On April 16th, BYD’s personalized brand Equation Leopard officially released a brand-new trendy SUV, with an official guide price of 133,800 yuan. Five versions of the model were launched, and the financial discount policy of up to 5,500 yuan and five major car purchase rights were launched simultaneously.

Titanium 3 is positioned as a "high-tech SUV". Inspired by "Star Wars Aesthetics", it innovatively creates a "one machine, three cabins" trend configuration, equipped with an "E+2C" intelligent three-piece suit and an "iCT" safety three-piece suit, achieving all-round leapfrog in terms of technology, space and configuration, and is committed to making "the whole people share high-tech products".

Three leapfrog experiences to create a new benchmark for "high-tech products" SUV

Titanium 3 opens a differentiated experience with "one machine and three cabins". The "One Machine" refers to the Lingyuan vehicle-mounted UAV system built by BYD and DJI, which supports accompanying shooting and one-click filming to create a new interesting and practical intelligent entertainment experience.

The "3 Cabin" includes a 151L front cabin, an intelligent ecological cockpit and a convenient rear cabin: the central control is equipped with a 15.6-inch large screen and a Divare stereo, and the seat supports one-button tilting and exclusive air mattress to create a mobile "big bed room"; 28L’s rear "small schoolbag" design is both fashionable and practical, meeting the needs of multiple storage.

The "iCT" safety three-piece set escorts travel, including iTAC intelligent torque control system, CTB vehicle safety architecture and TSC high-speed tire puncture stability control system, which comprehensively improves the active and passive safety performance of vehicles.

The intelligent three-piece set is online, and the performance and control are all advanced.

In terms of intelligent driving and control experience, Titanium 3 is equally sincere. Its intelligent EVO+ platform is equipped with iATS system which can automatically identify various road conditions. At the same time, it only takes 18 minutes to support 30-80% fast charging at room temperature, and the charging time at low temperature is shortened by 40%.

The vehicle adopts a million-class McPherson+five-link independent suspension with the same front double-ball joint and the same rear, with a high-performance motor of 20,000 rpm, achieving an acceleration of 4.9 seconds per 100 kilometers. In terms of intelligent driving, Titanium 3 is equipped with "Eye of God" high-order intelligent driving assistance system and Yunqi -C intelligent damping body control system to further enhance the handling fluency and ride comfort.

The five rights and interests are full of sincerity, and buying a car in 0 yuan is not a dream.

Titanium 3 will be delivered as soon as it is listed, providing multiple financial solutions: 0 down payment (up to 5 years’ long loan), 0 interest (50% down payment, 24 interest-free installments) and 0 monthly payment (50% down payment and 50% final payment, up to 1 year’s monthly payment). In addition, car buyers can also enjoy 6,000 yuan replacement subsidy, free 7kW charging pile and basic installation service, 2-year 5G car traffic and OTA upgrade, 6-year/150,000-kilometer vehicle warranty and three-power system lifetime warranty.

Tide reform plan goes online, creating exclusive personalized titanium 3

Titanium 3 also launched the world’s first front face modular dressing system, breaking the traditional design formula and realizing "a variety of titanium". The "Titanium 3 Face Change Plan" and 12 joint schemes of tide reform are launched simultaneously, and users can make one-click appointments and change clothes in stores through the official mall. On April 23, Equation Leopard will also launch the "Titanium 3 Tide Reform Co-creation Competition", set up a dual track for the whole people and professionals, invest millions of bonuses, and invite users to create a feast of personalized tide reform.

Everyone can enjoy the latest technology products. BYD Equation Leopard Titanium 3Strengthen the market layout of compact SUVNow it has been fully listed, and users can make a snap purchase through Equation Leopard Auto APP, WeChat applet or national stores to start a new life.

Also as a BYD SUV model, on April 16th, Tengshi N9 passed the certification of China Automobile Research Institute, an authoritative organization, and once again set a new global fishhook test record at a speed of 180 km/h.. Tengshi N9 has also become the first model in China to obtain the hook test certification from an authoritative organization. The fishhook test, also known as the "dead corner", is the test to maximize the simulation of high-speed obstacle avoidance emergency steering, and it is also the most stringent verification standard for vehicle handling stability and rollover prevention, which can test the emergency steering stability and show the extreme safety performance of Tengshi N9.

Science and Technology Daily reporter Zhang Wei correspondent Wu Qi

On April 20th, on the occasion of the 56th World Earth Day, a construction site in Wuxi City, Jiangsu Province opened its doors to popularize the technological achievements of low-carbon construction for the citizens.

"This is the pier of the bridge, just like the’ leg’ of the bridge. Under our feet is an integrated ladder cage and an outer frame platform used for pier construction. Different from other construction sites, these facade platforms are composed of modularity, just like building blocks, which can be assembled by themselves according to production needs, which reduces the steel loss by 25% compared with traditional scaffolding, which is both environmentally friendly and efficient. " The technician of Zhenghe Avenue Project of China Railway Eighth Bureau, the construction party, said.

"In the past, we were faced with all units in the industry. This time, opening the door to the general public is not only a test of the project construction level, but also enhances the communication between enterprises and society." At the activity site, Yang Zhiqiang was introducing the energy-saving and emission-reduction technologies, green construction techniques and the results of resource recycling applied in the project construction to the surrounding residents who came to visit.

Walking into the construction site, there was no smoke and dust generated by mechanical exhaust, and rows of piers rose from the ground to take shape. The standardized and intelligent construction scene made the visiting residents stop to take pictures. Yang Zhiqiang said: "This is an automatic dust monitoring system, which can be intelligently linked with the enclosure spray device. When the values of PM2.5 and PM10 on site exceed the standard, the system will automatically trigger the spray to let the dust’ fall to the ground’, thus realizing dynamic control." Not only do environmental protection in the enclosure be well implemented, but the project department also upgraded the automatic car washing device at the entrance and exit of the construction site. The sewage after precipitation and filtration can be used for secondary washing of vehicles and sprinkling water on roads to suppress dust. Through recycling, the construction water can be saved by 2000 tons on site every year.

From the construction point of view, it is not an easy task to achieve low carbon. Since entering the site, the Zhenghe Avenue project team of China Railway Eighth Bureau has insisted on integrating the concept of "zero carbon" into the construction details, and introduced a number of environmental protection measures in view of the high energy consumption and high pollution points in traditional construction. Through the linkage of mechanization+intelligence+greening, the project construction has started at full speed.

According to Jiang Yong, the person in charge of the project, the idea of reducing carbon in the project department starts from "replacement" and "reduction". For example, after the construction wastes are classified, hard wastes such as concrete blocks and masonry are broken into construction access roads, steel scraps are recycled into safety guardrails, and wood scraps are processed into temporary facility templates, with a comprehensive utilization rate of over 60%; The temporary facilities on the site are all made of reusable materials, and 70% of the components can be reused after the project. In addition, the introduction of solar outdoor lighting in the living quarters of the construction site can save about 12,000 kWh of electricity every year.

"It’s really not the same as the imagined construction site. I used to worry that the production of construction sites nearby would affect my life. Today, I see that there are so many scientific and environmental protection measures to ensure it, and my heart is much more practical!" Ms. Zhang, a surrounding resident who participated in the event, said with emotion. As a key project in Huishan District, Wuxi City, the construction of the bridge substructure of the project is currently in full swing. Talking about the follow-up construction plan, Jiang Yong said that in the future, the project department will actively apply AI technology to help in resource allocation and further realize the carbon reduction goal of the project construction.

(Photo courtesy of the interviewee)

▍ Source: Announcement of Pharmaceutical Companies

▍ Finishing: Cypress Blue-Corn

▍ Industry concentration has been further improved.

