Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the c...Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS. Methods The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade. Results It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure (PEEP) should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve . Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended . The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS. Conclusion Evidence-based 展开更多
背景与目的 癌症是中国人群的主要致死原因之一,也是中国的主要经济负担。研究中国与发达国家在癌症模式和控制策略上的差异,可为政策规划提供参考,有助于改善癌症防控措施。本研究回顾了中国癌症发病率、死亡率和伤残调整生命年(disabi...背景与目的 癌症是中国人群的主要致死原因之一,也是中国的主要经济负担。研究中国与发达国家在癌症模式和控制策略上的差异,可为政策规划提供参考,有助于改善癌症防控措施。本研究回顾了中国癌症发病率、死亡率和伤残调整生命年(disability-adjusted life year,DALY)负担的比率及趋势,并与美国(United States,US)和英国(United Kingdom,UK)进行了比较。方法 本研究从GLOBOCAN 2020在线数据库、2019年全球疾病负担(global burden of disease,GBD)研究和五大洲癌症发病率plus数据库(Cancer Incidence in Five Continents plus database,CI5 plus)中获取中国、美国和英国的癌症发病率、死亡率和DALY数据。使用Joinpoint回归模型分析中国、美国和英国癌症发病率和死亡率的趋势,计算年度百分比变化(annual percent change,APC),并确定最佳拟合连接点。结果 2020年估算的中国新发癌症病例为4,568,754例,癌症死亡病例为3,002,899例。此外,在中国,癌症引起的DALY为67,340,309。与美国和英国相比,中国的癌症发病率更低,但癌症死亡率和DALY率更高。此外,中国的癌症谱正在发生变化,除了肝癌、胃癌、食管癌和宫颈癌的发病率高和负担沉重外,肺癌、乳腺癌、结直肠癌和前列腺癌的发病率和负担正在迅速增长。结论 中国的癌症谱正在从发展中国家向发达国家转变。人口老龄化和不健康生活方式将继续增加中国的癌症负担。因此,中国应参考发达国家已建立的癌症防控策略,并结合中国不同地区癌症类型的多样性,调整国家癌症控制政策。展开更多
文摘Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS. Methods The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade. Results It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure (PEEP) should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve . Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended . The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS. Conclusion Evidence-based
文摘背景与目的 癌症是中国人群的主要致死原因之一,也是中国的主要经济负担。研究中国与发达国家在癌症模式和控制策略上的差异,可为政策规划提供参考,有助于改善癌症防控措施。本研究回顾了中国癌症发病率、死亡率和伤残调整生命年(disability-adjusted life year,DALY)负担的比率及趋势,并与美国(United States,US)和英国(United Kingdom,UK)进行了比较。方法 本研究从GLOBOCAN 2020在线数据库、2019年全球疾病负担(global burden of disease,GBD)研究和五大洲癌症发病率plus数据库(Cancer Incidence in Five Continents plus database,CI5 plus)中获取中国、美国和英国的癌症发病率、死亡率和DALY数据。使用Joinpoint回归模型分析中国、美国和英国癌症发病率和死亡率的趋势,计算年度百分比变化(annual percent change,APC),并确定最佳拟合连接点。结果 2020年估算的中国新发癌症病例为4,568,754例,癌症死亡病例为3,002,899例。此外,在中国,癌症引起的DALY为67,340,309。与美国和英国相比,中国的癌症发病率更低,但癌症死亡率和DALY率更高。此外,中国的癌症谱正在发生变化,除了肝癌、胃癌、食管癌和宫颈癌的发病率高和负担沉重外,肺癌、乳腺癌、结直肠癌和前列腺癌的发病率和负担正在迅速增长。结论 中国的癌症谱正在从发展中国家向发达国家转变。人口老龄化和不健康生活方式将继续增加中国的癌症负担。因此,中国应参考发达国家已建立的癌症防控策略,并结合中国不同地区癌症类型的多样性,调整国家癌症控制政策。
