A small drop of water highlights people’s livelihood. In order to systematically grasp and analyze the drinking water situation of residents in the whole region and ensure the safety of drinking water for residents, recently, the water quality testing personnel of Jining District Municipal Public Utilities Service Center carried out water quality testing and sampling work for urban drinking water to ensure the safety of drinking water for residents.

First, make overall arrangements and make preparations for actual testing. According to the tasks and requirements of sampling inspection, make a detailed sampling plan, define the sampling points, sampling time and times, testing items and sampling quantity, determine the selection and cleaning of sampling equipment, sampling quality assurance measures, etc., and arrange sampling trucks for sampling personnel.

The second is scientific sampling to improve the quality of sample collection. Collect and save water samples correctly in strict accordance with the operation flow of drinking water sample collection, mark the water samples on site, and fill in the sampling records to ensure that no safety accidents occur during the sampling process and ensure the quality of sample collection. This time, the testing staff did all the tests on the peripheral water of seven pipe networks, three daily tests on the factory water of six water plants, and seven tests on the water of two pipe networks.

The third is to strictly standardize testing to ensure the quality of testing. After water samples are collected, the central inspection personnel will conduct inspection in strict accordance with the Standard Inspection Method for Drinking Water (GB/T5750-2023) and related specifications. The main inspection items include: routine indicators such as chromaticity, turbidity, pH value, permanganate index (calculated by O2), total hardness, total coliform bacteria and total colonies. During the inspection, the samples will be retested and parallel.

This sampling and testing of drinking water provides reliable data support for the safety management of drinking water in urban areas, and also better ensures that people can use safe water, safe water and satisfactory water. In the next step, the center will continue to do a good job in water quality testing to protect the people from eating "safe water, safe water and happy water".

On December 3, the reporter learned from the Department of Ecology and Environment that in October this year, the province’s "12369 Environmental Reporting Networking Management Platform" (hereinafter referred to as "networking platform") received a total of 895 environmental reports, down 13.7% from the previous month and 36% from the same period last year. Of the reports received, 614 have been accepted. It is worth noting that the number of reports reflecting the types of air pollution is the largest, with a total of 454, accounting for 40.4%.

Why did you receive 895 reports and only accept 614? It turned out that there were 281 reports that were not accepted because the clues were unknown or did not fall within the scope of responsibility of the ecological environment department. In addition, according to the requirement that the report should be completed within 60 days, 608 reports accepted by the province in August 2019 should be completed in October 2019, and all of them have been completed.

The reporter combed the data and found that the number of online reports in the province increased by over 30% in October compared with September. In October 2019, among the reports received by the province, 273 were reported by the "12369" environmental reporting hotline, accounting for 44.5%; Wechat reported 253 cases, accounting for 41.2%; 88 cases were reported online, accounting for 14.3%. Among them, telephone reports decreased by 21.1% month-on-month and 12.5% year-on-year; WeChat reported a decrease of 9% from the previous month and a decrease of 33% year-on-year; Online reporting increased by 35.4% month-on-month and decreased by 38.5% year-on-year.

Problems reflecting the types of air pollution account for the highest proportion. In terms of pollution types, there are 454 air pollution problems, accounting for 40.4%; Noise pollution, water pollution, solid waste pollution, radiation and other pollution problems accounted for 29.7%, 16%, 6.8% and 7.1% respectively.

Among the air pollution complaints, the pollution problem of irritating gas emitted in the production process of pharmaceutical and chemical enterprises is more prominent, accounting for 8.4% and 7% of air pollution complaints respectively; Among the noise pollution complaints, there are many pollution problems that reflect the social life noise of accommodation, catering and entertainment and the construction noise, accounting for 11.7% and 8% of the noise pollution complaints respectively; Among the water pollution complaints, there are many pollution problems that reflect the disorderly discharge of manure from livestock and poultry breeding enterprises and the direct discharge of wastewater from agricultural and sideline food processing enterprises, accounting for 11.4% and 8.9% of the water pollution complaints respectively.

Judging from the reports of pollution problems in various places, Ziyang, Deyang and Chengdu report air pollution problems relatively prominently; Pollution reports in Zigong and Panzhihua mainly reflect the problem of entertainment noise at night; The pollution report in Ya ‘an mainly reflects the problem of industrial noise; The reports of water pollution in Suining, Ya ‘an and Meishan are more prominent, mainly reflecting the problem of industrial wastewater pollution. (Reporter   Yin Peng)

On March 29th, Country Garden (02007.HK) issued an announcement, delaying the publication of 2023 annual results; Trading in the company’s shares was suspended on the Stock Exchange from 9: 00 am on April 2.

Country Garden explained that due to the continuous fluctuations in the industry, the business environment faced by the Group is becoming increasingly complex, and the company needs to collect more information to make appropriate accounting estimates and judgments, so as to reasonably reflect the changes in the industry and the company in the consolidated financial statements for 2023.

At the same time, as the debt restructuring work of the Company is still in progress, the projects are numerous and widely distributed, and the related due diligence involves a large amount of work and high complexity, the Company needs more time to collect relevant financial data to evaluate the current and future financial resources and financial obligations of the Group.

Country Garden said that the company continued to go all out to ensure the smooth progress of the delivery work. In 2023, more than 600,000 houses were delivered, with a total delivery area of 71.62 million square meters. Country Garden told The Paper that it expects to deliver over 480,000 sets this year and over 1 million sets in two years.