In 2019, there were frequent mergers and acquisitions between pharmaceutical companies. Observing these cases, we can find that some of them spun off their subsidiaries and some strengthened their own strengths through acquisitions. In addition, the sale of non-core assets by foreign pharmaceutical companies and the takeover by domestic pharmaceutical companies have also caused industry analysis.

In these cases, some of them have been completed and some are still in progress. Through the inventory of one-year acquisition cases, it seems that the industry is progressing in the direction of increasing concentration.

With the deepening of medical reform, the implementation of policies such as consistency evaluation, quantity procurement and DRG, and the improvement of industry access threshold, SMEs will be acquired more frequently by large enterprises.

Of course, this is just like the plan of "supporting the merger and reorganization of pharmaceutical production enterprises, cultivating a number of large enterprise groups with international competitiveness, and improving the concentration of pharmaceutical industry" in the "Several Opinions on Further Reforming and Improving the Policy of Drug Production, Circulation and Use" issued by the State Council in early 2017.

Suzhou Novartis completed the sale.

On December 21st, Zhejiang Jiuzhou Pharmaceutical Co., Ltd. issued the Announcement on Completion of 100% Equity Delivery of Suzhou Novartis Pharmaceutical Technology Co., Ltd., and formally merged Suzhou Novartis into its subsidiary.

Jiuzhou Pharmaceutical announced on November 30 that the board of directors passed the Proposal on Foreign Investment to Buy 100% Equity of Suzhou Novartis Pharmaceutical Technology Co., Ltd., and estimated to buy 100% equity of Suzhou Novartis held by Novartis Investment with self-raised funds of about 790 million yuan.

According to the data, Suzhou Novartis acquired by Jiuzhou Pharmaceutical Co., Ltd. mainly consists of factory buildings, production lines, process equipment, etc. after divesting the technology and drug development assets held by Novartis.

Fosun Pharma sells assets for 3.6 billion yuan

On December 19th, Shanghai Fosun Pharma (Group) Co., Ltd. issued the Announcement on the Progress of Selling Assets and Foreign Investment, intending to transfer all the limited partnership interests of Healthy Harmony Holdings, L.P. (whose main assets are "United Family" hospitals and clinics) and the management partner of Healthy Harmony Holdings, L.P.. The consideration for this transfer is about US$ 523.15 million (equivalent to about RMB 3.6 billion).

Tasly sells Tasly Medicine Marketing Group.

On December 17th, Tasly announced that it had signed the Framework Agreement with Chongqing Pharmaceutical, and made an agreement on selling the equity of its holding subsidiary Tianjin Tasly Pharmaceutical Marketing Group.

According to the Framework Agreement, Chongqing Pharmaceutical intends to acquire 87.47% of the shares directly and indirectly held by the company and the shares held by other shareholders of Tianshi Marketing by paying cash consideration.

Nanjing pharmaceutical holding enhua herun

On December 13th, Nanjing Pharmaceutical Co., Ltd. issued the Announcement on Completion of Change Registration Procedures for Acquisition of Equity, indicating that the acquisition of Jiangsu Enhua Herun Pharmaceutical Co., Ltd. for 72.24 million yuan has completed the change registration procedures for shareholders and legal representatives. So far, Nanjing Pharmaceutical directly holds 70% equity of Enhua Herun.

China Resources Sanjiu acquires Aonuo Pharmaceutical.

On November 27th, China Resources Sanjiu Pharmaceutical Co., Ltd. issued the Announcement on Acquisition of 100% Equity of Aonuo (China) Pharmaceutical Co., Ltd., and planned to acquire 100% equity of Aonuo (China) Pharmaceutical Co., Ltd. held by Yuheng Pharmaceutical for 1.42 billion yuan.

According to the announcement, the core products of Aonuo Pharmaceutical are calcium zinc gluconate oral solution, vitamin C chewable tablets and Shenzhi Dendrobium granules, and its "Aonuo" and "Jinxin Jinjiute" are well-known brands for children to supplement calcium. China Resources Sanjiu said that the acquisition can improve the category layout of self-diagnosis and treatment (CHC), which can be organically combined with the advantages of China Resources Sanjiu in consumer insight, brand operation and terminal coverage.

Pfizer merged with Mylan.

On November 12th, Mylan and Pfizer officially announced the name of the new company-Via Tris, which was formed by the merger of Mylan and Pfizer’s subsidiary Pfizer Puqiang.

The 2018 financial report shows that Pfizer’s global revenue is $12.5 billion, and the China market contributes $2.4 billion. Mylan is a multinational giant, with a global revenue of 11.434 billion US dollars in 2018, and has not yet started business in China.

Da Shen Lin bought 123 chain pharmacies.

On November 7, Dashenlin Pharmaceutical Group Co., Ltd. issued the Announcement on Acquisition of 51% Equity of Nantong Jianghai Pharmacy Chain Co., Ltd., and plans to acquire 51% equity of Nantong Jianghai Pharmacy Chain Co., Ltd., with the target company including 123 chain pharmacies and the acquisition amount of 120 million yuan.

GSK sells Suzhou factory and Hepudin.

On July 8, Fosun Pharma announced that its holding subsidiary, Chongqing Yaoyou Pharmaceutical Co., Ltd., intends to acquire 100% equity of GlaxoSmithKline Pharmaceutical (Suzhou) Co., Ltd. for no more than RMB 250 million. If the transfer is completed, it will hold the drug registration approval of lamivudine tablets (specification: 0.1g) for the treatment of chronic hepatitis B and the production license and GMP certificate of its production facilities.

On July 9th, GSK China confirmed to Cyberland that both parties expected the transaction to be completed by the end of November.

Sinopharm Holdings acquired Anhui Pharmaceutical Group

On May 8, the official public platform of Sinopharm Holding Anhui Co., Ltd. released a message: Sinopharm Holdings officially signed a contract to acquire Anhui Pharmaceutical Group. According to public information, Anhui Pharmaceutical Group is a large-scale commercial circulation enterprise approved by the Anhui provincial government in December 2002.

China Resources Medicine Acquires Jiangzhong

On April 17, Jiangzhong Pharmaceutical Co., Ltd. announced that the company recently received a notice from the controlling shareholder of the company. With the approval of Jiangxi Provincial Market Supervision Administration, the controlling shareholder completed the industrial and commercial change registration of the enterprise name and business scope on April 8, 2019.

After the change, Jiangxi Jiangzhong Pharmaceutical (Group) Co., Ltd. was changed to China Resources Jiangzhong Pharmaceutical Group Co., Ltd. Jiangzhong Pharmaceutical said in its 2018 annual report that the brand value of "Jiangzhong" was 20.715 billion yuan, ranking 231st among the top 500 Chinese brands and 6th in the pharmaceutical industry. For China Resources Medicine, the acquisition of Jiangzhong Group won brands such as "Jiangzhong" and "Chuyuan".

Bristol-Myers Squibb acquires Xinji.

On January 3rd, Bristol-Myers Squibb announced a $74 billion acquisition of Xinji. According to the agreement between the two parties, Bristol-Myers Squibb will acquire Xinji Company in the form of $74 billion in cash and stock transactions to build a first-class biopharmaceutical giant that can compete with the world’s largest pharmaceutical manufacturer.

In fact, the merger and acquisition of pharmaceutical companies in 2019 is far more than that. By combing the actions of well-known enterprises, the purpose is to find the trend of industry changes under these mergers and acquisitions. In addition, in the announcements of many listed pharmaceutical companies selling assets this year, many properties were thrown out. Some analysts believe that pharmaceutical companies sell houses to survive, but a more rational view should be due to the limited value-added space of real estate.

