Efficient purification and high-quality regeneration of graphite from spent lithium-ion batteries by surfactant-assisted methanesulfonic acid.

With the vigorous development of the new energy industry, the use of lithium-ion batteries (LIBs) is growing exponentially, and the recycling of spent LIBs has gradually become a research hotspot. Currently, recycling both cathode and anode materials of LIBs is important to environmental protection and resource recycling. This research reportsa method ofefficient purification and high-quality regeneration of graphite from spent LIBs by surfactant-assisted methanesulfonic acid (MSA). Under the optimal conditions (0.006 mol/L sodium dodecyl sulfonate, 0.25 mol/L MSA, 10 vol% hydrogen peroxide, liquid-solid ratio of 30:1 mL/g, 60 °C, 1.5 h), the purity of the regenerated graphite was 99.7 %, and the recovery efficiency was 98.0 %. The regenerated graphite showed the characteristics of small interplanar spacing, high degree of graphitization, a small number of surface defects, and excellent pore structure, which was closer to commercial graphite. Furthermore, the regenerated graphite electrode exhibited superior rate performance and cycling stability with a high specific capacity of 397.03 mAh/g after 50 cycles at 0.1C and a charge-discharge efficiency of 99.33 %. The recovery of anode graphite beneficial for resource utilization, environmental protection, and cost control throughout the entire production chain.

Preparation and Performance of Regenerated Al2O3-Coated Cathode Material LiNi0.8Co0.15Al0.05O2 from Spent Power Lithium-Ion Batteries.

In this study, LiNi0.8Co0.15Al0.05O2@x%Al2O3-coated cathode materials were regeneratively compounded by the solid-phase sintering method, and their structural characterization and electrochemical performance were systematically analyzed. The regenerated ternary cathode material precursor synthesized by the co-precipitation method was roasted with lithium carbonate at a molar ratio of 1:1.1, and then completely mixed with different contents of aluminum hydroxide. The combined materials were then sintered at 800 °C for 15 h to obtain the regenerated coated cathode material, LiNi0.8Co0.15Al0.05O2@x%Al2O3. The thermogravimetry analysis, phase composition, morphological characteristics, and other tests show that when the added content of aluminum hydroxide is 3%, the regenerated cathode material, LiNi0.8Co0.15Al0.05O2@1.5%Al2O3, exhibits the highest-order layered structure with Al2O3 coating. This material can better inhibit the production of Ni2+, and improve material structure and electrochemical properties. The first charge-discharge efficiency of the battery assembled with this regenerated cathode material is 97.4%, a 50-cycle capacity retention is 93.4%, and a 100-cycle capacity retention is 87.6%. The first charge-discharge efficiency is far better than that of the uncoated regenerated battery.

The Prevalence of Dyslexia: A New Approach to Its Estimation.

How prevalent is dyslexia? A definitive answer to this question has been elusive because of the continuous distribution of reading performance and predictors of dyslexia and because of the heterogeneous nature of samples of poor readers. Samples of poor readers are a mixture of individuals whose reading is consistent with or expected based on their performance in other academic areas and in language, and individuals with dyslexia whose reading is not consistent with or expected based on their other performances. In the present article, we replicate and extend a new approach for determining the prevalence of dyslexia. Using model-based meta-analysis and simulation, three main results were found. First, the prevalence of dyslexia is better represented as a distribution that varies as a function of severity as opposed to any single-point estimate. Second, samples of poor readers will contain more expected poor readers than unexpected or dyslexic readers. Third, individuals with dyslexia can be found across the reading spectrum as opposed to only at the lower tail of reading performance. These results have implications for screening and identification, and for recruiting participants for scientific studies of dyslexia.

N-terminal pro-B-type natriuretic peptide for predicting fluid challenge in patients with septic shock.