As for the guaranteed delivery, Country Garden said in the announcement that as of the announcement date, the company will continue to adhere to the earmarking of funds and strictly manage the pre-sale monitoring funds, and at the same time use various support policies and rely on policies to help the project delivery.

In terms of liquidity, Country Garden said that the company is striving to revitalize assets such as bulk businesses and reduce non-core and non-essential operating expenses, so as to keep the delivery bottom line and make every effort to improve the liquidity situation.

In addition, Country Garden attaches great importance to the cooperative relationship with suppliers. In the current market fluctuation, the Group keeps continuous communication with major contractors and suppliers to ensure that all parties maintain a consensus on the project schedule and funding arrangements, and continue to effectively ensure the normal operation of the project and complete the task of ensuring the delivery of the building through negotiation of a reasonable payment plan.

At the same time, the company attaches great importance to debt risk resolution. In the past few months, the Company has been working with financial advisers and legal advisers to assess the Group’s situation and formulate debt restructuring plans to alleviate the current liquidity problem.

Country Garden said that the company is still working with financial consultants and legal consultants. The company also actively engaged in constructive dialogue with creditors, and accelerated the formulation of a restructuring plan agreed by all parties on the premise of respecting the existing legal status and legal repayment order of all creditors.

As of press time, Country Garden was HK$ 0.485 per share, up 1.04%.

Choose a car. What do we have to see? The most important thing is to sit comfortably and drive safely. There are many styles of cars on the market now, and they are dazzling. Speaking of which, are these two cars, Krypton 001, reliable and worthy of our trust?

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First of all, talk about the chassis, which is the key to determine the handling and comfort of a car. Extreme Yue 01 and Extreme Krypton 001 have made great efforts in chassis design, but each has its own advantages.

The chassis design of this car is quite regular, the front and rear guard plates are complete, and the comprehensive coverage is realized, and the technology level is quite high. This design not only helps to reduce the wind drag coefficient and improve the energy efficiency of the vehicle, but also protects the chassis from the damage of pavement gravel and foreign bodies. In addition, there is a protective beam under the steering gear, which further enhances the protective ability of the chassis.

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Its chassis is based on Geely’s vast SEA architecture, which is Geely’s flagship platform in the field of pure electricity. This platform is not only advanced in technology, but also superior in materials, which provides a solid support for Extreme Vietnam 01. The similarity in quality with Volvo SPA platform makes people full of confidence in the chassis of this car.

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Great efforts have also been made in materials, and a large number of aluminum alloys have been used. For example, its front suspension adopts double-ball and double-wishbone structure, and it is all aluminum alloy. This design not only reduces the weight of the car body, but also improves the sensitivity and response speed of handling. The rear suspension is an aluminum alloy full-frame structure, which also takes into account the lightweight and strength. This lightweight design not only helps to improve the energy efficiency of the vehicle, but also makes it more flexible.

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Whether driving at high speed or in corners, you can feel the solid support of the chassis. Especially when passing through a continuous curve, its suspension system performs well, the body posture is stable, and there is no excessive sense of roll. In addition, the suspension system of Extreme Yue 01 is properly adjusted, neither too tough nor too soft, which can provide sufficient comfort while maintaining maneuverability.

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As another masterpiece from the same brand, the chassis of Krypton 001 is equally excellent. The ground clearance of krypton 001 is 14.5cm at full load and 17cm at no load. It is lower than SUV, but higher than car. This design not only ensures passability, but also gives consideration to handling and stability. Part of Krypton 001 equipped with air suspension system, its chassis height can be adjusted as required. Its chassis also adopts the suspension combination of front double wishbone and rear multi-link, which has excellent support and can easily cope with high-speed cornering or bumpy roads.

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The driving of Extreme Yue 01 takes intelligence as the core, and the ASD Apollo high-order intelligent driving and Qualcomm Snapdragon 8295 chip provided powerful computing support for the vehicle, which enabled the intelligent driving assistance function to be realized. Its visual technical scheme is excellent in dealing with complex urban road conditions, like a pair of keen eyes, always escorting us. There is also its automatic parking function, which can easily complete the parking task in a narrow space and feel very convenient.

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Krypton 001 pays more attention to the passion and fun of driving. Its dynamic performance is excellent, and the motor responds quickly and continuously. When driving, you can feel a strong feeling of pushing your back when you step on the accelerator deeply, as if you were in a racing car. In addition, the chassis adjustment of Krypton 001 is also biased towards sports, which makes the vehicle more flexible and accurate in handling. Krypton 001 also provides a variety of driving modes for drivers to choose from, including economy mode, comfort mode and sports mode. Each mode has different driving experience and power output performance.

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The chassis of the ultra-01 gives people the feeling of walking on a flat road, solid and stable. The design is light, does not increase the extra burden, and runs smoothly. It’s easy to get through a hurdle and turn a corner. Flat chassis, small wind resistance and high efficiency. The braking and transmission system is also very sensitive, safe and reliable. The chassis of Krypton 001 is also unambiguous. As soon as the front and rear roll bars are installed, the sense of security is full. Wide tires and low pressure design are like putting running shoes on a car, which has strong grip and runs steadily, and is not afraid of slipping or drifting. I like intelligent driving, which makes me feel comfortable and worry-free. The intelligent configuration and delicate chassis adjustment of Ultra 01 are absolutely possible, and it is easy and enjoyable to drive. And if you are a crazy driver, pursuing speed and passion, the power and control of Krypton 001 will ensure that you can’t put it down as soon as you get started. Every time you step on the switch, it is an exciting adventure.