CCTV News:In the past ten years, China’s total trade in goods has been continuously improved, ranking first in the world for five consecutive years since 2017, and the total trade in goods and services has also jumped to the top in the world in 2020. While the high-quality development of trade has made historic achievements, the continuous improvement of China’s foreign trade has also played an important role in the development of the national economy and the recovery of the world economy.

At 3 o’clock in the morning, the stall of fruit distributor Zheng Yuqiang became lively. This evening, a new batch of imported jackfruit was welcomed.

Zheng Yuqiang, Beijing fruit distributor:We seldom sold jackfruit a few years ago. Now, if it is normal, it is no problem to sell (sell) more than ten tons a day.

In Beijing’s largest wholesale market for agricultural products — — In Xinfadi market, mid-October is not the peak season for fruit sales, and several imported fruits promoted by Zheng Yuqiang have increased his business.

Beijing fruit buyer Zheng Zhen:I bought some jackfruit and red pitaya today. I come here almost every day and sell everything. There are about 30 to 40 kinds of imported fruits.

In the wholesale market in Beijing, the varieties of imported fruits sold are increasing year by year. Xiao Yang, who just entered the business last year, opened a shop specializing in selling Malaysian Maoshanwang durian. He told reporters that this expensive imported fruit has been selling better and better since it entered the China market in 2019.

Xiao Yang, a distributor of imported fruits in Beijing:Sales are gradually increasing. At the beginning, the people still didn’t approve of it because the price was relatively high. Up to this year, the people’s recognition level is still relatively high, especially people like Beijing who buy more.

In the past ten years, more and more imported fruits such as Philippine avocado, Cambodian banana, Lao citrus and South African pear have entered the mouth of China people. In 2021, China imported more than 7 million tons of fruit, compared with less than 3.45 million tons in 2012, and the import volume doubled in ten years.

Zhang Xiao, Director of the Inspection and Quarantine Department of Animals and Plants and Food of Nanning Customs:At present, the imported fruit varieties from ASEAN have increased from 53 varieties in six countries ten years ago to 77 varieties in the whole ASEAN countries.

Not only high-quality consumer goods such as fruit, but also the import scale of advanced technology and equipment, key parts and other products has been expanding over the past decade, which has better met the needs of domestic production and people’s lives, and also allowed the world to share more dividends brought by China’s economic growth. In 2021, China’s total import value reached 17.37 trillion yuan, an increase of 51.2% compared with 2012.

Professor Cui Fan, School of International Business and Economics, University of International Business and Economics:The country’s opening up, especially (import), includes high-quality products that are beneficial to people’s living standards and meet people’s needs, so that our trading partners can share the fruits of China’s economic development.

In the past ten years, China has taken the initiative to reduce commodity tariffs, and the total tariff level has dropped from 9.8% in 2012 to 7.4% in 2021. New trade formats and new kinetic energy are constantly being stimulated, and the import and export scale of cross-border e-commerce has increased nearly tenfold in the past five years.

High-level import and export will further optimize the trade structure. In a factory in Qingdao, Shandong Province, 10 sets of high-speed EMUs for Jakarta-Bandung High-speed Railway have been manufactured and are waiting for delivery. Last month, the first batch of Jakarta-Bandung High-speed Railway high-speed EMUs and comprehensive inspection trains exported to Indonesia arrived in Jakarta Port smoothly, which was the first time that China’s high-speed trains were exported abroad.

Zhang Fangtao, Chief Designer of Jakarta-Bandung High-speed Railway High-speed EMU:The Jakarta-Bandung High-speed Railway high-speed EMU will be sent to Indonesia in November, and Jakarta-Bandung High-speed Railway will be put into operation in 2023 according to the plan. By then, the travel time from Jakarta to Bandung will be shortened from the current three hours to about 40 minutes.

Going out with high-end equipment, there are our supporting services. In the past ten years, the leading export industries have been transformed and upgraded from traditional labor-intensive products to high-tech industries, and the knowledge-intensive service trade has maintained rapid growth.

Ma Qiang, Deputy General Manager of overseas business department of CRRC Sifang Co., Ltd.:We provide maintenance technical support for Argentine national railway company. Up to now, the company’s products and services have been exported to 29 countries and regions around the world.

From 24.4 trillion yuan in 2012 to 39.1 trillion yuan in 2021, in the past ten years, China’s total trade in goods has continued to increase, and its international market share has also increased from 10.4% in 2012 to 13.5% last year, and its position as the largest country in global trade in goods has been further consolidated. Nowadays, there are more and more high-level platforms for opening to the outside world, such as China China International Import Expo(CIIE), Service Trade Fair and Consumer Expo. China has set up 21 free trade zones and one free trade port, with free trade partners spread across five continents. In the past ten years, China’s average contribution rate to world economic growth reached 38.6%, ranking first in the world.

You may think that you are in good health and there will be no major problems, but you know what? Some people suddenly fell down and never woke up because of temporary excitement or fatigue. This is sudden death, an unpredictable fatal event.

There seems to be nothing wrong. Why did you die suddenly?

Is there any rule of sudden death? Is there any warning? Can we avoid it? To answer these questions, let’s take a look at a recent study.

This study was published in the journal chinese journal of critical care medicine in April, 2020, entitled "Analysis of Epidemiological Characteristics of 5,516 Cases of Autopsy Sudden Death in China". The researchers dissected the bodies of 5516 cases of sudden death and found the following important findings:

1. Emotional excitement and fatigue are the most common causes.

The study found that among the causes of sudden death, emotional excitement accounted for 26%, fatigue accounted for 25%, and blood volume change accounted for 8.95%. Other inducements include drinking, satiety and minor injuries.

2. Heart problem is the main reason.

It was found that among the causes of sudden death, cardiogenic sudden death accounted for 57.76%, pulmonary sudden death accounted for 21.63%, and brain-derived sudden death accounted for 9.21%. Sudden cardiac death is mainly caused by coronary heart disease, myocardial infarction and arrhythmia.

3. There are often some uncomfortable signals before sudden death.

It is found that people with symptoms and signs in sudden death are most often manifested as sudden attack (20.10%), rest and sleep (16.71%), followed by vomiting (7.49%), dyspnea, chest tightness and sweating, dizziness, chest pain, abdominal pain, convulsion, headache, palpitation, cough and disturbance of consciousness.

People with chronic diseases are more prone to sudden death.

It was found that hypertension (37.95%), heart disease (30.02%) and diabetes (23.79%) were the most common among those with past history. Followed by dysplasia, hyperlipidemia, tumor, infection, hyperthyroidism and so on.

5.30 ~ 63 years old is the high incidence age of sudden cardiac death.

People in this age group are at an important stage of their career and family, with high work pressure, fast pace of life, irregular diet, and addiction to cigarettes and good wine, which may easily lead to "three highs" and coronary heart disease.

How to avoid sudden death? Please do the following three points.

From these laws, we can get some enlightenment:

Middle-aged people should pay attention to controlling their emotions!

Do you often get angry and quarrel with others because of some small things? Are you sometimes so excited that you get carried away and even laugh until you cry? You may think these are normal emotional expressions, but you know what? These mood swings may bring fatal danger to your heart!

A media person once witnessed such a tragedy. Her father-in-law was taken to the hospital because of a sudden acute myocardial infarction, and survived after the rescue. However, she found that in her father-in-law’s ward, the other six patients have one thing in common: they are all quick-tempered and short-tempered, and they are emotional, angry and angry when things happen.

She learned a lesson from it: these people are all out of control because of their emotions, which leads to heart problems!

Why is emotional excitement harmful to the heart?

It turns out that when we are angry or excited, the body will secrete a lot of hormones such as adrenaline and cortisol, which will double the blood flow of the heart, strengthen the contractility of the heart and accelerate the heartbeat. At the same time, blood vessels will contract, blood pressure will increase and blood viscosity will increase. In this way, the heart will bear a greater burden, prone to arrhythmia, myocardial ischemia, chest tightness, palpitation and other symptoms. If the duration is too long or the frequency is too high, it may induce serious cardiovascular events such as angina pectoris or myocardial infarction.

