Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is the primary cause of mortality in sepsis, with its core pathophysiological mechanism being severe ischemia and hypoxia in critical units—composed of microcirculation and the mitochondria of functional cells—resulting from disruptions in blood flow and oxygen flow following a dysregulated host response. Due to the systemically convergent yet clinically heterogeneous nature of the host response, current understanding and management strategies for hemodynamics remain inconsistent, often leading to inadequate resuscitation or overtreatment. To improve the quality of care, based on a systematic review of the "blood flow-oxygen flow" theory, an expert panel emphasizes reevaluating septic shock from an integrated perspective of blood flow and oxygen flow, and has formulated the Expert Consensus on Blood Flow and Oxygen Delivery Phenotyping and Clinical Management of Septic Shock (2025). The consensus proposes that clinical typing of blood flow-oxygen flow should comprehensively consider cardiac function, vascular tone, oxygen flow utilization status in critical units, and disease trajectory, while optimizing subtype identification by integrating host response phenotypes and artificial intelligence technologies. It advocates establishing a continuous assessment system through multi-site oxygen flow monitoring for organ perfusion, peripheral perfusion monitoring, and critical care ultrasound. Under the framework of the "critical care triangle", the consensus promotes the implementation of individualized, bundled management strategies, providing guidance for multiple management points to restore blood flow-oxygen flow matching, reduce the risk of organ failure, and decrease patient mortality.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective:To investigate the clinical effectiveness of anastomosis fixation method of lifting the suborbicularis oculi fat (SOOF) and fixing with the orbital septum and fat to correct eyelid bags with tear trough deformity.Methods:A retrospective analysis was conducted on patients treated at Hunan Provincial People’s Hospital (the First Affiliated Hospital of Hunan Normal University) from January 2019 to January 2021. The patients underwent lower eyelid blepharoplasty via a sub-lower eyelid skin approach. During the surgery, the SOOF was lifted and fixed with the orbital septum and fat, correcting the eye bags, filling the tear troughs, and lifting the midface. Postoperative observations included incision healing and complications. The correction of eye bags, tear troughs, and midface sagging was followed up. Adobe Photoshop CS6 software was used to measure the vertical distance from the nasolabial and buccal fat prominent point to the lower eyelid margin before surgery and at the last follow-up to evaluate the correction of midface sagging. Data were expressed as Mean ± SD, and pre- and post-operative comparisons were analyzed using paired t-test, with P<0.05 indicating statistical significance. Patients’ and nurses’ satisfaction evaluations of surgical outcomes were classified into three levels: satisfied, basically satisfied, and dissatisfied, requiring consensus between the two evaluators. Results:A total of 132 patients (264 eyes) were included, consisting of 23 males and 109 females, with an average age of (50.3±6.0) years. Hirmand tear trough classification included 178 type Ⅱeyes and 86 type Ⅲ eyes. Postoperative wound healing was well, with no hematoma, infection, diplopia, corneal foreign body sensation, and discomfort from external eye corner tightness. Follow-up ranged from 6-12 months, with 252 out of 264 eye bags disappeared and 12 eye bags reduced. Among the 86 type Ⅲ tear trough eyes, 10 improved to type Ⅰ, while the remaining 76 type Ⅲ and 178 type Ⅱ tear troughs disappeared postoperatively. All 264 midface sagging cases showed improvement, with the vertical distance from the nasolabial fat prominence point to the lower eyelid margin significantly shortening postoperatively [(29.23±1.58) mm vs. (34.08±3.23) mm, t=22.88, P<0.001)]. Satisfaction evaluation result showed 118 cases were satisfied (satisfaction rate of 89.4%), and 14 cases were basically satisfied. Conclusion:The anastomosis fixation method of lifting the SOOF and fixing with the orbital septum and fat effectively removes eyelid bags, smooths tear troughs, and lifts the midface, achieving a rejuvenated appearance and renders a high patient satisfaction rate.

The training of lunar rover driving skills for astronauts requires the simulation of realistic motion perception characteristics.The key lies in understanding the differences of driving motion perception between ground and moon.A high-fidelity simulation scene was created to compare the driving characteristics of a lunar rover on the moon and on Earth.Additionally,a software framework based on spatial orientation model was developed to simulate and compare the differences in forward motion perception between lunar and ground driving.The results indicate that under lunar conditions the lunar rover experiences reduced acceleration changes and slower acceleration and deceleration,which increases the displacement of sideslip.Additionally,limited visual information leads to a significantly larger dynamic pitch angle perception compared to ground conditions,while static pitch angle perception is greatly reduced.However,this difference could be greatly reduced when visual information is available.The differences in motion perception characteristics were revealed between lunar and ground driving rover,providing a basis for optimizing lunar rover driving motion simulation strategies.

