with fatigue, dizziness, and positive tests for SARS-CoV-2 on nasopharyngeal swab specimens. The patient was intubated. Diagnosis: The patient's positive tests for SARS-CoV-2, chest computed tomography findings, and clinical symptoms were consistent with a diagnosis of severe COVID-19. Interventions: When the patient's condition did not improve with mechanical ventilation and intermittent prone positioning, she was placed in the prone position for 72 hours. She received sedation, analgesics, anti-infective medications, and enteral nutrition support in the intensive care unit. Nurses performed dynamic monitoring based on blood gas analysis results to guide lung rehabilitation. Outcomes: The patient was weaned from the ventilator on day 20 and successfully discharged home on day 28 of hospitalization. Conclusion: During prolonged prone ventilation of a patient with severe COVID-19, nursing strategies included airway management, early lung rehabilitation training guided by pulmonary ultrasonography, skin care, hierarchical management of nurses, hemodynamic support, and enteral nutrition. This report may assist critical care nurses caring for similar patients. [ABSTRACT FROM AUTHOR]

Electrocatalytic water splitting provides an eco-friendly and efficient way to generate hydrogen energy. The anodic half reaction, oxygen evolution reaction (OER), with a four-electron process leads to sluggish kinetics and then high-energy consumption. Devising and synthesis of efficient and low-cost OER catalysts could overcome this issue. Fe-based non-noble electrocatalysts are observed to have suitable atomic and electronic structures; moreover, they are cheaper and more accessible than noble electrocatalysts. Various Fe-based electrocatalysts are showing a promising catalytic performance for OER. In this review, we concentrate on recent advancement and progress in utilizing these Fe-based catalysts with different supporting materials, including carbon-based materials, layered double hydroxides, Prussian blue analogous, metal–organic frameworks, and so forth. We highlight the OER mechanism and some typical OER electrochemical parameters of Fe-based electrocatalysts supported on various supporting materials from the experimental and theoretical viewpoint. With the gathered information provided in this review, some challenges and expectations for promoting the catalytic performance of Fe-based electrocatalysts are deeply discussed. Indeed, this review could furnish the design of more efficient non-noble metal electrocatalysts with promising directions. [ABSTRACT FROM AUTHOR]

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Photocatalytic degradation has received considerable emphasis since it shows significant possibilities in environmental pollution. In this work, ternary Z-scheme heterojunction g-C3N4/TiO2/Ti3C2 photocatalysts are designed and fabricated. The Z-scheme heterojunctions formed on the surfaces of g-C3N4 and TiO2 dramatically modify the photocatalytic performances of the compound under illumination. Meanwhile, in this process, multilayer Ti3C2, as the transport medium of Z-scheme heterojunction, is tightly bonded to TiO2 generated by hydrothermal oxidation and g-C3N4 with large specific surface area, which effectively facilitates the space charge separation and depresses the charge recombination. When the addition amount of TiO2/Ti3C2 is 80 mg and calcined at 450 ℃ for 4 h, g-C3N4/TiO2/Ti3C2 has the greatest photocatalytic performance, and the kinetic constant for degradation methyl orange (MO) was about 3.62 times that of g-C3N4 and 14.55 times that of Ti3C2, respectively. This work illustrates that g-C3N4/TiO2/Ti3C2 has outstanding potential and offers novel insights for designing and synthesizing new ternary heterojunction materials. [ABSTRACT FROM AUTHOR]

Delirium, an acute brain dysfunction, is a common and serious complication in burn patients. The occurrence of delirium increases the difficulty of patient treatment, is associated with various adverse outcomes, and increases the burden on the patient's family. Many scholars have studied the factors that cause delirium, but the causes, pathogenesis, and treatment of delirium in burn patients have not been fully revealed. There is no effective pharmacological treatment for delirium, but active preventive measures can effectively reduce the incidence of delirium in burn patients. Therefore, it is necessary to study the relevant factors affecting the occurrence of delirium in burn patients. This study was conducted on December 20, 2021 by searching the PubMed database for a narrative review of published studies. The search strategy included keywords related to "burns," "delirium," and "risk factors." We reviewed the characteristics of delirium occurrence in burn patients and various delirium assessment tools, and summarized the risk factors for the development of delirium in burn patients in terms of personal, clinical, and environmental factors, and we found that although many risk factors act on the development of delirium in burn patients, some of them, such as clinical and environmental factors, are modifiable, suggesting that we can estimate the exposure of burn patients to risk factors by assessing their likelihood of delirium occurring and to make targeted interventions that provide a theoretical basis for the prevention and treatment of burn delirium. [ABSTRACT FROM AUTHOR]