Therefore, middle-aged people should learn to adjust their emotions and maintain peace. Don’t vent or suppress things that don’t go your way, but find a suitable way to release the pressure. For example, you can chat with friends, listen to music, do sports and read books. This can not only relax the body and mind, but also enhance the physical fitness, which is beneficial to the heart.

Middle-aged people should rest moderately and avoid overwork!

Are you often so busy with work and family that you even ignore your physical discomfort? You may think it’s your responsibility and responsibility, but you know what? This lifestyle may make your heart stop beating at any time!

Research shows that many sudden deaths have experienced high pressure, long-term and high-intensity working conditions. This kind of work will make your sympathetic nerves overexcited, leading to heart overload, arrhythmia and myocardial ischemia. If the duration is too long or the frequency is too high, it may lead to fatal cardiovascular events such as arrhythmia or myocardial infarction. Some people die suddenly because of working overtime overnight, mood swings and nervous stress, which leads to neurological dysfunction, coronary artery spasm and sudden stop of blood supply to the heart.

Therefore, middle-aged people should arrange their work and rest reasonably, don’t be overworked, and don’t stay up late to hurt themselves. It is necessary to do some aerobic exercise properly to relax and enhance physical fitness. It is necessary to have a regular physical examination to find and treat chronic diseases in time. Keep good living habits and stay away from alcohol, tobacco and greasy food. Only in this way can you protect your heart from the threat of sudden death.

Middle-aged people should pay attention to body signals and seek medical treatment in time!

You may not know that before sudden death, your body actually gave you many warnings. If you can find and deal with it in time, it is possible to avoid the tragedy.

So, what are the signals before sudden death? According to research, the most common symptom before sudden death is chest discomfort, which mainly has the following three manifestations:

Angina pectoris. This is a feeling of pain or oppression in the chest or precordial area, which usually lasts less than 15 minutes and is often accompanied by dysphagia or chest tightness. This is caused by heart ischemia and hypoxia.

Flustered. This is a feeling of rapid or irregular heartbeat, which usually lasts less than 10 minutes and is often accompanied by discomfort such as chest tightness, fatigue and dizziness. This is due to cardiac electrophysiological dysfunction.

Low blood pressure. This is a state in which blood pressure drops below the normal value, which generally lasts less than 5 minutes, and is often accompanied by symptoms such as cold sweat and dyspnea. This is because the pumping function of the heart is weakened.

These signals mostly occur after physical activity, emotional excitement or satiety. If they can be relieved after rest, it means a mild heart problem. However, if it still doesn’t improve after rest, or there are frequent or persistent signals, it means that it is a serious heart problem and needs immediate medical attention.

In addition to these signals, there are some less obvious signals, such as left arm pain, sore throat or toothache. These signals may be nerve reflexes caused by heart problems, which also need attention.

In short, middle-aged people should pay special attention to their physical changes. If there is any chest discomfort, dull pain or fatigue, they should go to the hospital for examination in time and don’t take it lightly. Only early detection and treatment of heart problems can effectively prevent and reduce the risk of sudden death.

Paper materials: Analysis of Epidemiological Characteristics of 5516 Cases of Autopsy Sudden Death in China, chinese journal of critical care medicine Journal in April 2020.

Original title: "Doctors dissected more than 5,000 cases of sudden death and found that people who died suddenly had these rules! 》

Read the original text

Beijing Medical Insurance No.41 [2022].

The medical insurance bureaus of all districts, the Social Affairs Bureau of Beijing Economic and Technological Development Zone, and the designated medical institutions:

　　In order to continuously improve people’s sense of gain, happiness and security in medical treatment settlement in different places, according to the spirit of the Notice of the National Medical Insurance Bureau and the Ministry of Finance on Further Improving the Direct Settlement of Medical Treatment in Different Provinces of Basic Medical Insurance (No.22 [2022] of Medical Insurance), this Municipality further improves the direct settlement of medical treatment in different provinces of basic medical insurance (hereinafter referred to as direct settlement) and regulates the management of direct settlement services. The relevant matters are hereby notified as follows:

　　First, improve the direct settlement policy

　　(a) unified hospitalization, general outpatient and outpatient chronic diseases direct settlement fund payment policy. The medical expenses for inpatient, general outpatient and outpatient chronic and special diseases directly settled by the insured shall, in principle, implement the payment scope and relevant regulations (payment scope of basic medical insurance drugs, medical service items and medical consumables) stipulated by the insured place, and implement the relevant policies such as the basic medical insurance fund Qifubiaozhun, payment ratio, maximum payment limit and outpatient chronic and special diseases.

　　(two) to clarify the scope of medical records in different provinces. Insured persons in this city can apply for inter-provincial medical record when they need medical treatment in different places. After the record, the insured persons can enjoy direct settlement service in the inter-provincial networked designated medical institutions where medical treatment is filed.

　　(3) Standardizing the validity period of inter-provincial medical records in different places. Insured persons in this Municipality may, when filing medical treatment in different places across provinces, choose their own effective period of filing according to actual needs, and the effective date and deadline of filing shall be subject to the date of system registration. When the insured person’s place of filing for medical treatment or unit, insurance type and other insured relationships change, it is necessary to go through the filing procedures again, and the original filing validity period will automatically expire after re-filing.

　　(4) It is allowed to re-submit medical records in different provinces and places, and the injured insured without third-party liability can enjoy direct settlement services. Before the settlement of the insured’s inter-provincial medical treatment in different places, the inter-provincial networked designated medical institutions shall provide direct settlement services for the insured. If the insured person who goes to different provinces for medical treatment goes through the filing formalities according to the regulations after being discharged from hospital at his own expense, he can apply for manual reimbursement of medical insurance according to the regulations of the insured place. At the same time, the medical expenses of trauma without third-party liability that meet the management regulations of medical treatment places can be included in the direct settlement scope.

　　Two, standardize the direct settlement management services

　　(a) simplify the inter provincial medical record. Insured persons in this city need to go through the inter-provincial medical record before seeking medical treatment in different places. The filing procedures can be handled through online and offline channels, such as the national medical insurance service platform APP, the national remote medical filing applet, the the State Council client applet or the window of each district agency, by registering my information and signing a personal commitment letter.

　　(two) clear the scope of direct settlement. When the insured persons in this city apply for medical treatment in different provinces for the record, in principle, the medical treatment place only needs to be put on record in the co-ordination area where the medical treatment place is located. All the inter-provincial networked designated medical institutions in the co-ordination area for the record medical treatment are designated medical institutions for the insured persons in different places, and they can enjoy hospitalization, general outpatient service or direct settlement service for drug purchase. The insured persons in this city who seek medical treatment for special diseases in different provinces need to be filed with the designated medical institutions at the place where they seek medical treatment. In principle, two designated medical institutions can be selected for a special disease, and they can seek medical treatment in the inter-provincial networked designated medical institutions that have opened the direct settlement service for corresponding outpatient chronic and special diseases, and the treatment expenses related to special diseases can enjoy direct settlement service.

　　(three) standardize the insured to medical insurance electronic certificate, social security card. Insured persons who seek medical treatment in different places across provinces should take the initiative to show their insured status in the designated medical institutions networked across provinces where they seek medical treatment, and produce valid certificates such as medical insurance electronic certificate or social security cards. Inter-provincial networking designated medical institutions should do a good job in the authentication of insured persons in different places, guide those who have not filed for the record to go through the filing procedures in time, and provide reasonable and standardized diagnosis and treatment services and convenient and fast settlement services for insured persons who meet the requirements of medical places.