In short, no matter whether it’s Extreme Yue 01 or Extreme Krypton 001, as soon as the label of new energy is attached, it’s green and full of driving fun. Which car to choose is the pursuit and enjoyment of a better life!

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　　On September 23rd, the 19th Asian Games in Hangzhou opened! Hangzhou Asian Games is not only a sports event, but also a big stage to show Chinese culture. As a bronze "Hangzhou business card" presented to the world,"Zhu Bingren Bronze" also inserted the wings of the Asian Games and "flew" to everyone.

Now, let’s look at it from the perspective of copper

Let’s take a look at the different Hangzhou Asian Games ~

"Zhu Bingren Copper" welcomes all of you to meet in Hangzhou.

Watch the game, enjoy the beautiful scenery and enjoy the culture together ~

Please keep this bronze sculpture map of the Asian Games.

17 places to visit

Let’s punch in one place at a time and set off after reading it!

Cultural House of Technical Officials Village in Asian Games Village 　

　　Entering the cultural house of technical officials’ village, the atmosphere of "national style" is full. What you see is a map of a thousand miles of mountains and rivers nearly 6 meters long. In the hut, there are also lifelike "Thousands of Waves Rolling Snow", "Sunflowers Facing the Sun" and "Fulu China Zun". These bronze works of art from Zhu Bingren, the master of China, all reflect the ingenuity of intangible skills and highlight the elegant charm of Jiangnan literati.

Asian Games Village Media Village

　　Walk into the Media Village of the Asian Games Village on the Qiantang River. During the Asian Games, it will be the "home" of about 12,000 media reporters around the world. The Lotus Zun of the Asian Games, designed by Zhu Bingren with Liangzhu culture, is displayed here. Celadon and bronze carving are two intangible crafts that collide and merge to create an exclusive gift for the Asian Games in Hangzhou.

Asian Games Village Protocol Service Center

　　In the Protocol Service Center of the Asian Games Village, which undertakes the heavy reception task of the Asian Games Village, three collections of Zhu Bingren’s "Gifts to the Asian Games" were exhibited, namely, Three Seals of Hearts, China Chess for the Asian Games, and Lucky Runze Geng Cai Copper Bottle. Traditional bronze art is combined with the spirit of the Asian Games, and the bronze heart is dedicated to the Asian Games.

Asian Games Village Licensed Goods Retail Store

　　In the licensed retail stores in the Asian Games Village, all the licensed commemorative collections created by Zhu Bingren for the "Gift Asian Games" are listed! Soul mate three consecutive seals, Lotus Zun of Asian Games, Lucky Runze Geng Cai Copper Bottle, Asian Games China Chess, Asian Rhyme Runze Series, Oriental Grand Ceremony Asian Games with Jade … … Inheriting ingenuity and stunning the world!

Main Media Center of Hangzhou Asian Games

　　The main media center of the Hangzhou Asian Games is the base camp for Chinese and foreign media reporters during the Games, where the exhibition "Golden Pine welcomes guests" extends obliquely, as if it were a hospitable host. The beautiful meaning of "welcoming guests", "accompanying guests" and "seeing them off" complements the image of the main media center of Hangzhou Asian Games in welcoming visitors from all directions and displaying the window of the host city.

Linping sports center

　　Entering the Linping Sports Center Stadium, the venues are firmly connected in series by a "Silk Road". In the venue, 10 pieces of bronze works of art, including "Zhu Bingren Copper", such as "Celebrating the Year", "Longevity and Longevity", "Splendid Harmony" and "Fulu Xianbao", presented a magnificent cultural feast of the national tide!

Tonglu equestrian center

　　Tonglu Equestrian Center, located in Tonglu County, Hangzhou, is the venue for equestrian events of Hangzhou Asian Games and one of the few professional equestrian competition venues in China. The "Zhu Bingren Imperial Horse Works Exhibition" was held here, and 26 non-legacy bronze horses were full of heroic spirit, showing the glory of the Asian Games.

Hangzhou World Tourism Expo

　　At the "Hangzhou 2023 Olympic Expo" held by Hangzhou World Tourism Museum, you can not only see the centuries-old legacy of previous Asian Games and Olympic Games, such as torches, medals, mascots, posters and images, but also appreciate Zhu Bingren’s classic works inspired by Asian Games elements ~

Zhu Bingren presented the Soul of the Sword to IOC President Bach.