BACKGROUND: The aim of this study is to examine whether plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration could predict fluid responsiveness in septic shock patients following fluid challenge (FC). METHODS: We reviewed prospectively collected data from 79 septic shock patients who received invasive cardiac output (CO) monitoring following a 500 mL FC. Haemodynamics were recorded, and blood sampling for NT-proBNP values was performed. Patients were divided into responders and non-responders according to fluid responsiveness, which was defined as cardiac index (CI) increase ≥10% induced by FC. The NT-proBNP and the CI changes were analysed using Pearson correlation. The area under the curve (AUC) for NT-proBNP was used to test its ability to distinguish responders and non-responders. Subgroup analyses were also explored. RESULTS: Among 79 patients, there were 55 responders. High NT-proBNP values were common in the study cohort. Baseline NT-proBNP values were comparable between responders and non-responders. In general, NT-proBNP values were not significantly correlated with CI changes after FC (r=-0.104, P=0.361). Similarly, the NT-proBNP baseline values could not identify responders to FC with an AUC of 0.508 (95% confidence interval, 0.369-0.647). This result was further confirmed in the subgroup analyses. CONCLUSIONS: Baseline NT-proBNP concentration value may not serve as an indicator of fluid responsiveness in patients with septic shock and should not be an indicator to withhold fluid loading.

[Choice of assessment time after fluid challenge in patients with septic shock].

OBJECTIVE: To explore the short-term hemodynamic change of fluid challenge (FC) with crystalloid or colloid and define fluid responsiveness at the optimal time in patients with septic shock. METHODS: A prospective observational study was conducted. Septic shock patients monitored with pulmonary catheters admitted to medical intensive care unit (ICU) of the Peking Union Medical College Hospital from July 2016 to December 2018 were enrolled. All included patients received FC and were divided into two groups according to the type of fluid used, i.e. crystalloid group (normal saline for 500 mL) and colloid group (4% succinyl gelatin for 500 mL). The choice of fluid type was decided by the attending physician. Hemodynamic variables were measured at baseline, and 0 (immediately), 10, 30, 45, 60, 90, 120 minutes after FC, included cardiac index (CI), heart rate (HR), mean artery pressure (MAP), central venous pressure (CVP) and pulmonary arterial wedge pressure (PAWP). Fluid responsiveness was defined as CI increased by more than 10% after FC. The data were analyzed by repeated measurements of variance between the two groups as well as responders and nonresponders. RESULTS: Forty patients were included, 20 cases each in colloid group and crystalloid group; of whom 26 were fluid responders with 12 of colloid group and 14 of crystalloid group. Of the 14 nonresponders, 8 were of colloid group and 6 of crystalloid group. (1) Compared with before FC, CI (mL×s-1×m-2) was significantly increased in crystalloid and colloid groups after FC (71.7±16.7 vs. 65.0±16.7, 68.3±25.0 vs. 63.3±23.3, both P < 0.05). In the colloid group, volume expansion increased the CI to maximum (76.7±18.3) at 30 minutes after FC, at 120 minutes after FC, a significantly higher CI (70.0±16.7) was also observed (P < 0.05), an increased in CI ≥ 10% was observed at 60 minutes after FC. In the crystalloid group, CI was increased to maximum at 10 minutes (73.3±28.3) and decreased to baseline at 60 minutes, an increased in CI ≥ 10% was also observed at 10 minutes after FC. In addition, there was no significant difference in CI changes between colloidal group and crystalloid group at different time points after FC. (2) CI did not change over time in nonresponders groups, whereas in responders CI increased parallelly to that in both crystalloid and colloid groups over time. However, an increased in CI ≥ 10% was observed through the 120 minutes after FC in responders of colloid group compared with that of at 30 minutes after FC in crystalloid group. There was significant difference in CI changes between colloidal group and crystalloid group at 30, 45, 60, 90 minutes after FC (mL×s-1×m-2: 18.3±3.3 vs. 8.3±1.7, 18.3±3.3 vs. 5.0±1.7, 13.3±1.7 vs. 3.3±1.7, 11.7±3.3 vs. 3.3±1.7, all P < 0.05). (3) The maximal values of CVP and PAWP were observed at the end of FC. In colloid group, both the two variables were notably higher than that before FC over 120 minutes compared with that of only at 10 minutes in crystalloid group. The MAP in colloid increased to maximum immediately at the end of FC and decreased to baseline at 45 minutes, however, the MAP in crystalloid group and HR of both groups showed no differences over 120 minutes. CONCLUSIONS: Hemodynamic changes were significantly different between crystalloid and colloid after FC in patients with septic shock. Therefore, the timing of fluid responsiveness assessment should be different individually. The assessment time of colloid group may be prolonged to 30 minutes after FC while that of crystal group can be at 10 minute after FC.