It was observed for the first time that the specific surface area of graphitic carbon nitride (g-C3N4) increased from 32 m2g−1 to 142 and 171 m2g−1 for Pt and Ru, respectively, due to the etching of g-C3N4 by Pt and Ru nanoparticles. Metal nanoparticles catalyze hydrogenation of C – N bonds and "move" through the structure of g-C3N4 etching tunnels in it and creating "spongy graphitic carbon nitride" (sgCN). The reactions take place on the surface of metal NPs, which are covered with oxidized forms of Pt and Ru capable of strong interactions with nitrogen, which was confirmed by XPS studies. The activation energy of hydrogenation of g-C3N4 is 112 and 151 kJmol−1 for Ru and Pt nanoparticles, respectively. The process of etching of g-C3N4 was observed by mass spectrometry and temperature programmed reduction coupled with on-line infrared spectroscopy. On the basis of thermodynamic considerations and quantum mechanical calculations of bonds strengths, a probable mechanism of g-C3N4 hydrogenation was proposed. [ABSTRACT FROM AUTHOR]

Improving organ perfusion is the aim of shock resuscitation; therefore, improving organ blood perfusion is a direct indicator for shock resuscitation. During shock, different organs have different capacities for blood flow autoregulation. The kidney is an important organ with excellent ability to autoregulate the blood flow and with vulnerability to poor organ perfusion, which places kidney perfusion in a position of necessity and priority relative to that of other organs in shock. Critical-care ultrasonography provides the best evaluation of renal perfusion. [ABSTRACT FROM AUTHOR]

Background: It is unclear if different genetic drivers in papillary thyroid cancer (PTC) confer different phenotypic tumor behavior leading to more aggressive disease. We hypothesized that RET-driven cancers are more aggressive. Patients and Methods: We reviewed records of consecutive patients treated for newly diagnosed PTC at this single institution from 2015 to 2016. Tumor samples from these patients were genotyped to identify RET-translocated, BRAFV600E mutant, and HRAS, KRAS, and NRAS mutant tumors. Patient demographic, clinicopathologic, and outcomes data were compared to identify genotype-specific patterns of disease. Results: Of the 327 patients who underwent initial surgery for PTC during the study period, 192 (58.7%) had BRAFV600E mutant tumors (BRAF), 14 (4.3%) had RET-rearranged tumors (RET), 46 (14.1%) had RAS mutant tumors (RAS), and 75 (22.9%) had BRAF, RET, and RAS wildtype tumors. RET-driven tumors were more likely to have extrathyroidal extension (50.0% versus 27.0% for BRAF and 2.2% for RAS, P < 0.001), multifocal disease (85.7% versus 60.3%, and 44.4%, respectively, P = 0.017), and distant metastases (14.3% versus 1.1%, and 0%, respectively, P = 0.019). RET and BRAF patients also had worse disease-free survival than RAS patients (Kaplan–Meier log rank, P = 0.027). Conclusions: Patients with RET-driven PTCs had higher rates of extrathyroidal extension, multifocal disease, and distant metastases than patients whose tumors had BRAFV600E or RAS mutations. Patients with RET-rearranged tumors had similar disease-free survival to patients with BRAFV600E mutant tumors. RET rearrangement may confer an aggressive phenotype in PTC. [ABSTRACT FROM AUTHOR]

Copyright of Rare Metals is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rare Metals is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this paper, a single-machine semi-online scheduling problem with rejection is addressed. In this model, "semi-online" implies that p max p min ≤ γ , where p max and p min are the maximum processing time and the minimum one among all jobs, respectively, γ ≥ 1. In this setting, each job arrives online over time, and rejection is allowable. Our goal is minimizing the total penalty cost of rejected jobs plus the total completion time of processed jobs. The seminal result of this study is that we offer an algorithm with competitive ratio 1 + 1 + γ (γ − 1) − 1 γ , which matches the result of the problem without rejection. [ABSTRACT FROM AUTHOR]