　　China Jiangnan Water Town Culture Museum

　　See how the elements of the Asian Games in Hangzhou "collide" with the water culture in the south of the Yangtze River. There are 40 pieces (sets) of Zhu Bingren’s selected works, 800 square meters of art space, and the "Melting into the South of the Yangtze River" art exhibition in China. The exhibition will simultaneously carry out a number of non-legacy experience activities, waiting for you to participate ~

Zhejiang Zhu Bingren Bronze Carving Art Museum

　　The Asian Games "Collection Show", Ink "Dopamine" and Copper "Blind Box" were unpacked & HELIP; … The bronze houses in the south of the Yangtze River, located in Hefang Street, are in full swing to present the Asian Games. In the experience area of non-legacy activities, there are also non-legacy copper activities waiting for you. "Zhu Bingren Copper" and you "Copper" go to a national non-genetic inheritance "relay" outside the Asian Games schedule … …

Zhijiang New Library of Zhejiang Library

　　From the "temple of books" to the "ladder of knowledge", the bronze mural of "starry sky" is just around the corner. Hand-painted starry sky "cloud ink painting", combined with the art of melting copper and high-temperature glaze color production, builds a beautiful landscape of the "universe" of the book sea, and takes pictures by punching in.

Hangzhou east railway station arrivals and departures center VIP room

　　Hangzhou east railway station is known as the "first gateway" of Hangzhou. In the strong atmosphere of the Asian Games, four exquisite copper artworks from "Zhu Bingren Copper", such as Luwang Tianzun, Qianli Jiangshan Series and Ruihe Chengxiang Tea Tray, are displayed in the VIP room, showing the beauty of mountains and rivers and the charm of culture.

Hangzhou east railway station wanxianghui

　　Coming out of the East Station, I just went to Vientiane for a stroll. In the circular area of Wanxianghui Atrium, several innovative copper artworks of "Zhu Bingren Copper" kicked off. Near one of the largest transportation hubs in Asia — — At the Vientiane Meeting next to hangzhou east railway station, "Zhu Bingren Copper" tells the cultural story of China to the whole world.

Hangzhou city balcony

　　With the Asian Games, the city balcony has become a new landmark in online celebrity, and the light show on both sides of Qianjiang River attracts thousands of people to watch it. The presence of "Zhu Bingren Bronze" melts the intangible bronze art into the city landmark, and interprets the spirit of the Asian Games with the elements of song rhyme, which is intertwined with ancient and modern times and has a unique charm.

Beichen Hotel Hangzhou International Expo Center

　　Official reception hotels at the main venue of G20 Hangzhou Summit and Hangzhou Asian Games — — In the Beichen Hotel of Hangzhou International Expo Center, works of "Zhu Bingren Copper" can be seen everywhere, such as Yayun Runze Series, Deer King Tianzun, Bronze Pots Flourishing All the Way and Good Luck All the Way … … 18 pieces of non-legacy bronze works of art complement each other, and the sub-rhyme is wonderful ~

Grand hyatt Hangzhou

　　Grand Hyatt Hangzhou, located on the beautiful West Lake, is also one of the designated reception hotels for the 19th Hangzhou Asian Games. Bottle flowers, bonsai, tea ware … … A piece of bronze works of art is displayed here. They come from Zhu Junmin, a master of arts and crafts in Zhejiang Province and a representative inheritor of national intangible bronze carving skills in Zhejiang Province, and spread the cultural code of "Song Yun" with the wind of the Asian Games.

Sofitel Hangzhou Westlake

　　In Sofitel Hangzhou West Lake Hotel, the "Zhu Bingren Copper" Intangible Life Experience Museum is located here, surrounded by French romance with bright bronze art, and the beautiful poetry of combining Chinese and Western styles is interpreted. At first glance, the licensed commemorative collection created by Zhu Bingren for the Asian Games is displayed in the "C position", and the elements of the Asian Games "collide" with the Song Yun culture, showing the grand scene of Hangzhou culture and the beauty of Song Yun which have been passed down for thousands of years.

The original Xiaobu Medical Breathing Channel is included in the topic # Breathing Guide Interpretation of 6 Contents.

* For medical professionals only.

The latest expert consensus on clinical application of nasal high-flow oxygen therapy for emergency adults, an analysis!

Respiratory doctors should be familiar with nasal high-flow humidified oxygen therapy (HFNC). Since it was applied in mainland China in 2014, HFNC has been rapidly promoted and popularized in recent years, and its clinical effect is obvious to all.

Compared with traditional oxygen therapy (COT), noninvasive positive pressure ventilation (NPPV) and invasive positive pressure ventilation, HFNC has its unique advantages and certain limitations. In February, 2019, the Respiratory Critical Care Medicine Group of the Respiratory Branch of the Chinese Medical Association released the Expert Consensus on the Application of Clinical Norms of High-flow Humidified Oxygen Therapy for Adults (hereinafter referred to as the "Expert Consensus of 2019 Edition"), which gave everyone a comprehensive understanding of HFNC.

With the outbreak of COVID-19 epidemic, HFNC has also played an important role in the treatment of severe and critical COVID-19 patients. Therefore, the Respiratory Therapy Group of the Respiratory Branch of the Chinese Medical Association issued the Expert Consensus on the Use and Management of Nasal High-flux Oxygen Therapy for Patients in novel coronavirus [2] (hereinafter referred to as the Expert Consensus in 2020), which provided guidance for the use of HFNC in patients in COVID-19.

Of course, the clinical application of HFNC is not limited to respiratory patients, and any patient who needs aerobic treatment has potential indications for HFNC. Recently, the Emergency Medicine Branch of the Chinese Medical Association issued the Expert Consensus on Clinical Application of Nasal High-flux Oxygen Therapy for Emergency Adults [3] (hereinafter referred to as the Expert Consensus in 2021), focusing on the application of HFNC in emergency environment.