Usefulness of qSOFA and SIRS scores for detection of incipient sepsis in general ward patients: A prospective cohort study.

PURPOSE: To prospectively assess the diagnostic value of quick Sequential Organ Failure Assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) scores for sepsis in ward patients with infections. MATERIALS AND METHODS: Consecutive patients admitted with infection or developing infection during hospital stay were included. All variables for calculating qSOFA, SIRS, and SOFA scores were collected, and the maximum scores were determined until hospital discharge, death, or day 28, whichever occurred earlier. The primary outcome was sepsis at 28 days. Diagnostic and prognostic values were assessed using the area under the receiver operating characteristic curve (AUROC) with the conventional cutoff value of 2. RESULTS: Of 409 general ward patients, 146 patients and 371 patients met qSOFA and SIRS criteria, 229 patients developed sepsis. Although qSOFA score had a better overall diagnostic performance of sepsis (AUROC 0.75 vs. 0.69), it had a much lower sensitivity (53% vs. 98%) and higher specificity (87% vs. 18%) than SIRS score. In addition, qSOFA score had a better prognostic value than SIRS score (AUROC 0.86 vs. 0.67). CONCLUSIONS: Neither SIRS score nor qSOFA score could serve as an ideal screening tool for early identification sepsis, whereas qSOFA score might help to identify patients with higher risk of poor clinical outcome. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02930070.

[Predictive value of central venous-to-arterial carbon dioxide partial pressure difference for fluid responsiveness in septic shock patients: a prospective clinical study].