Objective:To investigate the clinical effectiveness of anastomosis fixation method of lifting the suborbicularis oculi fat (SOOF) and fixing with the orbital septum and fat to correct eyelid bags with tear trough deformity.Methods:A retrospective analysis was conducted on patients treated at Hunan Provincial People’s Hospital (the First Affiliated Hospital of Hunan Normal University) from January 2019 to January 2021. The patients underwent lower eyelid blepharoplasty via a sub-lower eyelid skin approach. During the surgery, the SOOF was lifted and fixed with the orbital septum and fat, correcting the eye bags, filling the tear troughs, and lifting the midface. Postoperative observations included incision healing and complications. The correction of eye bags, tear troughs, and midface sagging was followed up. Adobe Photoshop CS6 software was used to measure the vertical distance from the nasolabial and buccal fat prominent point to the lower eyelid margin before surgery and at the last follow-up to evaluate the correction of midface sagging. Data were expressed as Mean ± SD, and pre- and post-operative comparisons were analyzed using paired t-test, with P<0.05 indicating statistical significance. Patients’ and nurses’ satisfaction evaluations of surgical outcomes were classified into three levels: satisfied, basically satisfied, and dissatisfied, requiring consensus between the two evaluators. Results:A total of 132 patients (264 eyes) were included, consisting of 23 males and 109 females, with an average age of (50.3±6.0) years. Hirmand tear trough classification included 178 type Ⅱeyes and 86 type Ⅲ eyes. Postoperative wound healing was well, with no hematoma, infection, diplopia, corneal foreign body sensation, and discomfort from external eye corner tightness. Follow-up ranged from 6-12 months, with 252 out of 264 eye bags disappeared and 12 eye bags reduced. Among the 86 type Ⅲ tear trough eyes, 10 improved to type Ⅰ, while the remaining 76 type Ⅲ and 178 type Ⅱ tear troughs disappeared postoperatively. All 264 midface sagging cases showed improvement, with the vertical distance from the nasolabial fat prominence point to the lower eyelid margin significantly shortening postoperatively [(29.23±1.58) mm vs. (34.08±3.23) mm, t=22.88, P<0.001)]. Satisfaction evaluation result showed 118 cases were satisfied (satisfaction rate of 89.4%), and 14 cases were basically satisfied. Conclusion:The anastomosis fixation method of lifting the SOOF and fixing with the orbital septum and fat effectively removes eyelid bags, smooths tear troughs, and lifts the midface, achieving a rejuvenated appearance and renders a high patient satisfaction rate.

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”.

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:To describe the features of point-of-care cardiopulmonary ultrasound (POCUS) in the critically ill patients and analyze the independent factors associated with treatment changes after POCUS assessment.Methods:This was a prospective multicentric observational study from January to December 2018 in 13 intensive care units (ICU) in China. Consecutive patients admitted to the ICU were enrolled, POCUS were performed within the first 24 h of admission. The POCUS parameters included acute or chronic cardiac abnormality, diameter of inferior vena cava (IVC) at end-expiration, right ventricular systolic function, systolic and diastolic function of left ventricle (LV) and lung ultrasound score. The general features of patients and performers were recorded. Based on the treatment proposed by the performer before and after POCUS assessment, the patients were divided into treatment changed and unchanged groups. Factors associated with treatment changes were identified by multiple logistic regression analysis.Results:Totally 1 913 patients were enrolled including 322 (16.8%) patients with shock, 638 (33.3%) patients with respiratory failure, 139 (7.3%) patients with both shock and respiratory failure and 814 (42.6%) perioperative patients. POCUS had contributed to treatment changes in 1 204 (62.9%) patients, including 867 (72.0%) cases involved fluid management. Univariate analysis showed that there were significant differences in general characteristics of patients, performers and POCUS parameters between groups(all P<0.05). Logistic regression analysis showed that independent factors of treatment changes included ministry of education or university affiliated teaching hospitals (vs.general hospitals, OR=1.891, 95% CI=1.314-2.722, P<0.001 and OR=1.644, 95% CI=1.152-2.347, P=0.006 separately), middle and senior title performers (vs.primary title, OR=2.112, 95% CI=1.358-3.284, P=0.001, OR=3.271, 95% CI=2.129-5.025, P<0.001 separately), mechanical ventilation (vs.without, OR=0.488, 95% CI 0.381-0.626, P<0.001), IVC diameter ≤1 cm (vs.1-2 cm, OR=0.317, 95% CI 0.231-0.434, P<0.001), LV ejecting fraction <50% (vs.≥50%, OR=0.328, 95% CI=0.210-0.512, P<0.001), lung ultrasound score of 6-12 and >12 points(vs.score ≤ 6 points, OR=0.237, 95% CI=0.178-0.315, P<0.001 and OR=0.619, 95% CI=0.457-0.837, P=0.002 separately). Conclusions:POCUS assessment contributes to treatment changes, most of which involves fluid management strategy, in 62.9% critical patients. The independent influencing factors associated with POCUS parameters includes IVC diameter at end-expiratory, LV systolic function and lung ultrasound score. The performers′ title and hospital grade also have a noticeable effect.

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.