The guide is so spicy that I can’t read it. Today, the author will summarize and summarize the essence of these three guidelines, and show you what is unique about HFNC and how to use it in patients and emergency environment in COVID-19.

Let’s cut to the chase.

one

Basic concepts and principles of HFNC

In fact, nasal high-flow humidified oxygen therapy (HFNC) is well understood, which is a kind of treatment that can provide patients with high-flow inhaled gas with adjustable and relatively constant oxygen concentration, temperature and humidity through nasal congestion.

Compared with COT, HFNC highlights two advantages: high flow rate and heating and humidification. The common nasal tube has a small diameter, so it is difficult to achieve relatively constant high flow rate and oxygen concentration. However, HFNC can achieve these goals at the same time through high flow rate nasal plug and heating and humidification device.

Figure 1 AIRVO2 HFNC

On this basis, HFNC can also achieve physiological effects similar to NPPV:

Positive End-expiratory Pressure (PEEP) effect: High-velocity gas can maintain a certain level of PEEP, which is beneficial to alveolar recruitment and qi-blood exchange at end-expiratory;

Physiological dead space scouring effect: high-velocity gas can also scour the gas left in the anatomically ineffective cavity of nasal cavity, oral cavity and pharynx at the end of expiration;

Maintain the function of mucociliary clearance system: relatively constant heating and humidifying gas can obviously reduce the dryness of nose, mouth and throat of patients, which is helpful to dilute sputum and expel phlegm;

Reduce the patient’s upper airway resistance and respiratory work: high-flow gas makes the patient not need to inhale hard, which can reduce the inspiratory resistance and reduce the patient’s respiratory work.

Of course, there are still some differences between HFNC and NPPV. The two oxygen therapy methods have their own advantages and are suitable for different patients and oxygen inhalation environments.

Table 1 Differences between HFNC and NPPV

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Indications and contraindications of HFNC

As the saying goes, although something is good, it depends on whether it is useful or not. When to use it and when not to use it is a topic that everyone really cares about.

In fact, at present, there is no uniform standard for indications and contraindications of clinical application of HFNC. The indications of HFNC recommended by expert consensus in 2019 include:

Patients with mild or moderate hypoxemia (100 mmHg≤ PaO _ 2/fio _ 2 < 300 mmHg), no indication of emergency tracheal intubation and relatively stable vital signs;

Patients with mild ventilation dysfunction (pH≥7.3) can also be used cautiously, but they should be prepared to switch to NPPV or invasive positive pressure ventilation with tracheal intubation.

On this basis, the consensus of experts in the 2020 edition points out that it meets the diagnostic criteria of severe COVID-19 (respiratory distress, respiratory frequency ≥30 beats/min; At rest, oxygen saturation is ≤ 93%; Patients with PaO2/FiO2≤300mmHg) can consider using HFNC.

The 2021 edition of expert consensus did not specifically list the indications of HFNC, but recommended specific clinical scenarios:

Acute type I respiratory failure: using HFNC instead of COT to reduce the rate of tracheal intubation and the need for respiratory support upgrade; Patients who have received NPPV can try HFNC； under close monitoring if they are intolerant of NPPV.

Chronic obstructive pulmonary disease (COPD) with mild to moderate hypercapnia (pH > 7.25): HFNC can be used as one of the options for initial respiratory support; Patients who are intolerant of NPPV are advised to use HFNC；. HFNC； is not recommended for patients with pH < 7.25;

After extubation with mechanical ventilation: Patients who have been intubated for more than 24 hours and have high risk factors of respiratory failure after extubation should use HFNC instead of COT； after extubation; Patients with sequential NPPV after mechanical ventilation extubation should continue to use NPPV. If they are intolerant of NPPV, it is recommended to use HFNC；.

After surgery: High-risk and/or obese patients undergoing cardiac or thoracic surgery should use HFNC instead of COT immediately after surgery to reduce the need for re-intubation and respiratory support upgrade; Routine use of HFNC； is not recommended for patients after abdominal surgery.

Pre-oxygenation of tracheal intubation (providing oxygen to patients before tracheal intubation to maintain the stability of blood oxygen saturation during short-term asphyxia): HFNC； is not recommended for routine application during pre-oxygenation of tracheal intubation; Patients who have received HFNC before tracheal intubation can continue to use HFNC during preoxygenation and intubation.

Bronchoscopy: For patients without respiratory failure, HFNC should be used instead of COT to prevent hypoxemia during bronchoscopy; In patients with acute respiratory failure, HFNC can be used as a substitute for NPPV during bronchoscopy.

In addition, the 2021 edition of expert consensus also lists the application recommendations of HFNC in emergency special populations:

Immunosuppression: HFNC can be used as one of the initial oxygen therapy options for patients with immunosuppression complicated with acute type I respiratory failure. If patients who use NPPV are intolerant of NPPV, they can consider HFNC replacement therapy.

Heart failure: HFNC can be used as one of the initial oxygen therapy options for patients with heart failure, and patients who use NPPV can consider HFNC replacement therapy if they are intolerant;

Carbon monoxide poisoning: HFNC can be used as one of the initial oxygen therapy options for patients with mild carbon monoxide poisoning;

Palliative treatment: HFNC can be used as one of the initial oxygen therapy options for patients with palliative treatment, and patients with intolerance to NPPV can try HFNC.