　　(4) Standardize the direct settlement process. When medical treatment is directly settled in different provinces, the medical treatment place should upload the cost information to the national medical security information platform according to the unified requirements of the state for direct settlement between designated medical institutions and insured persons connected across provinces. If it cannot be settled directly for some reason, the inter-provincial networked designated medical institutions should also upload medical expenses details, diagnosis and other medical information, and support the pilot online processing of manual reimbursement.

　　(five) the unified management of medical treatment. Medical insurance agencies at all levels should bring medical personnel from different places into the unified management of this Municipality, and provide the same services and management as the insured in this Municipality in terms of medical information recording, performance appraisal, medical behavior monitoring, cost audit, total budget, etc., and make it clear in the medical security service agreement of designated medical institutions; Explore the application of medical insurance payment reform in medical settlement in different places, and guide designated medical institutions to make reasonable diagnosis and treatment.

　　(six) to strengthen the collaborative management of medical services across provinces. Medical insurance departments at all levels should gradually improve the working mechanism, form a coordinated management system of inter-provincial medical services in different places with clear division of labor, clear responsibilities and unified processes, and comprehensively improve the coordinated management ability of inter-provincial medical services in terms of problem coordination, online reimbursement, cost investigation and information sharing.

　　Three, strengthen the management of medical funds across provinces and different places.

　　The medical insurance fund payment part of the inter-provincial medical expenses in different places shall be paid in advance and then liquidated. Inter-provincial medical expenses in different places shall be settled in full on a monthly basis in accordance with the unified national clearing method. The municipal medical insurance agency and the municipal finance department shall, in accordance with the detailed rules for the implementation of direct settlement of medical treatment in different provinces of Beijing (Annex), coordinate in the allocation and collection of clearing funds. Bank charges and bank bill fees incurred in the process of allocating funds for medical treatment in different provinces shall not be charged in the fund. The interest generated by the advance payment in the financial special account of the medical treatment place belongs to the medical treatment place.

　　Fourth, improve the support for standardization of medical insurance informationization

　　(a) continue to deepen the national unified medical insurance information platform for the whole business process application. Medical insurance departments at all levels should solidly promote the dynamic maintenance and deepening application of coding in accordance with the unified national norms and requirements, improve the management system of medical insurance operation and maintenance of information technology, continuously improve the level of medical insurance data governance, and provide strong system support for direct settlement.

　　(2) Continue to optimize and improve the system. Medical insurance departments at all levels should constantly optimize system performance, reduce response time and effectively improve the direct settlement experience of insured persons in accordance with the unified national interface standards and specifications. When the medical insurance system stops and switches, it should be reported in advance, verified in the process and monitored afterwards to ensure that the data migration is timely, complete and accurate, to solve the influence of information changes such as personal number on the business in transit, and to ensure the smooth connection of business and the stable operation of the system.

　　(3) Strengthen system operation and maintenance management and security. Medical insurance departments at all levels should continue to build professional and reliable operation and maintenance management teams, build operation and maintenance management processes in infrastructure, network security, cloud platforms, business subsystems and other fields, and form a scientific and effective operation and maintenance management system. Implement safety management responsibilities, improve system safety operation and maintenance capabilities, strengthen information system boundary protection, prohibit cross-provincial networked designated medical institutions from connecting the information system of medical insurance system to the Internet, standardize cross-provincial medical identity verification, and ensure data security. Standardize the quality control standard of abnormal transaction error information, classify the problems, describe the reasons of errors concisely and easily, facilitate the problem location of abnormal transactions, and respond to them in time.

　　Five, strengthen the supervision of direct settlement funds

　　Medical insurance departments at all levels should earnestly implement the regulatory responsibilities of medical treatment places and insured places. As a place for medical treatment, direct settlement should be regarded as the key content of daily supervision, special inspection and flight inspection, and all kinds of fraudulent insurance fraud should be severely cracked down. At the same time, it is necessary to cooperate with medical insurance departments in different places to do relevant verification; As an insured place, it is necessary to regularly analyze the use of medical insurance funds across provinces and different places, accurately lock the clues of suspicious problems, and actively carry out problem verification to ensure the safe and rational use of medical insurance funds.

　　Medical insurance departments at all levels shall, in accordance with the spirit of this circular, take direct settlement as an important task to deepen the reform of the medical security system, strengthen organizational leadership, coordinate and promote, and do a good job in publicity and training to ensure a smooth transition of direct settlement in this Municipality.

　　This notice shall be implemented as of January 1, 2023. If the previous documents are inconsistent with this notice, this notice shall prevail.

Beijing Municipal Medical Security Bureau　　　　

December 30, 2022　　

Xinhua News Agency, Beijing, October 23 rd, the Central Committee of the Communist Party of China’s Decision on Further Deepening Reform and Promoting Chinese Modernization pointed out: "Promote the coordinated development and governance of medical care, medical insurance and medicine." Medical treatment refers to the medical and health services provided by medical and health institutions and medical personnel. It is the core content of medical treatment, health care and rehabilitation for the masses. It has the most direct relationship with the masses and the most concrete feelings of the masses. Medical insurance refers to the medical security system and its level of protection. Medical insurance fund is the "life-saving money" for people to see a doctor, and it is also an important source of financing for medical services and medical products. Medicine refers to Chinese and western medicines, medical devices, medical consumables and other related products. As an important means of medical and health services, it is directly related to the quality, safety and ability of services. The state exercises strict supervision over medical products to ensure quality, safety and effectiveness, and encourages innovation to increase the supply of high-quality medical products. There are three main considerations for the coordinated development and governance of "three medicines".

First, the "three doctors" are interrelated and inseparable. Medical care plays a major role in serving the people’s life, illness, illness, and medical treatment. By deepening the structural reform of the supply side of medical services, we will vigorously develop new quality productivity of health care, mobilize the enthusiasm, initiative and creativity of the majority of medical staff, promote the high-quality development of health care, and better meet the people’s yearning for a better life. Medical insurance is connected with the "demand side" of the people, which reduces the economic burden of patients by exerting the guarantee function; The other end is connected with the two "suppliers" of medical care and medicine, which can not only adjust the supply of medical services, standardize medical service behavior, promote hospital reform and promote graded diagnosis and treatment through payment methods and price policies, but also reduce the price of medical products through centralized procurement of pharmaceutical consumables and exert leverage. The production and supply of high-quality and high-efficiency pharmaceutical products provide necessary technical means and material guarantee for medical and health services, and at the same time get reasonable compensation from payers such as medical insurance to realize the healthy development of the industry. Medical care, medical insurance and medicine jointly protect people’s health. To improve the development level of health undertakings, it is necessary for relevant departments to cooperate closely and make concerted efforts to promote the coordinated development and governance of "three medicines".

Second, the coordinated development and governance of the "three medicines" can further benefit the people and the people and better solve the people’s livelihood problems. Medical and health service is an important part of public service and an important field that people expect for a better life. With the development of economy and society and the continuous improvement of people’s living standards, people hope to obtain more safe, effective, convenient and cheap medical and health services, more comprehensive coverage and higher level of basic medical security, and innovative and advanced medical products. Only by vigorously promoting the coordinated development and governance of the "three medicines" and forming a joint effort can we better meet the people’s new expectations for a better life, improve the people’s sense of acquisition, happiness and security, and deepen the reform of the medical and health system to benefit people’s livelihood more directly.

