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National Health Commission: The cause of Chinese medicine has developed steadily in the past ten years.

At the press conference of "All for People’s Health-Our Decade" held in National Health Commission on September 23rd, National Health Commission spokesperson Hu Qiangqiang introduced that since the 18th National Congress of the Communist Party of China, the cause of Chinese medicine has developed steadily, traditional medicine has been closely integrated with modern technology, and the inheritance, development and innovation of Chinese medicine have ushered in new opportunities because of the integration of modern technology.

upholding fundamental principles and breaking new ground

Traditional Chinese medicine is a treasure of Chinese civilization. "Be sure to protect, explore and pass on." Li Yu, director of the Science and Technology Department of state administration of traditional chinese medicine, said that in recent years, China has carried out in-depth combing and excavation of the essence of classical medical books; Accelerate the academic live transmission of traditional Chinese medicine, and systematically sort out and study the experiences of more than 200 famous old Chinese medicine practitioners, including Chinese medicine masters; Study and formulate the Regulations on the Protection of Traditional Chinese Medicine Knowledge.

Not only should we be upright, but also the development of Chinese medicine needs innovation. In this regard, Wu Zhendou, Director of the Department of International Cooperation of state administration of traditional chinese medicine, said that the support of the CPC Central Committee and the State Council for scientific and technological innovation of traditional Chinese medicine has increased steadily. The State Administration of Traditional Chinese Medicine, together with the Ministry of Science and Technology, the Health and Health Commission and other ministries, has built 14 national key laboratories, two national clinical research centers of traditional Chinese medicine, five national engineering technology research centers, five national engineering research centers and six national engineering laboratories. Together with the National Development and Reform Commission, we will build 40 national clinical research bases of traditional Chinese medicine and lay out 175 key laboratories in state administration of traditional chinese medicine.

Li Wei also said that in the past ten years, through clinical and mechanism research, Chinese medicine has made important progress in treating a series of major diseases and common frequently-occurring diseases such as ischemic stroke, non-small cell lung cancer, diabetes, chronic obstructive pulmonary disease, and formed a number of Chinese medicine treatment programs.

In the research of basic theory of TCM, with the support of the "973 Plan" project, a number of important theoretical questions of TCM, such as the specificity of acupoints, were answered, which promoted the establishment of new disciplines such as collateral diseases of TCM and constitution of TCM, and enriched and improved the theoretical system of TCM. Li Yu said that the research results of a number of rare and endangered medicinal materials such as artificial musk have provided a good support for the sustainable utilization of traditional Chinese medicine resources.

It is reported that the Ministry of Science and Technology and state administration of traditional chinese medicine recently jointly issued the "Special Plan for Scientific and Technological Innovation of Chinese Medicine in the 14th Five-Year Plan". The state will continue to strengthen the construction of scientific and technological support platform for Chinese medicine, promote the systematic interpretation and innovation of original theories of Chinese medicine, explain the core pathogenesis of major diseases treated by Chinese medicine, optimize prevention and treatment plans, strengthen the creation of new Chinese medicine and the research and development of key technologies and equipment of Chinese medicine, and play a leading and supporting role for the high-quality development of Chinese medicine.

Build a solid foundation for talent training

Talents are the foundation of the development of Chinese medicine.

"It should be said that this decade is a decade of rapid development of Chinese medicine." Yang Hongjun, vice president of Chinese Academy of Traditional Chinese Medicine, said that as the national team of Chinese medicine industry, especially after the National Congress of Chinese Medicine in 2019, they effectively promoted "making Chinese Academy of Traditional Chinese Medicine bigger and stronger" as the development strategy of the hospital and laid a solid foundation for personnel training.

How to promote outstanding young talents to stand out? "We have taken a series of reform measures. From the past talent’ to the horse mechanism’ to the’ horse racing mechanism’, in the process of scientific and technological innovation and entrepreneurship, I hope that talents can emerge. We will give different support to the talents at different levels that have emerged, so that they can fully display their space. " Yang Hongjun said.

The development of Chinese Academy of Traditional Chinese Medicine is a microcosm of Chinese medicine. According to Wu Zhendou, in recent years, the construction of Chinese medicine science and technology talents has been continuously strengthened: seven people were elected as academicians of China Academy of Engineering and one was elected as an academician of China Academy of Sciences; The State Administration of Traditional Chinese Medicine has established 15 national multidisciplinary innovation teams and 20 national inheritance and innovation teams of traditional Chinese medicine. 149 strategic leading talent Qihuang scholars and 100 young Qihuang scholars were selected.

Chinese medicine "going out" into the fast lane

At present, Chinese medicine "going out" has entered the fast lane, taken new steps and achieved a series of remarkable results. Wu Zhendou introduced that Chinese medicine has spread to 196 countries and regions. China has signed special cooperation agreements on Chinese medicine with more than 40 foreign governments, regional authorities and international organizations, and carried out the construction of 30 high-quality overseas Chinese medicine centers, 75 international Chinese medicine cooperation bases and 31 national Chinese medicine service export bases. The content of Chinese medicine has been included in 16 free trade agreements.