Let’s talk about the contraindications of HFNC. In fact, the relevant contents of these three guides are similar. The contraindications mainly include:

Cardiac arrest;

Severe type I respiratory failure;

Moderate and severe respiratory acidosis hypercapnia (pH < 7.30);

Combined with multiple organ dysfunction.

three

Parameter setting of HFNC

After talking about indications and contraindications, let’s give you some dry goods and see how to set the parameters of HFNC. Compared with NPPV, HFNC needs to set fewer parameters, mainly including temperature, gas flow and oxygen concentration.

The setting range of temperature is generally 31~37℃, which is mainly adjusted according to the patient’s comfort and tolerance, and at the same time, a certain sputum viscosity is maintained, which makes the sputum easy to cough up.

The setting range of gas flow rate is generally 8-80L/min, and the highest oxygen concentration can reach 100%, which are mainly set according to the type of respiratory failure of patients:

Type I respiratory failure: the initial setting of gas flow rate is 30 ~ 40l/min; Titration of FIO _ 2 to maintain SpO2 _ 2 at 92%~96%, combined with dynamic adjustment of blood gas analysis, if the oxygenation target is not reached, the oxygen flow rate can be gradually increased to increase FIO _ 2 to 100% at the highest;

Type Ⅱ respiratory failure: the gas flow rate is initially set at 20~30 L/min, which is adjusted according to the patient’s tolerance and compliance. If CO2 retention is obvious, the flow rate can be set at 45~55 L/min or even higher, reaching the maximum flow rate that the patient can tolerate; Titrate FiO2 _ 2 to maintain the oxygen saturation (SpO2 _ 2) at 88%~92%, and dynamically adjust it with blood gas analysis.

To put it simply, the difference between type I respiratory failure and type II respiratory failure is that the former has no CO2 retention, and it is only necessary to adjust the oxygen concentration to achieve the oxygenation goal, while the latter has CO2 retention, so it is necessary to adjust the gas flow rate to achieve the goal of CO2 removal, and at the same time, it is necessary to adjust the oxygen concentration to maintain SpO2 in a relatively low constant range.

However, the use of HFNC does not mean that you can sit back and relax. It is necessary to closely monitor and identify patients who do not respond well to HFNC treatment as soon as possible to avoid delaying the upgrade of respiratory support and worsening the clinical prognosis. The consensus of experts in the 2021 edition points out that:

During the first 1-2 hours of HFNC, close observation should be made. If there are any failure prediction indicators (respiratory rate > 35 beats /min, SPO2≤88%, the ratio of SPO2/FiO2 to respiratory rate (ROX index) < 2.85, contradictory movements of chest and abdomen or use of auxiliary respiratory muscles, etc.), respiratory support should be upgraded in time (NPPV or invasive ventilation).

If the respiratory condition is still not improved after 48 hours of using HFNC, there are still any of the above predictors of failure, or the ROX index is gradually decreased, or the hemodynamics is unstable, it is regarded as a failure of HFNC treatment, and it is recommended to upgrade to invasive ventilation.

So when can the HFNC be removed? According to the consensus of experts in 2019, the parameters of HFNC will be gradually reduced after the primary disease is controlled. If the following criteria are met, the HFNC can be removed: inspiratory flow < ＜20L/min and fio2 < 30%.

On this basis, the 2021 edition of expert consensus recommended the specific process of evacuation of HFNC: during the evacuation of HFNC, it is suggested to reduce FiO2 first, and then reduce the gas flow rate. When the gas flow rate is reduced to 15L/min, stop using HFNC and change to COT.

Fig. 2 Flow chart of HFNC usage

The above are the essence of the three HFNC guides. If you are interested, please read the original text, which contains more exciting contents!

Tips at the end of the article: forward this article to more people in need ~

References:

[1] Group of Respiratory Critical Care Medicine, Respiratory Branch of Chinese Medical Association, Working Committee of Critical Care Medicine, Respiratory Branch of Chinese Medical Association. Expert consensus on the application of clinical norms of high-flow humidified oxygen therapy for adults [J]. Chinese Journal of Tuberculosis and Respiratory Medicine, 2019,42(2):83-91.

[2] Ni Zhong, Qin Hao, Li Jie, et al. Expert consensus on the use and management of nasal high-flow oxygen therapy for novel coronavirus patients [J]. chinese journal of respiratory and critical care medicine, 2020,19(2):110-115.

[3] Emergency Physician Branch of Chinese Medical Association, Emergency Medicine Branch of Chinese Medical Association, China Emergency Medical Association, etc. Expert consensus on clinical application of nasal high-flow oxygen therapy for emergency adults [J]. chinese journal of critical care medicine, 2021,41(9):739-749.