OBJECTIVE: To evaluate the accuracy of central venous-to-arterial carbon dioxide partial pressure difference (Pcv-aCO2) before and after rapid rehydration test (fluid challenge) in predicting the fluid responsiveness in patients with septic shock. METHODS: A prospective observation was conducted. Forty septic shock patients admitted to medical intensive care unit (ICU) of Peking Union Medical College Hospital from October 2015 to June 2017 were enrolled. All of the patients received fluid challenge in the presence of invasive hemodynamic monitoring. Heart rate (HR), blood pressure, cardiac index (CI), Pcv-aCO2 and other physiological variables were recorded at 10 minutes before and immediately after fluid challenge. Fluid responsiveness was defined as an increase in CI greater than 10% after fluid challenge, whereas fluid non-responsiveness was defined as no increase or increase in CI less than 10%. The correlation between Pcv-aCO2 and CI was explored by Pearson correlation analysis. Receiver operating characteristic (ROC) curves were established to evaluate the discriminatory abilities of baseline and the changes after fluid challenge in Pcv-aCO2 and other physiological variables to define the fluid responsiveness. The patients were separated into two groups according to the initial value of Pcv-aCO2. The cut-off value of 6 mmHg (1 mmHg = 0.133 kPa) was chosen according to previous studies. The discriminatory abilities of baseline and the change in Pcv-aCO2 (ΔPcv-aCO2) were assessed in each group. RESULTS: A total of 40 patients were finally included in this study. Twenty-two patients responded to the fluid challenge (responders). Eighteen patients were fluid non-responders. There was no significant difference in baseline physiological variable between the two groups. Fluid challenge could increase CI and blood pressure significantly, decrease HR notably and had no effect on Pcv-aCO2 in fluid responders. In non-responders, blood pressure was increased significantly and CI, HR, Pcv-aCO2 showed no change after fluid challenge. Pcv-aCO2 was comparable in responders and non-responders. In 40 patients, CI and Pcv-aCO2 was inversely correlated before fluid challenge (r = -0.391, P = 0.012) and the correlation between them weakened after fluid challenge (r = -0.301, P = 0.059). There was no significant correlation between the changes in CI and Pcv-aCO2 after fluid challenge (r = -0.164, P = 0.312). The baseline Pcv-aCO2 and ΔPcv-aCO2 could not discriminate between responders and non-responders, with the area under ROC curve (AUC) of 0.50 [95% confidence interval (95%CI) = 0.32-0.69] and 0.51 (95%CI = 0.33-0.70), respectively. HR and blood pressure before fluid challenge and their changes after fluid challenge showed very poor discriminative performances. Before fluid challenge, 16 patients had a Pcv-aCO2 > 6 mmHg. Their mean CI was significantly lower and Pcv-aCO2 was significantly higher than that in 24 patients whose Pcv-aCO2 ≤ 6 mmHg [n = 24; CI (mL×s-1×m-2): 48.3±11.7 vs. 65.0±18.3, P < 0.01; Pcv-aCO2 (mmHg): 8.4±1.9 vs. 2.9±2.8, P < 0.01]. Pcv-aCO2 was decreased significantly after fluid challenge in patients with an initial Pcv-aCO2 > 6 mmHg and their ΔPcv-aCO2 was notably different as compared with the patients whose baseline Pcv-aCO2 ≤ 6 mmHg (mmHg: -3.8±3.4 vs. 0.9±2.9, P < 0.01). 68.8% (11/16) patients responded to the fluid challenge in patients with an initial Pcv-aCO2 > 6 mmHg. The AUC of the baseline Pcv-aCO2 and ΔPcv-aCO2 to define fluid responsiveness was 0.85 (95%CI = 0.66-1.00) and 0.84 (95%CI = 0.63-1.00), respectively, and the positive predictive value was 1 when the cut-off value was 8.0 mmHg and -4.2 mmHg, respectively. 45.8% (11/24) patients responded to the fluid challenge in patients whose baseline Pcv-aCO2 ≤ 6 mmHg. There was no predictive value of baseline Pcv-aCO2 and ΔPcv-aCO2 on fluid responsiveness. CONCLUSIONS: Pcv-aCO2 and its change cannot serve as a surrogate of the change in cardiac output to define the response to fluid challenge in septic shock patients whose baseline Pcv-aCO2 ≤ 6 mmHg, while the predictive values of baseline Pcv-aCO2 and the change in Pcv-aCO2 are presented in patients with the initial value of Pcv-aCO2 > 6 mmHg. CLINICAL TRIAL REGISTRATION: Clinical Trials, NCT01941472.

High-flow oxygen therapy in immunocompromised patients with acute respiratory failure: A review and meta-analysis.

PURPOSE: Acute respiratory failure remains a common hazardous complication in immunocompromised patients and is associated with increased mortality rates when endotracheal intubation is need. We aimed to evaluate the effect of high-flow nasal cannula oxygen therapy (HFNC) compared with other oxygen technique for this patient population. METHODS: We searched Cochrane library, Embase, PubMed databases before Aug. 15, 2017 for eligible articles. A meta-analysis was performed for measuring short-term mortality (defined as ICU, hospital or 28-days mortality) and intubation rate as the primary outcomes, and length of stay in ICU as the secondary outcome. RESULTS: We included seven studies involving 667 patients. Use of HFNC was significantly association with a reduction in short-term mortality (RR 0.66; 95% CI, 0.52 to 0.84, p=0.0007) and intubation rate (RR 0.76, 95% CI 0.64 to 0.90; p=0.002). In addition, HFNC did not significant increase length of stay in ICU (MD 0.15days; 95% CI, -2.08 to 2.39; p=0.89). CONCLUSIONS: The results of current meta-analysis suggest that use of HFNC significantly improve outcomes of acute respiratory failure in immunocompromised patients. Owing to the quality of the included studies, further adequately powered randomized controlled trials are needed to confirm our results.

Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults: A Systemic Review and Meta-Analysis.

BACKGROUND: Endotracheal intubation (EI) in ICU patients is associated with an increased risk of life-threatening adverse events due to unstable conditions, rapid deterioration, limited preparation time, and variability in the expertise of operators. The goal of this study was to compare the effect of video laryngoscopy (VL) and direct laryngoscopy (DL) in ICU patients requiring EI. METHODS: We searched for relevant studies in PubMed, Embase, and the Cochrane database from inception through January 30, 2017. Randomized controlled trials were included if they reported data on any of the predefined outcomes in ICU patients requiring EI and managed with VL or DL. Results were expressed as risk ratios (RRs) or mean differences (MDs) with accompanying 95% CIs. RESULTS: Five randomized controlled trials with 1,301 patients were included. Despite better glottic visualization with VL (RR = 1.24; 95% CI, 1.07 to 1.43; P = .003), use of VL did not result in a significant increase in the first-attempt success rate (RR = 1.08; 95% CI, 0.92-1.26; P = .35) compared with DL. In addition, time to intubation (MD = 4.12 s; 95% CI, -15.86-24.09; P = .69), difficult intubation (RR = 0.72; 95% CI, 0.30-1.70; P = .45), mortality (RR = 1.02; 95% CI, 0.84-1.25; P = .83), and most other complications were similar between the VL and DL groups. CONCLUSIONS: The VL technique did not increase the first-attempt success rate during EI in ICU patients compared with DL. These findings do not support routine use of VL in ICU patients.

Use of noninvasive ventilation in immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis.

BACKGROUND: Acute respiratory failure (ARF) remains a common hazardous complication in immunocompromised patients and is associated with increased mortality rates when endotracheal intubation is needed. We aimed to evaluate the effect of early noninvasive ventilation (NIV) compared with oxygen therapy alone in this patient population. METHODS: We searched for relevant studies in MEDLINE, EMBASE, and the Cochrane database up to 25 July 2016. Randomized controlled trials (RCTs) were included if they reported data on any of the predefined outcomes in immunocompromised patients managed with NIV or oxygen therapy alone. Results were expressed as risk ratio (RR) and mean difference (MD) with accompanying 95% confidence interval (CI). RESULTS: Five RCTs with 592 patients were included. Early NIV significantly reduced short-term mortality (RR 0.62, 95% CI 0.40 to 0.97, p = 0.04) and intubation rate (RR 0.52, 95% CI 0.32 to 0.85, p = 0.01) when compared with oxygen therapy alone, with significant heterogeneity in these two outcomes between the pooled studies. In addition, early NIV was associated with a shorter length of ICU stay (MD -1.71 days, 95% CI -2.98 to 1.44, p = 0.008) but not long-term mortality (RR 0.92, 95% CI 0.74 to 1.15, p = 0.46). CONCLUSIONS: The limited evidence indicates that early use of NIV could reduce short-term mortality in selected immunocompromised patients with ARF. Further studies are needed to identify in which selected patients NIV could be more beneficial, before wider application of this ventilator strategy.

[Treatment of transplantation of NT-3 gene modified olfactory ensheathing cells on experimental autoimmune encephalomyelitis in rats].

OBJECTIVE: To explore the effects of transplantation of NT-3 gene modified olfactory ensheathing cells (OECs) on nerve function of rats with experimental autoimmune encephalomyelitis (EAE). METHODS: The experimental autoimmune encephalomyelitis model was established in Lewis rats. The animals were randomly divided into 3 group: blank control group (transplantation of saline), OECs transplanted group (transplantation of OECs), and OECs-NT-3 transplanted group (transplantation of NT-3 modified OECs). The neurological function was assessed and recorded every day. The migration and distribution of transplanted cells were observed. The nerve regeneration was valued in the aspect of morphological structure by means of immunohistochemistry and retrograde tracing technique of horseradish peroxidase (HRP). RESULTS: The neurological functional score of OECs-NT-3 transplanted group was obviously inferior to OECs transplanted group after transplantation (P < 0.05). A large number of OECs-NT-3 survived and migrated with axon in OECs-NT-3 transplanted group at Day 28. The number of nerve fibers in one microscopic field was much more in OECs-NT-3 transplanted group (38.8 ± 3.4, Day 28) than those in OECs transplanted group (32.5 ± 2.8, Day 28) (P < 0.05). The number of cortex neurons labeled by HRP in OECs-NT-3 transplanted group were significantly higher than those in OECs transplanted group, (P < 0.01). CONCLUSION: NT-3 gene modified OECs have better capacities of survival and migration in EAE rats. The transplanted OECs-NT-3 can promote the regeneration of axon, reduce the injury of cortical neurons and improve the motor functions of EAE rats.

