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Background The effect of corticosteroids on clinical outcomes in patients with influenza pneumonia remains controversial. We aimed to further evaluate the influence of corticosteroids on mortality in adult patients with influenza pneumonia by comparing corticosteroid-treated and placebo-treated patients. Methods The PubMed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and Information Sciences Institute (ISI) Web of Science databases were searched for all controlled studies that compared the effects of corticosteroids and placebo in adult patients with influenza pneumonia. The primary outcome was mortality, and the secondary outcomes were mechanical ventilation (MV) days, length of stay in the intensive care unit (ICU LOS), and the rate of secondary infection. Results Ten trials involving 6548 patients were pooled in our final analysis. Significant heterogeneity was found in all outcome measures except for ICU LOS ( I 2  = 38%, P  = 0.21). Compared with placebo, corticosteroids were associated with higher mortality (risk ratio [RR] 1.75, 95% confidence interval [CI] 1.30 ~ 2.36, Z  = 3.71, P  = 0.0002), longer ICU LOS (mean difference [MD] 2.14, 95% CI 1.17 ~ 3.10, Z  = 4.35, P  < 0.0001), and a higher rate of secondary infection (RR 1.98, 95% CI 1.04 ~ 3.78, Z = 2.08, P  = 0.04) but not MV days (MD 0.81, 95% CI − 1.23 ~ 2.84, Z  = 0.78, P  = 0.44) in patients with influenza pneumonia. Conclusions In patients with influenza pneumonia, corticosteroid use is associated with higher mortality. Trial registration PROSPERO (ID: CRD42018112384 ).

Considering the synthetic value of introducing active alcoholic hydroxyl group, developing C–H functionalization of alcohols is of significance. Herein, we present a photochemical method that under visible light irradiation, selectfluor can effectively promote the oxidative cross-coupling between alcohols and heteroarenes without the external photocatalysis, achieving the selective α sp 3 C–H arylation of alcohol, even in the presence of ether. The N-F activation of selectfluor under blue LEDs irradiation is evidenced by electron paramagnetic resonance (EPR) study, which is the key process for the oxidative activation of α sp 3 C–H alcohols. The observed reactivity may have significant implications for chemical transformations. Alcohols are very useful building blocks in organic synthesis, however C–H functionaliztion in presence of free –OH groups is highly challenging. Here, the authors report a selective visible light-promoted α-functionalization of free alcohols with heteroarenes mediated by Selectofluor.

Crystal-phase engineering offers opportunities for the rational design and synthesis of noble metal nanomaterials with unusual crystal phases that normally do not exist in bulk materials. However, it remains a challenge to use these materials as seeds to construct heterometallic nanostructures with desired crystal phases and morphologies for promising applications such as catalysis. Here, we report a strategy for the synthesis of binary and ternary hybrid noble metal nanostructures. Our synthesized crystal-phase heterostructured 4H/fcc Au nanowires enable the epitaxial growth of Ru nanorods on the 4H phase and fcc-twin boundary in Au nanowires, resulting in hybrid Au–Ru nanowires. Moreover, the method can be extended to the epitaxial growth of Rh, Ru–Rh and Ru–Pt nanorods on the 4H/fcc Au nanowires to form unique hybrid nanowires. Importantly, the Au–Ru hybrid nanowires with tunable compositions exhibit excellent electrocatalytic performance towards the hydrogen evolution reaction in alkaline media.

Background Studies investigating the role of hyperoxia in critically ill patients have reported conflicting results. We did this analysis to reveal the effect of hyperoxia in the patients admitted to the intensive care unit (ICU). Methods Electronic databases were searched for all the studies exploring the role of hyperoxia in adult patients admitted to ICU. The primary outcome was mortality. Random-effect model was used for quantitative synthesis of the adjusted odds ratio (aOR). Results We identified 24 trials in our final analysis. Statistical heterogeneity was found between hyperoxia and normoxia groups in patients with mechanical ventilation (I 2  = 92%, P  < 0.01), cardiac arrest(I 2  = 63%, P  = 0.01), traumatic brain injury (I 2  = 85%, P  < 0.01) and post cardiac surgery (I 2  = 80%, P  = 0.03). Compared with normoxia, hyperoxia was associated with higher mortality in overall patients (OR 1.22, 95% CI 1.12~1.33), as well as in the subgroups of cardiac arrest (OR 1.30, 95% CI 1.08~1.57) and extracorporeal life support (ELS) (OR 1.44, 95% CI 1.03~2.02). Conclusions Hyperoxia would lead to higher mortality in critically ill patients especially in the patients with cardiac arrest and ELS.