This article starts: medical respiratory channel

Author: Xiao Bu

Editor in charge: Dai Dai Zhang Li

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[Autohome Putian Discount Promotion Channel] Recently, preferential promotions are being carried out in Putian area, with a maximum discount of 28,000 yuan. At present, the minimum starting price of this car series is 188,600 yuan. If you are interested in eπ 008, you may wish to click "Check the car price" in the quotation form for higher discounts.

eπ008的前脸设计极具未来感，采用了极具辨识度的封闭式进气格栅，简洁而富有科技感。车身线条流畅，整体风格动感且充满力量感。在细节上，eπ008的LED大灯和日间行车灯巧妙地融入了前脸设计，使整车更具视觉冲击力。

eπ008的车身尺寸为5002mm*1972mm*1732mm，轴距为3025mm，前后轮距均为1650mm。车侧线条流畅动感，搭配21英寸的轮圈，采用265/45 R21的轮胎规格，展现出强烈的运动气息。

eπ008内饰采用现代简约的设计风格，配备了一个15.6英寸的中控屏幕，内置多媒体系统和导航功能，支持语音识别控制。方向盘采用高品质皮质包裹，可手动调节上下和前后位置。车内提供USB和Type-C接口，满足多种充电需求，前排还配备无线充电功能。座椅方面，主副驾驶位及后排座椅均采用仿皮材质，提供加热和通风功能，主驾驶位还特别配备了头枕扬声器。此外，前排座椅支持电动调节，包括前后、靠背、高低及腰部支撑，具备电动座椅记忆功能，后排座椅则支持前后、靠背和腿托调节，放倒形式为比例放倒，确保舒适性和实用性。

eπ008搭载了一台1.5T涡轮增压发动机，拥有147马力的强劲动力输出，最大功率达到108千瓦，最大扭矩为210牛·米，为车辆提供了出色的加速性能和驾驶体验。此外，与之匹配的电动车单速变速箱保证了动力传递的高效和平顺。

汽车之家车主表示，虽然他对eπ008的整体表现感到满意，但仍然注意到一些小瑕疵。新车上路不久，车内存在些许异味，车漆厚度也让他有些担忧，担心不小心就会出现划痕。此外，高速行驶时车门风噪声较大，这可能会影响驾驶体验。尽管如此，他仍然认为这些问题可以通过一些简单的方法来解决，例如使用空气清新剂和注意驾驶细节。

A few days ago, I learned that Dongfeng Yipai e π 008 will be officially listed on June 14. As the second model under the Dongfeng Yipai brand, Dongfeng Yipai e π 008 is positioned as a medium and large SUV, providing range extension and pure electric power. It has been pre-sold on April 25. The pre-sale price range is 200,000 – 250,000 yuan.

From the perspective of the product itself, the appearance design of Dongfeng Yipai eπ 008 is relatively simple. The traditional front grille area is integrated with many dot matrix light sources, and it is equipped with a luminous brand logo and a through-type headlight group. After lighting, it can present a rather cool lighting effect and enhance the technological attributes of the vehicle. On this basis, the Dongfeng Yipai eπ 008 front surrounds both sides with an integrated blackened air diversion groove design, so that the wide and full front face does not appear too calm.

Dongfeng Yipai eπ 008 has the body profile of a mainstream SUV, and the hidden door handle, low wind resistance aluminum alloy rim and other design elements that are commonly used in new energy are not absent. At the same time, the lower edge of the door is integrated into black decoration, which weakens the heaviness of the vehicle to a certain extent. In addition, the rear tail light group of Dongfeng Yipai eπ 008 is also a through style, and the light sources on the left and right sides are arranged in dotted lines, which looks normal. In terms of body size, the length, width and height of Dongfeng Yipai eπ 008 are 5002/1972/1732mm respectively, and the wheelbase is 3025mm.

Entering the car, the Dongfeng Yipai eπ 008 is equipped with an independently designed floating LCD instrument and a large-size central control screen. The steering wheel shape is basically the same as the Dongfeng Yipai eπ 007, and it is covered with a two-color material, with a correction logo at 12 o’clock. On this basis, some areas of the Dongfeng Yipai eπ 008 are covered with wood grain trims, which helps to enhance the sense of class in the cockpit.

Due to the Huai block design, the design layout of the central channel functional area of Dongfeng Yipai eπ 008 is quite regular, with the upper layer designed with horizontal double cup slots and mobile phone wireless charging panels, etc.; the lower layer is hollowed out to further enhance the storage space in the car.

Positioned as a medium and large SUV, the Dongfeng Yipai eπ 008 adopts a cockpit layout of 2 + 2 + 2 with a total of six seats. The first and second rows of seats provide heating/ventilation functions, and the third row of seats is equipped with independent cup holders, charging ports, reading lights, etc. At the same time, the Dongfeng Yipai eπ 008 third row of seats supports reclining, and the trunk volume can be expanded to 783 liters.

Other configuration parts, Dongfeng Yipai eπ 008 provides second-row right-hand small table board, 15.6-inch rear entertainment screen, 20-speaker sound system, high-speed NOA pilot assist driving, remote car transfer, LAPA over-the-horizon memory parking and other functional configurations; while the dual-purpose car refrigerator will not be absent, and the refrigerator can achieve electric sliding before and after the first row to the third row, but it is not expected to be standard in all systems.

In terms of power, the Dongfeng Yipai eπ 008 range extension version uses a 1.5-liter engine with a maximum power of 108 kW as a range extender, and is equipped with a drive motor with a maximum power of 200 kW and a 34.32 kWh group. The pure electric cruising range of the CLTC condition can reach 210 kilometers. The Dongfeng Yipai eπ 008 pure electric version also adopts the rear drive form, and the maximum power of the drive motor is 200 kW. With the support of the 82.28 kWh group, the pure electric cruising range of the CLTC condition is 636 kilometers.