Due to the poor photocatalytic hydrogen evolution ability of pure CdS, we need to develop a photocatalytic hydrogen evolution catalyst with high activity and no precious metal doping. Therefore, in this article, we used a simple hydrothermal synthesis of CdS nanoparticles, using water as a carrier, loading a small amount of amorphous CoS, by changing the loading ratio of amorphous CoS, synthesized TYPE–II type heterojunction composite catalyst CCS. The successful synthesis of the composite catalyst CCS was verified by XRD, SEM and other characterization methods. UV–vis, PL and other characterization showed that the supported amorphous CoS could significantly improve the photocatalytic activity of CdS, and the photochemical detection also showed that the performance of composite catalyst CCS was better than that of pure CdS. Using Na2S and Na2SO3 mixed solution as electron sacrificial agent, the hydrogen production performance of CCS composite catalyst was determined through hydrogen evolution experiment and cyclic stability experiment. It was found that the sacrificial agent had a great promotion effect on the hydrogen production performance of photocatalyst. It was found that the hydrogen production rate of the composite catalyst could reach 2.01 mmol·g−1·h−1, which was 6.3 times of the pure CdS. This study offers a novel approach for the design of amorphous–based nanostructures as efficient hydrogen evolution cocatalysts. First, CdS are excited by light, consuming S2− and SO32− ions in the sacrificial agent, generating a large number of electrons and holes. Due to the energy difference between the conducting band (CB) of CdS and amorphous CoS, the electrons are transferred from the surface of CdS to the conducting band (CB) of amorphous CoS, while the electrons obtained from water and H+ in the sacrificial agent are reduced to H2. The amorphous CoS is used as the transfer medium of electron acceptor, and the synergistic effect between heterojunctions is used to improve the charge separation efficiency and electron transfer rate. Therefore, the photocatalytic hydrogen production effect of the composite catalyst CCS–7 has been greatly improved. [ABSTRACT FROM AUTHOR]

Pd-based nanostructures have high catalytic activity and good light trapping ability for photothermal catalysis. In this work, PdFe nanosheets (NSs) were synthesized through a hydrothermal method and efficiently catalyzed ethylene glycol electrooxidation reaction (EGOR). Under the irradiation of light, the mass activity of EGOR enhanced 1.78 times (from 4.02 to 7.17 A mg−1) comparing with no light, which was 18 times higher than commercial Pd/C. The high activity is attributed to the combination of high photothermal conversion efficiency and the exposure of high energy facet (111) of PdFe NSs. The effects of Pd/Fe ratio, light intensity, and wavelength were investigated. [ABSTRACT FROM AUTHOR]

2D transition metal dichalcogenides such as MoS2 with the unique layered structure have received great attention in the field of lithium-ion batteries (LIBs). However, the low conductivity and poor structural stability adversely affect the rate performance of LIBs. Herein, a flexible and free-standing high-performance lithium-ion battery electrode (MoS2/C@Ti3C2Tx) composed of rice-candy-like MoS2/C intercalated Ti3C2Tx and PVP-derived carbon with a large interlayer distance of MoS2 is designed and demonstrated. Lithium-ion batteries have attracted great attention due to their high energy density. Consequently, as an anode material for lithium-ion batteries, MoS2/C@Ti3C2Tx provides a high discharge capacity of 538.5 mAh g−1 at 0.05 A g−1 and rapid charge/discharge capability of 256.7 mAh g−1 at 2 A g−1, as well as outstanding cycling property (96.7% capacity retention after 150 cycles at 2 A g−1). Density-functional theory (DFT) calculation reveals that the rice-candy-like MoS2/C structure favors adsorption and diffusion of lithium ions and facilitates the redox reactions. The MoS2/C@Ti3C2Tx structure is expected to boost the development of novel 2D materials for high-performance lithium-ion batteries. [ABSTRACT FROM AUTHOR]

Graphitic carbon nitride (g-C3N4) can be indexed as a high-content N-doped carbon material, appealing great attentions in energy storage devices. However, poor conductivity and serious irreversible capacity loss were found for the g-C3N4 due to its high nitrogen content. Urea, dicyandiamide or melamine can be used as organic precursor to form g-C3N4 because they can be pyrolyzed into g-C3N4 easily. In this work, high nitrogen content (up to 17 at.%)-doped carbon materials embedded with superfine-Sn particle are synthesized by one-step thermal treatment of the g-C3N4 organic precursor and SnCl2 in a simple self-designed quartz tube. Regarding their high nitrogen doping content, large surface area and porous structure, the obtained material could deliver a high specific capacity and excellent capacity retention when applied as lithium ion battery anode. Its excellent rate performance is attributed to the high Li diffusion coefficient demonstrated by the GITT kinetics analysis. This extremely simple and low-cost preparation process could provide a new strategy to obtain high nitrogen content carbon-based materials. [ABSTRACT FROM AUTHOR]