Third, the coordinated development and governance of the "three medicines" is conducive to promoting the governance of all links in the whole chain of the medical field and correcting unhealthy trends. Influenced by many factors, there are still some phenomena and problems in the field of medicine and health that endanger the interests of the people and harm public welfare and people’s health rights and interests. Among them, there are some problems in medical service, such as big prescription, excessive examination and overuse of drugs, which damage people’s health and waste health resources; There are also fraudulent behaviors in the field of medical insurance, which seriously threaten the safety of medical insurance funds; There are also problems in the field of pharmaceutical production, circulation and sales, such as "sales with gold", price increases at different levels, and imaginary costs. These problems are often intertwined, connecting multiple stakeholders and running through many links of "three medicines". To solve these problems, we must adhere to the party’s leadership, treat both the symptoms and the root causes, strengthen supervision in the whole chain, comprehensively adopt institutional supervision, functional supervision, behavioral supervision, penetrating supervision, continuous supervision and other means, strengthen the linkage between the "three medical" departments, strengthen the connection between discipline and law and execution, and severely crack down on and punish acts that infringe on public rights and interests according to law. The coordinated development and management of the "three medicines" can achieve the above objectives, and play a positive role in controlling unhealthy trends and establishing new trends in the industry, and play a significant role.

　　　　　　 CCTV News:These days, a storm surrounding Madagascar chameleon has been fermenting. The cause of the incident should also start with a post from a Weibo netizen named @ Daiwa Exploring the World. On February 18th, the day before the Lunar New Year Lantern Festival, this Weibo netizen @ Daiwa explored the world and published an article entitled "Help my mother quickly". This article said that two China men, Wu Mou and Ma Moumou, organized and led a group of 19 parents and children to Madagascar for the New Year in February this year, and participated in outdoor activities such as parent-child popular science tours.

　　　　　　 According to the article, the so-called China men Wu Mou and Ma Moumou claimed to be "entomologists of China Academy of Sciences", but they led their children and parents to "teach children to catch wild animals with their bare hands" and even violated local laws during their travels in Madagascar, regardless of their lives. According to the article, when the group returned to China, they put a live chameleon in the bag of a child’s parents and tried to smuggle it back to China. As a result, the so-called "organizer" Ma Moumou and the parents were arrested by the Madagascar police at the airport, with a maximum of 10 years’ imprisonment and a high fine of up to 200 million Malagasy dollars (about 400,000 yuan).

　　　　　　 There are many questions to be solved about the private chameleon.

　　　　　　 At present, there are still many doubts about this incident. Are the "Wu Mou and Ma Moumou" mentioned in this net really the so-called "insect experts of China Academy of Sciences"? During the Chinese New Year this year, the 19-member scientific delegation led by them, including parents and children, traveled to Madagascar. Is it really qualified? The most controversial point is whether a China parent who was detained by the Malagasy police involved brought the chameleon back to China privately, or "Wu Mou and Ma Moumou", as mentioned in the article, secretly put the live chameleon in her backpack in an attempt to bring it back to China without the parents’ knowledge. Although these questions haven’t been clearly answered, official website, the Embassy of China in Madagascar, has released the relevant notice of this incident. At present, this incident of "China tourists being detained by Madagascar police on suspicion of taking prohibited items such as chameleons out of the country" is in the judicial review stage, and there is no specific court date.

　　　　　　 There is no specific court date under judicial review.

　　　　　　 China’s Embassy in the Republic of Madagascar, official website, reported on February 18th that tourists from China were detained by Madagascar police on suspicion of bringing chameleons and other prohibited items out of the country. At present, the matter is in the stage of judicial review, and there is no specific court date.

　　　　　　 This outdoor activity was jointly initiated by Wu and Ma, and set off from China on February 6th at the tropical rain forest on the east and west coasts of Madagascar. Most of the members who participated in the outdoor activities were children and parents who liked insects, animals and plants. According to media reports, the wild animals seized this time, including a chameleon, a lizard and fifteen centipedes, were all placed in plastic boxes covered with cotton wool. Lawyers said that those involved may face a fine of 40,000 euros.

　　　　　　 Malaysia has strict regulations on the exit of "endangered animals and plants"

　　　　　　 Let’s also briefly understand Madagascar’s strict regulations on the entry and exit of endangered animals and plants. Just now, we saw a lawyer say that if you leave the country with endangered animals and plants according to previous local laws, you may face a fine of 40,000 euros, equivalent to about 300,000 yuan. However, we also checked the entry-exit customs office at the airport in Tanana Lifu, Madagascar’s capital, and clearly posted the management requirements for carrying jewelry, herbs, endangered animals and plants, frozen meat, alcohol and other items. The maximum penalty is far more than the 40,000 euros mentioned by lawyers.

　　　　　　 According to Malaysian customs regulations, if you carry "endangered animals and plants", you need to apply for the import and export license allowed by the Convention on International Trade in Endangered Species of Wild Fauna and Flora, and you need to apply for an epidemic prevention certificate if you carry "live animals"; Once violations are found, those who transport endangered animals and plants without permission will be punished with 2 to 10 years’ imprisonment and a fine of up to 200 million Arial (equivalent to about 400,000 yuan). Although not all kinds of chameleons, lizards and centipedes are endangered animals, the corresponding criminal punishment of "transporting endangered animals and plants" is the heaviest compared with illegal transportation of drugs, weapons and illegal food in Malaysian customs regulations.

　　　　　　 Not by chance? The organizers involved are frequently exposed.

　　　　　　 What is the truth of this case, we have to wait for the Malaysian judicial review and court session to come to the bottom. However, some background about this "China tourists are suspected of bringing chameleons back to China privately" has also attracted great media attention. After the incident, some media found that this did not seem to be an accident. Because the so-called "organizers" Ma Moumou and Wu Mou, who went to Madagascar for a popular science parent-child tour, were previously exposed to abetting and luring children and parents to hunt protected wild animals and bring them into the country, not only "teaching children to catch bats with their bare hands", but also "teaching children to catch wild animals". At the same time, another "organizer" Wu Mou also flowed out on the Internet, and in Weibo, he exposed various "intimate photos" of Malaysian animals and plants such as chameleons during his trip to Malaysia, but the legality could not be confirmed; However, after the incident, Wu Mou, the organizer of the group, deleted a large number of Weibo words and pictures. In addition, as far as Ma’s identity is concerned, some media have revealed that he is an "expert who impersonates a member of the Science Education Alliance of the Chinese Academy of Sciences", but in fact he is an insect dealer who sells wild animals and plants, but this statement has not been verified. In this regard, on February 19, the official micro "Voice of the Chinese Academy of Sciences" of the Chinese Academy of Sciences also forwarded "Ma Moumou pretends to be Weibo, a so-called expert of Chinese Academy of Sciences.

　　　　　　 Expert Interpretation: Wild animals and plants should be "viewed from a distance"

　　　　　　 In recent years, popular science parent-child travel is very popular, but what should we pay attention to when we are in close contact with wild animals? Come and listen to the expert’s analysis.

　　　　　　 Experts said that ecotourism, as a new way of tourism, is deeply loved by parents and friends because it is close to nature and entertaining. However, wild animals often carry viruses themselves and their temperament is elusive. It is very dangerous to reach out and touch without isolation measures, not to mention catching them by hand or even bringing exotic species back to China. Experts say that in addition to violating the Convention on International Trade in Endangered Species of Wild Fauna and Flora, bringing exotic species back to China will also lead to species invasion, which will damage biodiversity protection and ecological environment.

　　　　　　 So how should we treat wild animals? Experts suggest that tourists should respect all life in nature and get to know them without disturbing their normal life.

　　　　　　 Zhang Na, an expert in animal and plant protection, said, "I think we should follow the principle of three noes when dealing with wild animals, that is, no trapping, no touching and no disturbing. We should know from an early age that wild animals belong to nature and are our friends, so we should respect them. We will observe them and understand them without disturbing their normal life, and then we hope that everyone can respect all life in nature. "

　 　 　 　Recently, AHA has just released the 2020 Cardiopulmonary Resuscitation (CPR)-Cardiovascular First Aid (ECC) Guide. The guide is divided into five parts, namely, basic and advanced life support for adults, basic and advanced life support for children, life support for newborns, resuscitation education science and rescue system.