A chiral iridium complex serves as a sensitizer for photoredox catalysis and at the same time provides very effective asymmetric induction for the enantioselective alkylation of 2-acyl imidazoles; the metal centre simultaneously serves as the exclusive source of chirality, the catalytically active Lewis acid centre, and the photoredox centre. A new asymmetric photocatalyst The growing demand for optically active compounds in the chemical and pharmaceutical industries is focusing attention on asymmetric photocatalysis as a potentially economical means of synthesis, combining visible light photoredox chemistry with asymmetric catalysis. In this manuscript, the authors show that a chiral iridium complex can serve as a sensitizer for photoredox catalysis and at the same time provide effective asymmetric induction for the enantioselective alkylation of 2-acyl imidazoles. This new asymmetric photoredox catalyst, in which the metal centre serves simultaneously as the exclusive source of chirality, the catalytically active Lewis acid centre, and the photoredox centre, offers new opportunities for the 'green' synthesis of non-racemic chiral molecules. Asymmetric catalysis is seen as one of the most economical strategies to satisfy the growing demand for enantiomerically pure small molecules in the fine chemical and pharmaceutical industries 1 . And visible light has been recognized as an environmentally friendly and sustainable form of energy for triggering chemical transformations and catalytic chemical processes 2 , 3 , 4 , 5 . For these reasons, visible-light-driven catalytic asymmetric chemistry is a subject of enormous current interest 2 , 3 , 4 , 5 . Photoredox catalysis provides the opportunity to generate highly reactive radical ion intermediates with often unusual or unconventional reactivities under surprisingly mild reaction conditions 6 . In such systems, photoactivated sensitizers initiate a single electron transfer from (or to) a closed-shell organic molecule to produce radical cations or radical anions whose reactivities are then exploited for interesting or unusual chemical transformations. However, the high reactivity of photoexcited substrates, intermediate radical ions or radicals, and the low activation barriers for follow-up reactions provide significant hurdles for the development of efficient catalytic photochemical processes that work under stereochemical control and provide chiral molecules in an asymmetric fashion 7 . Here we report a highly efficient asymmetric catalyst that uses visible light for the necessary molecular activation, thereby combining asymmetric catalysis and photocatalysis. We show that a chiral iridium complex can serve as a sensitizer for photoredox catalysis and at the same time provide very effective asymmetric induction for the enantioselective alkylation of 2-acyl imidazoles. This new asymmetric photoredox catalyst, in which the metal centre simultaneously serves as the exclusive source of chirality, the catalytically active Lewis acid centre, and the photoredox centre, offers new opportunities for the ‘green’ synthesis of non-racemic chiral molecules.

The number of hospitalized young coronavirus disease 2019 (COVID-19) patients has increased significantly. However, specific data about COVID-19 patients under 65 years old who are admitted to the hospital are scarce. The COVID-19 patients under 65 years old who were admitted to the hospital in Sichuan Province, Renmin Hospital of Wuhan University, and Wuhan Red Cross Hospital were included in this study. Demographic information, laboratory data and clinical treatment courses were extracted from electronic medical records. Risk factors associated with oxygen therapy were explored. Eight hundred thirty-three COVID-19 patients under 65 years old were included. Of the included patients, 29.4% had one or more comorbidities. Oxygen therapy was required in 63.1% of these patients, and the mortality was 2.9% among the oxygen therapy patients. Fever (odds ratio [OR] 2.072, 95% confidence interval [CI] 1.312-3.271, p = 0.002), dyspnea (OR 2.522, 95% CI 1.213-5.243, p = 0.013), chest distress (OR 2.278, 95% CI 1.160-4.473, p = 0.017), elevated respiratory rate (OR 1.114, 95% CI 1.010-1.228, p = 0.031), and decreased albumin (OR 0.932, 95% CI 0.880-0.987, p = 0.016) and globulin levels (OR 0.929, 95% 0.881-0.980, p = 0.007) were independent factors related to oxygen therapy. Oxygen therapy is highly required in COVID-19 patients under 65 years old who are admitted to the hospital, but the success rate is high. Respiratory failure-related symptoms, elevated respiratory rate, low albumin and globulin levels, and fever at admission are independent risk factors related to the requirement of oxygen.

Background The effects of body mass index (BMI) on the prognosis of acute respiratory distress syndrome (ARDS) are controversial. We aimed to further determine the relationship between BMI and the acute outcomes of patients with ARDS. Methods We searched the Pubmed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and ISI Web of Science for trials published between 1946 and July 2016, using “BMI” or “body mass index” or “overweight” or “obese” and “ARDS” or “ALI” or “acute respiratory distress syndrome” or “acute lung injury”, without limitations on publication type or language. Heterogeneity and sensitivity analyses were conducted, and a random-effects model was applied to calculate the odds ratio (OR) or mean difference (MD). Review Manager (RevMan) was used to test the hypothesis using the Mann-Whitney U test. The primary outcome was unadjusted mortality, and secondary outcomes included mechanical ventilation (MV)-free days and length of stay (LOS) in the intensive care unit (ICU) and in hospital. Results Five trials with a total of 6268 patients were pooled in our final analysis. There was statistical heterogeneity between normal-weight and overweight patients in LOS in the ICU ( I 2  = 71%, χ 2  = 10.27, P  = 0.02) and in MV-free days ( I 2  = 89%, χ 2  = 18.45, P  < 0.0001). Compared with normal weight, being underweight was associated with higher mortality (OR 1.59, 95% confidence interval (CI) 1.22, 2.08, P  = 0.0006), while obesity and morbid obesity were more likely to result in lower mortality (OR 0.68, 95% CI 0.57, 0.80, P  < 0.00001; OR 0.72, 95% CI 0.56, 0.93, P  = 0.01). MV-free days were much longer in patients with morbid obesity (MD 2.64, 95% CI 0.60, 4.67, P  = 0.01), but ICU and hospital LOS were not influenced by BMI. An important limitation of our analysis is the lack of adjustment for age, sex, illness severity, comorbid illness, and interaction of outcome parameters. Conclusions Obesity and morbid obesity are associated with lower mortality in patients with ARDS.

