2014年 · 第94卷第27期

[Editor's note]This article is a special report delivered by Academician Chen Zhu, vice chairman of the Standing Committee of the 12th National People's Congress and president of Chinese Medical Association, at the Global Health Forum on May 13th, 2014 (with deletions). This article is detailed in content and profound in thought, comprehensively showing the world-renowned achievements of China's health cause since the founding of New China, and also pointing out the main health problems and challenges that China is facing at present; The paper comprehensively introduced the basic concepts, key areas, action plans and policy measures of the formulation and implementation of the "Healthy China 2020 Strategy", namely the "Healthy Connotation of the Chinese Dream-Healthy Country". This will make great achievements for safeguarding the health rights and interests of the broad masses of the people, protecting, maintaining and promoting national health. 2015 marks the 100th anniversary of the founding of the Chinese Medical Association and the 100th anniversary of the founding of the Chinese Medical Journal. With the consent of President Chen Zhu, this article is published in a special issue to commemorate it.

The first two authors contributed equally to this paper and are the first authors

Mechanical ventilation is one of the most important treatments to save the lives of adult patients with respiratory distress syndrome (ARDS), but lung injury associated with mechanical ventilation has been a serious clinical problem affecting the prognosis of ARDS patients. Data accumulated over the past half century suggest that mechanical ventilation, the most important treatment for ARDS, can cause or aggravate lung damage. There are two susceptibility factors to ventilator-associated lung injury (VILI) in ARDS: one is the decrease in the number of expandable alveoli upon inspiration, leading to the risk of these alveoli excessively expanding. The other is the injury caused by the periodic opening and collapse of the alveoli. The study showed that mechanical ventilation with a tidal volume of 6 ml/kg compared with a tidal volume of 12 ml/kg resulted in a 22% reduction in mortality^[1]。 According to this study, the strategy of pulmonary protective mechanical ventilation in patients with ARDS is proposed. The use of small tidal volume to prevent lung hyperventilation, and the use of positive end expiratory pressure (PEEP) to prevent periodic alveolar collapse and achieve more consistent lung expansion. This has led clinicians to have a broad understanding of VILI in patients with ARDS, recognizing that safe mechanical ventilation for ARDS should reduce VILI while providing life-sustaining gas exchange. So far, the mechanical ventilation treatment of ARDS has taken a step forward.

Carry out risk stratification to optimize the allocation of medical resources, and urgently initiate clinical evaluation and secondary prevention of TIA and mild stroke, which is beneficial to reducing the high risk of early stroke recurrence. Commonly used TIA early stroke risk stratification tool is ABCD scoring system^[6,10,18](Table 1，Table 2), wherein ABCD2^[10]The score can predict the risk of short-term stroke in TIA well and is the most widely used. Recent studies suggest that increasing the frequency of TIA episodes in addition to the ABCD2 score is associated with imaging (ABCD3 and ABCD3 – I)^[18]It can more effectively assess the early stroke risk of TIA patients. It is recommended that patients with suspected TIA should undergo early ABCD2 assessment and undergo comprehensive examination and assessment as soon as possible. The primary objective of the evaluation is to judge the etiology and possible pathogenesis of TIA^[19]。

stroke is one of the main causes of human disability and death, and acute ischemic stroke (AIS) accounts for about 80% of all strokes. The key of AIS treatment is to open occluded blood vessels and restore blood flow as soon as possible to save ischemic penumbra tissue. At present, the main treatment of early vascular opening in AIS is drug therapy (intravenous thrombolysis), but due to the strict time window limit (3~4.5 h)^[1,2]And the recanalization rate of combined aortic occlusion is low (13% ~18%), less than 3% of patients can benefit from this treatment, and the 90-day mortality and disability rates are as high as 21% and 68%^[3]The therapeutic effect is not satisfactory. In recent years, some new endovascular therapeutic devices (stent thrombectomy and thrombus aspiration devices, etc.) have been used in clinical practice successively, which significantly improved the opening rate of occluded blood vessels. Endovascular therapy (arterial thrombolysis, endovascular thrombectomy, angioplasty stent) has shown a good application prospect^[4,5]However, there is still a lack of positive clinical randomized controlled study support in terms of target population and time window selection, best treatment process, long-term benefits, etc. For a long time, AIS endovascular treatment may still be used as a contraindication for intravenous thrombolysis or intravenous thrombolysis A complementary or salvage treatment for patients with aortic occlusion who are ineffective. The interventional group of the Stroke Prevention and Control Committee of Chinese Association of Preventive Medicine summarized the results and preliminary evidence of existing international clinical trials for endovascular treatment of acute ischemic stroke, and formed this consensus based on the opinions of domestic experts in this field, aiming to provide clinical reference standards and management strategies for endovascular treatment of AIS. We expect further clinical trial results to provide theoretical basis for the problems that cannot be recommended at present.

A 5-year-old male was found to have a cardiac murmur for 5 years. Physical examination: blood pressure of right upper limb 95/50 mmHg (1 mmHg =0.133 kPa), left upper limb undetectable, both lower limbs 85/45 mmHg, developmental deviation, no cyanosis in the whole body, symmetrical development of both upper limbs, 2~4 intercostal systolic murmur on the left margin of sternum. After admission, cardiac ultrasound showed double right ventricular outlet, ventricular septal defect, right ventricular outflow tract stenosis, right aortic arch, and patent ductus arteriosus. Thoracic CTA showed that the left subclavian artery was not connected to the aortic arch but connected to the left pulmonary artery through an abnormal blood vessel, the left common carotid artery originated from the ascending aorta, and the left superior vena cava persisted (Figure 1)。 Right femoral vein puncture showed that the catheter could enter the pulmonary artery, aorta and left ventricle through the right ventricle. Right ventriculography showed stenosis of right ventricular outflow tract, and pulmonary artery and aorta were developed. Entering the ascending aorta angiography, the ascending aorta emits the left common carotid artery, and the right aortic arch emits the right common carotid artery and the right subclavian artery in turn. Delayed development of left subclavian artery, blood flow direction from left vertebral artery to left subclavian artery to pulmonary artery, left subclavian artery not connected to aorta (Figure 2)。 Comprehensive analysis showed that the isolated left subclavian artery connected to the pulmonary artery naturally formed a Blalock-Taussig shunt mechanism, so the child did not develop cyanosis. The operation was performed under general anesthesia and cardiopulmonary bypass. The intraoperative exploration was in line with the preoperative judgment, and the intracardiac defect was radically cured, and the postoperative recovery was smooth.

Acute respiratory distress syndrome (ARDS) is the most common type of acute respiratory failure, and mechanical ventilation is its main supportive treatment. Despite the continuous improvement of mechanical ventilation techniques and strategies, the mortality rate of ARDS remains high, and ventilator-associated lung injury (VILI) is closely related to this. Pulmonary stress and strain can directly reflect the mechanical changes of lung tissue. Excessive stress and strain are the essence of VILI in ARDS patients. Therefore, pulmonary stress and strain have attracted more and more attention in mechanical ventilation treatment of ARDS. Based on the concepts of pulmonary stress and strain, the relationship with VILI, and the application in the treatment of ARDS, this paper reviews.

The American Society of Reproductive Medicine (ASRM) defines recurrent miscarriage (RSA) as 2 or more consecutive spontaneous miscarriages with the same sexual partner^[1]。 At present, the incidence of RSA is about 2% ~4%, among which 65% ~70% of patients with recurrent abortion have abnormal immune factors^[2]。 This article summarizes its pathogenesis and treatment progress as follows.