High dose of TNF-α suppressed osteogenic differentiation of human dental pulp stem cells by activating the Wnt/ß-catenin signaling.

Dental pulp stem cells (DPSCs) were a clonogenic, highly proliferative cells capable of self-renewal and multi-lineage differentiation including chondrocytes, adipocytes, neural cells and osteoblasts, which make it an attractive choice for bone regeneration and repair of craniofacial defects. Recent studies showed that tumor necrosis factor α (TNF-α) may affect osteoclastogenesis and bone formation. However, the effect and mechanism of TNF-α on DPSCs is not clear. In this study, we found that low dose TNF-α promoted mineralization and high dose TNF-α suppressed osteogenic differentiation of DPSCs. Levels of ALP, Osteopontin, Osteocalcin, Osterix and Runx2 were up-regulated in DPSCs treated with TNF-α at low concentration, while down-regulated in DPSCs treated with TNF-α at high concentration. Blockade of Wnt/ß-catenin signaling reversed the inhibitory effect observed on osteogenic differentiation of DPSCs treated with TNF-α at high concentration. In addition, we did not detect any proliferative effect of TNF-α on DPSCs by cell cycle and cell counts analysis. In summary, our data suggested that high concentration TNF-α suppressed mineralization and mineralization-related gene expressions through the Wnt/ß-catenin signaling in DPSCs. Our findings may provide a foundation for autologous transplantation of DPSCs.

Tumor Necrosis Factor Alpha Stimulates Proliferation of Dental Pulp Stem Cells via Akt/Glycogen Synthase Kinase-3ß/Cyclin D1 Signaling Pathway.

INTRODUCTION: It has been widely accepted that dental pulp stem cells (DPSCs), which are a class of self-renewal and differentiation potential of adult stem cells, play an important role in the repair procession of pulp's inflammation. We investigated whether tumor necrosis factor alpha (TNF-α) could induce the proliferation of DPSCs and clarified the potential mechanism of this proliferation. METHODS: Cell Counting Kit-8 assay (Dojindo Laboratories, Mashiki-machi, Kumamoto, Japan) and 5-ethynyl-2'-deoxyuridine-based proliferation assays were determined to investigate various concentrations or hours of TNF-α inducing a cell number change of DPSCs. Next, flow cytometry analysis was performed to investigate the main cell cycle phase process of DPSCs. Furthermore, the signaling pathway of TNF-α-induced proliferation of DPSCs was analyzed using Western blot analysis. Then, inhibitors were added to confirm the mechanism of this signaling pathway. RESULTS: TNF-α induced the proliferation of DPSCs in a dose- and time-dependent manner. Cyclin D1, which controlled the cell cycle process from the G1 to the S phase, was up-regulated by TNF-α in a time-dependent manner, whereas its overexpression alone increased DPSC proliferation. Furthermore, TNF-α was capable of inducing Akt/GSK-3ß signaling pathway activation. Blockage of phosphoinositide 3-kinase/Akt by their kinase or genetic inhibitors could significantly reduce TNF-α-induced proliferation of DPSCs. CONCLUSIONS: This study confirmed that TNF-α induced the proliferation of DPSCs by regulating the Akt/GSK-3ß/cyclin D1 signaling pathway and then provided a suitable number for the requirements of cell differentiation.