Adult basic and advanced life support　

　 　 　 　Despite the progress in recent years, less than 40% of adults received CPR initiated by non-professionals, while less than 12% received AED first aid before EMS arrived. AHA adult IHCA and OHCA survival chain

(Click to enlarge, the same below)

Emergency procedures for adult cardiac arrest

Opioid-related emergency procedures for non-professional emergency personnel

Opioid-related emergency procedures for medical staff

Flow chart of treatment after recovery of spontaneous circulation in adult cardiac arrest

Suggested methods for multimodal neural prediction of adult patients after cardiac arrest and recovery of autonomic circulation

ACLS flow chart of pregnant women with cardiac arrest in hospital

Main new and updated suggestions in 2020 　　　

Non-professional rescuers should start as soon as possible.

CPR2020 (updated)：We recommend that non-professionals perform CPR on patients with possible cardiac arrest, because if the patient is not in a state of cardiac arrest, the risk of injury to the patient is low.

2010 (old):　If the adult suddenly falls down or the unresponsive patient’s breathing is abnormal, the non-professional rescuer should not check the pulse, but assume that there is cardiac arrest. The medical staff should check the pulse within no more than 10 seconds. If the pulse is not clearly touched within this time, the rescuer should start chest compressions.

Reason: New evidence shows that patients who receive chest compressions when they are not in cardiac arrest have a lower risk of injury. Non-professional rescuers cannot accurately determine whether the patient has a pulse, and the risk of not performing CPR on patients without a pulse exceeds the harm caused by unnecessary chest compressions.

Physiological monitoring of CPR quality

2020 (updated):　It may be reasonable to use physiological parameters such as arterial blood pressure or ETCO2 to monitor and optimize CPR quality when feasible.

2015 (old):　Although there is no clinical study to investigate whether adjusting resuscitation operation according to physiological parameters during CPR can improve the prognosis, it may be reasonable to use physiological parameters (quantitative carbon dioxide waveform, arterial diastolic pressure, arterial pressure monitoring and central venous blood oxygen saturation) to monitor and optimize CPR quality, guide vasopressor drug treatment and detect ROSC when feasible.

Reason: Although it is an established concept to monitor the quality of CPR by physiological monitoring methods such as arterial blood pressure and ETCO2, new data support its inclusion in the guidelines. According to the data of AHA’s "Follow the Guide-Resuscitation" registration study, the possibility of ROSC is increased when using ETCO2 or diastolic blood pressure to monitor CPR quality.

The monitoring depends on the existence of endotracheal intubation (ETT) or arterial catheterization. Adjusting the compression target so that the ETCO2 value is at least 10 mm Hg, ideally 20 mm Hg or higher, may be useful as a CPR quality marker. The ideal goal has not yet been determined.

Dual continuous defibrillation is not supported.

2020 (new):The usefulness of dual continuous defibrillation for refractory shockable rhythm has not been determined.

Reason: Double continuous defibrillation refers to the practice of using two defibrillators to perform electric shock almost simultaneously. Although some case reports show a good prognosis, the ILCOR system review in 2020 found no evidence to support dual continuous defibrillation, so routine use is not recommended. There are many forms of bias in existing studies, and observational studies have not shown improvement in prognosis. A recent experimental RCT shows that changing the direction of defibrillation current by repositioning electrode pads may be equivalent to the effect of dual continuous defibrillation, while avoiding the risk of injury caused by energy increase and defibrillator damage. According to the current evidence, it is not clear whether dual continuous defibrillation is beneficial.　　

Venous access takes precedence over intraosseous access.

2020 (new):It is reasonable for practitioners to try to establish venous access for drug administration in patients with cardiac arrest first.

2020 (updated):If venous access is not successful or feasible, we can consider using intraosseous access instead.

2010 (old):If there is no ready-made venous (IV) access, it is reasonable for practitioners to establish intraosseous (IO) access.

Reason: In 2020, ILCOR systematically reviewed and compared intravenous and intraosseous administration during cardiac arrest, and found that venous pathway was related to better clinical prognosis in five retrospective studies. RCT subgroup analysis focusing on other clinical problems also found similar results when intravenous or intraosseous routes were used for drug delivery. Although venous access is the first choice, intraosseous access is also a reasonable choice for the situation that it is difficult to establish venous access.　　

Treatment and support during rehabilitation

2020 (new):　We suggest that survivors of cardiac arrest undergo multimodal rehabilitation evaluation and treatment in terms of physical, neurological, cardiopulmonary and cognitive impairment before discharge.

2020 (new):　We suggest that cardiac arrest survivors and their caregivers receive a comprehensive multidisciplinary discharge plan to incorporate medical and rehabilitation treatment suggestions and expected goals of activity/work recovery.

2020 (new):　We suggest a structured assessment of anxiety, depression, post-traumatic stress response and fatigue for survivors of cardiac arrest and their caregivers.

Reason: Patients with cardiac arrest need to go through a long rehabilitation period after initial hospitalization. Support is needed during rehabilitation to ensure the best physical, cognitive and emotional health and restore social/role functions. This process should start from the initial hospitalization period and continue as needed. These topics are discussed in more detail in the 2020 AHA scientific statement.

Analysis and summary of rescuers

2020 (new):　After cardiac arrest, it may be beneficial to organize non-professional rescuers, EMS implementers and hospital medical staff to analyze and summarize and provide follow-up for them in the follow-up for emotional support.

Reason: The rescuer may feel anxious or have post-traumatic stress reaction because of providing or not providing BLS. Hospital medical staff may also encounter emotional or psychological influence when treating patients with cardiac arrest. Team analysis and summary can review team performance (education and quality improvement) and identify natural stress factors related to the treatment of dying patients. It is expected that an AHA scientific statement dedicated to this topic will be released in early 2021.　　

Cardiac arrest in pregnant women

2020 (new):　Because pregnant women are more prone to hypoxia, oxygenation and airway management should be given priority during the resuscitation of pregnant women’s cardiac arrest.

2020 (new):　Because it may interfere with the recovery of pregnant women, fetal monitoring should not be carried out during the cardiac arrest of pregnant women.

2020 (new):　We suggest that pregnant women who are still unconscious after cardiac arrest and resuscitation should be managed by target temperature.

2020 (new):　During the management of target body temperature for pregnant patients, it is suggested to continuously monitor the fetus for the possibility of bradycardia, and consult obstetrics and neonatology.

Reason: Reviewed the recommendations on the management of cardiac arrest in pregnant women in the guideline update in 2015 and AHA scientific statement in 2015. Due to the increase of maternal metabolism, the decrease of functional residual capacity caused by pregnant uterus and the risk of fetal brain damage caused by hypoxemia, airway, ventilation and oxygenation are particularly important in the context of pregnancy.

　 　 　 　It is not helpful to evaluate the fetal heart during the period of maternal cardiac arrest, and it may also distract attention from the necessary resuscitation operation. In the absence of contrary data, pregnant women who survive after cardiac arrest should be managed by the target temperature like other survivors, and the condition of the fetus who may stay in the uterus should be considered.

Basic and advanced life support for children　

The causes of cardiac arrest in infants and children are different from those in adults, and more and more pediatric specific evidence supports these suggestions.

AHA children’s IHCA and OHCA survival chain

Flow chart of cardiac arrest in children

Flow chart of bradycardia in children with pulse

Flow chart of pulse tachycardia in children

Checklist of treatment after spontaneous circulation recovery in children with cardiac arrest

Important Issues, Major Changes and Enhancements in the 2020 Guide 　

The flow chart and visual AIDS were modified to incorporate the best scientific knowledge and provide clearer information for PBLS and PALS resuscitation implementers.