Wu Zhendou said that in recent years, Tu Youyou, a Chinese scientist, won the 2015 Nobel Prize in Physiology or Medicine for his discovery of artemisinin, and the Tibetan medicine bath method was included in the UNESCO representative list of human intangible cultural heritage, which promoted the establishment of the International Organization for Standardization Technical Committee on Traditional Chinese Medicine (ISO/TC249), successively formulated and promulgated 89 international standards for traditional Chinese medicine, and promoted the World Health Organization to adopt the Resolution on Traditional Medicine and issue the World Health Organization’s Traditional Medicine Strategy for 2014-2023.

In the face of the sudden outbreak of COVID-19, Chinese medicine has actively contributed to the global epidemic prevention and control. Wu Zhendou introduced that China publicly released a multilingual version of COVID-19’s Chinese medicine diagnosis and treatment plan, supported more than 100 video exchanges and live broadcasts of anti-epidemic experts, introduced Chinese medicine diagnosis and treatment plans to more than 150 countries and regions, provided Chinese medicine products to some countries and regions in need, sent Chinese medicine experts to relevant countries and regions to help guide the anti-epidemic, sent the first Chinese medicine anti-epidemic expert group and medical team to Cambodia, and promoted the release of the Report of the World Health Organization’s Expert Evaluation Meeting on Chinese Medicine Treatment of COVID-19, and the "Three Drugs and Three Parties" and other anti-epidemic activities.

Since the 14th Five-Year Plan, state administration of traditional chinese medicine, together with relevant ministries and commissions, has formulated and implemented the Development Plan for Promoting the High-quality Integration of Chinese Medicine and Building the Belt and Road (2021-2025) around the overall requirements of promoting the high-quality development of the Belt and Road. Wu Zhendou said that the plan plans to cooperate with the "Belt and Road" countries to build 30 high-quality overseas centers for Chinese medicine, promulgate 30 international standards for Chinese medicine, build 10 overseas brand projects for Chinese medicine culture, build 50 international cooperation bases for Chinese medicine and a number of national export bases for Chinese medicine services, strengthen the construction of overseas registration service platforms for Chinese medicine products, organize Chinese medicine foreign aid medical teams, and encourage social forces to explore and build Chinese-foreign friendly Chinese medicine hospitals in a market-oriented way. (Reporter Jin Zhenya)

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Mom sees the kua series! What to give on Mother’s Day will not be said to be wasteful.

  Has the May Day holiday syndrome slowed down? Ladies and gentlemen, Mother’s Day will come quietly this weekend. Compared with previous years, this year’s atmosphere is quite special. Perhaps everyone has recently experienced a long period of contact or separation with their families, and everyone should maintain a sense of ceremony for the festival!

  Although the time is short, don’t rush to place an order to buy a gift. It’s better to see what kind of gift will make mothers feel disgusted and think you are wasting money. If you step on these minefields, it may not be too late to save them.

  I believe many people will take this opportunity to send gifts to their mothers who have worked hard to raise themselves to show their filial piety and gratitude. Women love flowers, and the best choice is often to choose a bunch of flowers with profound meaning, but carnations and the like seem to be nothing new every year. Black roses are advanced and beautiful, and flowers are gentle and sincere, which seems to be a good choice. But my mother feels happy when she receives flowers, but at the same time she feels that it is not real enough. Wouldn’t it be perfect if the gift is both beautiful, practical and meaningful?

  Keep mom elegant and beautiful with beauty cosmetics.

GISELE BU?NDCHEN celebrated Mother's Day together.

  At the moment of the epidemic, mothers originally liked to receive some lipsticks as gifts, but because the frequency of wearing masks is too high now, the probability of mothers wearing lipsticks is greatly reduced, and the utilization rate is not very high. Therefore, anti-aging and whitening skin care products are very important. After all, for middle-aged mothers, maintaining good skin is more important than making delicate makeup.

  When it comes to skin care products, in the final analysis, it is still necessary to choose products according to the skin quality of mothers. As mature female mothers, the main demands for skin care are still to lift and tighten, lighten spots and remove yellow, resist aging and wrinkle. According to these complaints, the editor has sorted out some popular whitening and anti-aging products. Come and choose gifts!

  First, lifting and firming-product recommendation for anti-aging products

  1, fresh Fu Lei Shi Gu Yuan White Diamond Truffle Mask 3500 yuan /100ml

  The precious "white truffle active essence" will be completely preserved in fresh Fu Lei Poetry, and the ancient white diamond truffle mask 2 will be carefully created. This extraction technology skillfully uses the enzyme as a catalyst to extract the active molecules of white truffles with specific enzymes, thus releasing the effect of active extraction of white truffles. This ingredient can effectively fade expression lines and improve skin toughness and elasticity. Therefore, Guyuan White Diamond Truffle Mask 2 can instantly and intensively nourish smooth skin for 4 or 1 night +18%6, smooth expression lines such as head lifting lines, decree lines and brow lines around 7, at the same time, skin elasticity +23%7, and skin brightness +27%7.