Lithium‐ion batteries (LIBs) are regarded to be the most promising electrochemical energy storage device for portable electronics as well as electrical vehicles. However, due to their limited‐service life, tons of spent LIBs are expected to be produced in the recent years. Suitable recycling technology is therefore becoming more and more important as improper treatment of spent LIBs, especially the aged organic electrolyte, can cause severe environmental pollution and threats to human health. The organic solvents and high concentration of lithium salts in aged electrolytes are always sensitive toward water and air, which would easily hydrolyze and decompose into toxic fluorine‐containing compounds, leading to severe fluorine pollution of the surrounding environment. Hence, recycling aged electrolytes from spent LIBs is an efficient way to avoid this potential risk to the environment. However, several issues inhibit the realization of electrolyte recycling, including the volatile, inflammable, and toxic nature of the electrolytes, the difficulty to extract electrolytes from the electrodes and separators, and various electrolyte compositions inside LIBs from different applications and companies. Herein, the current progress in recycling methods for aged electrolytes from spent LIBs is summarized and perspectives on future development of electrolyte recycling are presented. Aged electrolytes inside spent lithium‐ion batteries consist of volatile organic solvents and toxic lithium salts, which can cause severe environmental pollution and safety issues without proper treatment. This review summarizes the reported methods to recycle aged electrolytes as well as achieve progress during industrial recycling technology and proposes future perspectives for suitable electrolyte recycling directions.

Background Intraoperative radiotherapy (IORT) is a convenient treatment techniques for patients with early-stage breast cancer. We aimed to compare the outcome of IORT to that of whole-breast external beam radiotherapy (EBRT) in highly selected breast cancer patients based on the 2023 American Society for Radiation Oncology (ASTRO) Clinical Practice Guideline for Partial Breast Irradiation (PBI). Patients and methods We reviewed patients who underwent breast-conserving surgery (BCS) and received either IORT or EBRT for early-stage breast cancer between 2014 and 2019. The outcomes of these patients were analyzed and compared across different risk stratifications according to the 2023 ASTRO Clinical Practice Guideline for PBI, which categorized the patients into “recommended”, “conditionally recommended”, or “conditionally not recommended” groups. Results A total of 732 patients were enrolled with a mean follow-up time of 5.1 years. Among patients in the recommended group, the locoregional recurrence rates were 2.0% for IORT and 2.3% for EBRT ( p  = 0.978). Conversely, in the conditionally recommended or conditionally not recommended groups, IORT exhibited significantly higher locoregional recurrence rates compared to EBRT: in the conditionally recommended group, IORT had a recurrence rate of 11.1% versus 3.0% for EBRT ( p  = 0.044), and in the conditionally not recommended group, IORT had a rate of 13.8% versus 2.5% for EBRT ( p  = 0.010). Conclusions The locoregional recurrence rate in the IORT group was comparable to that of the EBRT group for patients recommended for PBI. However, for patients categorized as conditionally recommended or conditionally not recommended for PBI, the IORT group showed a higher locoregional recurrence rate, highlighting the need for careful patient selection.

The effects of high flow nasal cannula (HFNC) on adult patients when used before mechanical ventilation (MV) are unclear. We aimed to determine the effectiveness of HFNC when used before MV by comparison to conventional oxygen therapy (COT) and noninvasive positive pressure ventilation (NIPPV). The Pubmed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL) as well as the Information Sciences Institute (ISI) Web of Science were searched for all the controlled studies that compared HFNC with NIPPV and COT when used before MV in adult patients. The primary outcome was the rate of endotracheal intubation and the secondary outcomes were intensive care unit (ICU) mortality and length of ICU stay (ICU LOS). Eight trials with a total of 1084 patients were pooled in our final studies. No significant heterogeneity was found in outcome measures. Compared both with COT and NIPPV, HFNC could reduce both of the rate of endotracheal intubation (OR 0.62, 95% CI 0.38–0.99, P=0.05; OR 0.48, 95% CI 0.31–0.73, P=0.0006) and ICU mortality (OR 0.47, 95% CI 0.24–0.93, P=0.03; OR 0.36, 95% CI 0.20–0.63, P=0.0004). As for the ICU LOS, we did not find any advantage of HFNC over COT or NIPPV. When used before MV, HFNC can improve the prognosis of patients compared both with the COT and NIPPV.