According to the latest data of children’s resuscitation, it is suggested that the frequency of auxiliary ventilation should be increased to once every 2-3 seconds (20-30 times per minute) for all children’s resuscitation scenarios.

For patients of any age who need to be intubated, it is recommended to use a cuff ETT to reduce air leakage and the need to change tubes.

The routine use of cricoid cartilage compression during intubation is no longer recommended.

In order to maximize the chances of obtaining a good resuscitation prognosis, epinephrine should be given as soon as possible, and ideally it should be given within 5 minutes after cardiac arrest with non-shockable rhythm (cardiac arrest and pulseless electrical activity).

For patients with arterial catheterization, the feedback from continuous measurement of arterial blood pressure can improve the quality of CPR.

After Rosc, the patient’s seizure should be evaluated; Status epilepticus and any convulsive seizures should be treated.

Patients with cardiac arrest need to go through a long rehabilitation period after their initial hospitalization, so their physiological, cognitive and psychosocial needs should be formally evaluated and given corresponding support.

When epinephrine or norepinephrine is infused when vasopressor drugs are needed, it is appropriate to adopt titration liquid management method for resuscitation of septic shock.

According to adult data, it is generally inferred that the balanced blood component resuscitation scheme is reasonable for infants and children with hemorrhagic shock.

Opioid overdose management, including seizures by non-professional rescuers or trained rescuers, should be treated.

Patients with cardiac arrest need to go through a long rehabilitation period after their initial hospitalization, so their physiological, cognitive and psychosocial needs should be formally evaluated and given corresponding support.

When epinephrine or norepinephrine is infused when vasopressor drugs are needed, it is appropriate to adopt titration liquid management method for resuscitation of septic shock.

According to adult data, it is generally inferred that the balanced blood component resuscitation scheme is reasonable for infants and children with hemorrhagic shock.

Opioid overdose management includes CPR by non-professional rescuers or trained rescuers and timely administration of naloxone.

Children with acute myocarditis with arrhythmia, cardiac block, ST segment changes or low cardiac output are at higher risk of cardiac arrest. It is important to be transferred to the intensive care unit as soon as possible. Some patients may need mechanical circulatory support or extracorporeal life support (ECLS).

Babies and children with congenital heart disease and single ventricular physiological function need special consideration in the management of PALS if they are in the process of staged reconstruction.

The management of pulmonary hypertension may include the use of inhaled nitric oxide, prostacyclin, analgesic drugs, sedative drugs, neuromuscular blocking drugs, induced alkalosis or ECLS rescue treatment.

Neonatal life support

Newborn resuscitation needs to be predicted and prepared by the implementers who have received individual and team training.

Most newborns do not need umbilical cord ligation or resuscitation immediately, but can be evaluated and monitored during the skin contact between mother and baby after birth.

Preventing hypothermia is an important concern of neonatal resuscitation. As a way to close the parent-child relationship, promote breastfeeding and maintain normal body temperature, the importance of skin contact nursing for healthy infants is strengthened.

For newborns who need support after birth, lung dilatation and ventilation are the primary tasks.

The increase of heart rate is the most important index of effective ventilation and response to resuscitation intervention.

Pulse oxygen saturation is used to guide oxygen supply and achieve oxygen saturation target.

Routine endotracheal suction is not recommended for active or inactive infants born in meconium-contaminated amniotic fluid (MSAF). Endotracheal aspiration is only applicable when airway obstruction is suspected after providing positive pressure ventilation (PPV).

If proper ventilation correction steps are taken (preferably including tracheal intubation), but the heart rate does not respond well to ventilation, chest compressions can be performed.

Electrocardiogram should be used to monitor the response of heart rate to chest compressions and drugs.

When newborns need vascular access, umbilical vein pathway should be the first choice. When venous access is not feasible, the intraosseous approach can be considered.

If the response to chest compressions is not good, it may be reasonable to provide epinephrine, preferably through the intravascular route.

If there is no response to adrenaline and there is a history or examination consistent with blood loss, the newborn may need to expand.

If all these resuscitation steps have been effectively completed, but there is still no heart rate reaction after 20 minutes, we should discuss with the team and the family members of the child to adjust the treatment direction.

　 　 　 　 Survival after cardiac arrest depends on the establishment of an organic system covering personnel, training, equipment and organization. Willing bystanders, owners equipped with AED, emergency service telecommunication personnel and BLS and ALS implementers working in EMS system can all contribute to the successful recovery of OHCA.

　 　 　 　Within the hospital, the work of doctors, nurses, respiratory therapists, pharmacists and other professionals also provides support for the prognosis of resuscitation. Successful recovery also depends on the efforts of equipment manufacturers, pharmaceutical companies, recovery teachers, guide compilers and many others. Long-term survival depends on the support of family members and professional nurses, including experts in cognitive, physical and psychological rehabilitation and recovery. All links in the whole system are striving to improve the quality of treatment in an all-round way, which is very important for achieving a successful prognosis.

　　Xinhua News Agency, Beijing, October 30 (Reporter Zhang Xiao, Lu Chang) On October 30, the Beijing Municipal Transportation Commission, the Public Security Traffic Management Bureau of the Beijing Municipal Public Security Bureau and the Beijing Municipal Bureau of Ecology and Environment issued and implemented the Notice on Taking Temporary Traffic Management Measures to Deal with Heavy Air Pollution.

　　The circular mentioned that in order to cope with heavy air pollution and protect public health, in accordance with the provisions of the Beijing Emergency Plan for Heavy Air Pollution (Revised in 2023), when the emergency headquarters of Beijing issued a red and orange warning for heavy air pollution, temporary traffic management measures were taken for motor vehicles (including vehicles with temporary license plates) driving on roads within the administrative area of Beijing.

　　The circular shows that during the red warning period of heavy air pollution, the official vehicles of party and government organs at all levels in Beijing, social organizations, institutions and state-owned enterprises affiliated to Beijing will stop driving for 30% of the total number of vehicles on the basis of single and even number driving measures. Construction waste, muck and gravel transport vehicles are prohibited from driving on roads within the administrative area of Beijing all day (except pure electric and hydrogen fuel cell vehicles). Light gasoline vehicles (including driving school coaches) with national emission standards 1 and 2 are prohibited from driving on roads within the administrative area of Beijing all day. From 3: 00 to 24: 00 every day, motor vehicles (including driving school coaches) with emission standards of Grade III and above will be driven on a single day and even days according to the tail number of the license plate (odd numbers are 1, 3, 5, 7 and 9, and even numbers are 2, 4, 6, 8 and 0), and motor vehicles with English letters at the tail number of the license plate will be managed as No.0; At the same time, Beijing suspended the implementation of regional traffic management measures during peak hours of working days; However, from 7: 00 to 9: 00 and from 17: 00 to 20: 00 on weekdays, motor vehicles from other provinces, autonomous regions and municipalities are prohibited from driving on roads within the Fifth Ring Road in Beijing (including the Fifth Ring Road). Diesel trucks with national four emission standards issued by Beijing Municipality with license plates (including temporary license plates) are prohibited from driving on the road (except those confirmed by relevant administrative departments to ensure the transportation of production and living materials in this city and transport fresh agricultural products in whole vehicles).

　　The circular also stipulated temporary traffic management measures during the orange warning period of heavy air pollution and the types of motor vehicles in Beijing that are not restricted by the circular. The circular reminds that during the period of taking temporary traffic management measures, other traffic management measures in Beijing are still valid except for the implementation of the provisions of this circular. The Beijing Municipal Public Security Traffic Management Department will deal with motor vehicles driving in violation of regulations according to law.