Based on product positioning and pre-sale prices, Dongfeng Yipai eπ 008 Extended Range Edition is expected to compete with popular SUVs of the same level as Dongfeng Yipai Eπ 008; competitors of Dongfeng Yipai Eπ 008 pure electric version or models such as Direction, FAW-Volkswagen. Nowadays, the competition in the domestic new energy market is quite fierce, and Dongfeng Yipai branding impression and influence are still quite limited. Therefore, if Dongfeng Yipai eπ 008 wants to gain a firm foothold in the market and increase its volume quickly, the official may need to give more sincerity in the final pricing.

Projecting the phone screen onto Geely’s car can be achieved through Apple CarPlay or Baidu CarLife. Here are the specific steps:

1. Make sure your car supports Apple CarPlay or Baidu CarLife. If it does, you’ll see a dedicated USB port on the car’s center console and a cable to connect to your phone.

2. Make sure your mobile phone system is iOS 12.0 and above (for Apple CarPlay) or Android 5.0 and above (for Baidu CarLife).

3. Download and install the corresponding app. For Apple CarPlay, you need to download the Apple CarPlay app; for Baidu CarLife, you need to search for "CarLife" in the app store and download and install it.

4. Use the original data cable to connect the phone to the USB port on the center console.

5. Authorize the corresponding app on your phone to access your device.

6. Turn on the power in the car and start the engine.

7. On the mobile phone, find the installed application and click Open. Then follow the prompts on the screen to project the mobile phone screen to the central control screen of the car.

8. If you want to project your phone’s navigation, music, or other applications onto the car screen, simply select the corresponding function in the corresponding application and drag it to the car screen.

1905 movie network news The movie, directed by Qian Jiale and starring Zheng Yijian, Chen Xiaochun, Xie Tianhua, Qian Jiale, Lin Xiaofeng and others, was officially released on September 21. It won the single-day box office championship for four consecutive days in the Mid-Autumn Festival, becoming the box office of the same period. At the same time, as the only international action blockbuster in the period, the wonderful and professional action scenes of "Golden Brothers" have been recognized by the industry. Hong Jinbao, Jackie Chan, Yuan Heping and Yuan Biao personally praised it, calling it "a new journey for Hong Kong action movies".

Break 200 million! "Golden Brothers" won the box office championship for four consecutive days and became the leader of the mid-autumn film market.

Although the film market in recent years in the "coldest" Mid-Autumn Festival, but there are still 15 films in September 21 to get together for release, "Golden Brothers" box office all the way high, break out of the siege, the first day of release both won 46 million box office, more than 40% of the total box office on that day; then the Mid-Autumn Festival holiday, "Golden Brothers" won the box office championship, Zheng Yijian, Chen Xiaochun, Xie Tianhua, Qian Jiale, Lin Xiaofeng 20 years later screen reunion, for the Mid-Autumn Festival added a stronger atmosphere of reunion, the film has become the film market leader of this period.

Deflagration! The only international action blockbuster of the Mid-Autumn Festival, recommended by Jackie Hung personally, won praise for the new journey of Hong Kong action films.

The film was shot in Budapest, Japan, Taiwan, Montenegro, etc. The five brothers showed their skills and cooperated tacitly, or melee melee combat, or long-range sniping. Gunfights, drag racing, rock climbing and parkour are ubiquitous, and the people who watch it are thrilling. The wonderful action scenes of the film have not only been recognized by the audience, but also recently won praise and evaluation from heavyweights. The famous action predecessors Hong Jinbao, Yuan Heping, and Yuan Biao all praised the action scenes of "The Golden Brothers" after watching the film, and commented that director Qian Jiale "opened a new era of action movies." "The spirit of Hong Kong movies needs to be passed on by the younger generation like Qian Jiale." "The action design and the scene are wonderful, and the combination of real shots and special effects is the ultimate, which is the Hong Kong action movie New Journey ".

In addition to the collective praise of the three action bosses, Jackie Chan, the famous kung fu superstar and producer of the film, also posted on Weibo to express his satisfaction with the comments of the three old friends, and also expressed his views on the action scenes of the "Golden Brothers" movie and the director of Qian Jiale. He wrote on Weibo, "When I saw the action design and scenes in the film, I knew that Qian Jiale put his heart into it, and I was also shocked, and of course I knew how much hard work was paid behind it. With the efforts of these young generations in Hong Kong action movies, we have seen persistence and hope! Come on!"

It can be seen that being able to attract such influential action seniors’ praise, "Golden Brothers" is not only a sentimental film, but also a new banner of Hong Kong-made action films, representing the persistence and rise of Hong Kong action films. The professionalism and care of the design of thrilling action scenes in this film have been recognized in the industry, and its sincere production is comparable to international blockbusters. This is the inheritance of Hong Kong film spirit, and it also explains to some extent the reason why the film can continuously sit at the box office championship. After the National Day file, where strong players gathered, I believe this action blockbuster can also have its own place.

"Golden Brothers" is directed by Qian Jiale and produced by Zeng Zhiwei. Zheng Yijian, Chen Xiaochun, Xie Tianhua, Qian Jiale, Lin Xiaofeng, Zeng Zhiwei, Yamei, Wei Yunxi, and Cangtian Baozhao are starring. Zhang Yu starred in it, and Sheh Shiman starred in it. The film is currently being screened.