Electrochemical reduction of CO2 into value-added chemicals should reduce the consumption of fossil fuels and counteract global warming caused by CO2 generation. Nonetheless, CO2 is rather stable and chemically inert, calling for effective electrocatalysts to avoid problems such as sluggish kinetics, low reaction efficiency and poor product selectivity during CO2 conversion. Recently, single-atom catalysts have shown maximum atom utilization and unique catalytic performance during electrochemical reactions. Catalysts used have been developed from poorly controlled nanoparticles or nanoclusters to isolated atomic structures. Herein, we review the preparation, characterization, anchoring strategies and electrochemical applications of single-atom catalysts. Concerning methods of preparation, the use of organometallic ligands shows high potential for synthesis and industrial applications. Both characterization and calculations using the density functional theory allow to assess the atomic distribution, the coordination environment and the catalytic mechanism. To improve synthesis, we present four anchoring strategies: defect engineering, atom coordination, spatial confinement and sacrifice template. Applications in electrochemical reduction of CO2 to liquid and gaseous products reveal Faraday efficiency higher than 90%, excellent activity, selectivity, stability and kinetic properties. [ABSTRACT FROM AUTHOR]

Conducting polymers, such as polyaniline and polypyrrole, have frequently been discussed in the literature due to ease of preparation and high application potential. These polymers have been observed to interact with organic dyes because of the similarity in the conjugated molecular structure of both moieties. The interaction manifests itself in three fundamental directions that have been so far treated separately. The first is represented by the conductivity enhancement and morphology control when using organic dyes as templates in polypyrrole preparation. The adsorption of dyes on conducting polymers is the second field oriented at the water pollution treatment. Finally, the photocatalytic decomposition of organic dyes aims at the similar environmental target. The last two applications do not require the presence of conductivity which, on the other hand, is a key parameter of conducting polymers. The future design of advanced adsorbents, however, has to exploit both the conductivity and electroactivity in the control of pollutant adsorption or degradation. For this reason, all these interactions and their practical impact are considered in the present review. [ABSTRACT FROM AUTHOR]

Purpose: Recent studies have shown the potential benefits of pressure-controlled ventilation-volume guaranteed (PCV-VG) compared to volume-controlled ventilation (VCV), but the results were not impressive. We assessed the effects of PCV-VG versus VCV in elderly patients by using lung ultrasound score (LUS). Patients and methods: Elderly patients (aged 65–90 years) scheduled for hip joint surgery were randomly assigned to either the PCV-VG or VCV group during general anesthesia. LUS and mechanical ventilator parameters were evaluated before induction, 30 mins after a semi-lateral position change, during supine repositioning before awakening, and 15 mins after arrival to the post-anesthesia care unit (PACU). Pulmonary function tests were performed before and after surgery. Other recovery indicators were also assessed in the PACU. Results: A total of 76 patients (40 for PCV-VG and 36 for VCV) were included this study. Demographic data showed no significant difference between the two groups. In both groups, LUSs before induction were significantly lower than those at other time points. LUSs of the VCV group were significantly increased during perioperative periods compared with the PCV-VG group (p=0.049). Visualized LUS modeling suggested an intuitive difference in the two groups and unequal distribution in lung aeration. Higher dynamic compliance and lower inspiratory peak pressure were observed in the PVC-VG group compared to the VCV group (33.54 vs 27.36, p<0.001; 18.93 vs 21.19, p<0.001, respectively). Postoperative forced vital capacity of the VCV group was lower than that of PCV-VG group, but this result was not significant (2.06 vs 1.79, respectively; p=0.091). The other respiratory data are comparable between the two groups. Conclusion: The PCV-VG group showed better LUS compared with the VCV group. Moreover, LUS modeling in both groups suggests non-homogeneous and positional change in lung aerations during surgery. Clinical trial registration: This study was registered at the UMIN clinical trials registry (unique trial number: UMIN000029355; registration number: R000033510) [ABSTRACT FROM AUTHOR]