  2. Sea Blue Mystery Concentrated Repair Essence 15ml/1720 yuan.

  The concentrated essence of Sea Blue Mystery can deeply repair, quickly strengthen and resist oxidation, accelerate the self-healing and regeneration of cells, build a matrix network of healthy cells at the bottom, quickly strengthen the skin barrier, instantly relieve the redness and sensitivity of the skin surface, and make the skin strong and regenerate from the inside out. The new aquamarine mystery concentrated repair essence instantly relieves sensitive redness; Continuity-repair the strong barrier; Prospective-Anti-skin oxidation

  3. Yuebi Shidai Mengning Energy Cream 50ml/2965 yuan.

  For the skin that needs immediate special repair, Daimeng Repair Special Cream provides full-effect anti-aging and beauty-beautifying function, and at the same time gives the skin the best ability to self-adjust the protective layer. Pure ursolic acid extracted from "rosemary leaves" can repair damaged skin and enhance skin’s natural ability to resist elastin fiber decomposition. Use it every morning and evening. Evenly apply proper amount to the whole body and neck, and gently massage until completely absorbed. The best skin care effect will be obtained by combining it with Diamond Drops Dream Nourishing and Protecting Gel, and sealing the active ingredients directly to the bottom.

  4, IPSA INFOSHA high-energy black crystal cream 1280 yuan /30g

  The brand-new upgraded high-energy Black Crystal Cream (full name: Black Crystal Rui Misu Facial Cream) brings a brand-new anti-aging idea to the majority of women. A new generation of high-energy black crystal cream combines the cutting-edge technology and precious ingredients of IPSA Japan Research Center, focusing on revitalizing the strength of facial muscles, and making the whole face firm and uplifting by enhancing facial traction and support; At the same time, it contains multiple essences to cooperate with anti-aging and improve the traces of aging in all directions.

  5. Key Crystal Revitalizing Essence of CPB Skin Nickname: Diamond Essence ‘1980/50mL

  The diamond-polishing essence used in the first step after cleansing has three unique essences, and is rich in the brand soul ingredient’ Brightening Muscle and Revitalizing Essence’, which can go deep into the root of skin and start the qualitative change of skin; Adding the essence of five-fold thinning can effectively accelerate skin microcirculation, delay oxidation, deeply activate cell collagen, strengthen and stabilize skin; Activate epidermal cell regeneration; It also incorporates the exclusive’ Instant Penetration Muscle Bottom Technology’, so that multiple thinning and essence ingredients can quickly penetrate into the muscle bottom, awakening skin innovation and qualitative change. Improve the skin quality from the source, make the skin full, bright and tender, shine and beautify the skin, and praise the new beauty of the skin.

  6, Snow Show Yu Shi Tight Yan Shen Yang Essence Dew (super plastic time bottle) 50ml/1360 yuan

  Snow Show’ Superplastic’ Time Bottle contains ginseng peptide and legendary essence of GINSENOMICS?, which concentrates 100,000 rounds of superplastic energy, and adopts the tip suspension microcapsule sealing technology to achieve 7-day superplastic lifting and tightening of skin. Start collagen regeneration within 48 hours after touching the skin, moisten and relieve, improve irritation and make the skin firm layer by layer. A bottle of concentrated 100,000 rounds of legendary vitality and super-plastic energy can improve skin aging in many dimensions. After 8 weeks of use, the skin density was +35.907% filling +24.242% lines -19.962%.

  7, the new Yuxi gold eye cream 480 yuan /20ML.

  Gold-plated eye cream is also compounded with many ingredients, which can effectively fight the problem of dark circles. Aescin can effectively promote eye circulation, add caffeine, effectively dilute dark circles, solve the problem of dull eyes from the source, and make the skin around the eyes clear and bright, leaving a moist, soft and bright look on the bottom of the skin. The essence of rare CORDYSINESIS? high-functional Cordyceps sinensis can effectively reduce the production of protease MMP, thus inhibiting the decomposition and loss of collagen, staying in the muscle bottom collagen and stabilizing the supporting structure.

  8. BIOEFFECT Aurora Limited Edition Essence 4888 Yuan /50ml

  BIOEFFECT Aurora Limited Edition Essence Dew, a little bit can not only create a miracle of skin care. Only 2-4 drops per night can obviously and permanently improve the skin condition. This time, the unique black barley is still used to extract the main active ingredients. Compared with the regular version, the capacity is increased to 3 times and the concentration of active ingredients is increased to 2 times, bringing a truly effective skin care experience.

  9. French Guerlain Emperor Bee Face Cream 50ml/RMB1490

  Guerlain Restoring Cream can not only strengthen the skin barrier, maintain the skin balance, enhance the skin’s natural defense ability, protect it from environmental oxidation factors, bring you smoother, firmer and more balanced skin, and create a natural matte luster. Guerlain Restoring Cream adopts a brand-new formula that is more environmentally friendly, and combines the classic antioxidant vitamin E, which has a powerful repairing effect.

  Every mother was once a girl, who was weak, confused, self-centered and emotional. After years, they are still elegant and beautiful women.

  Second, light spots to remove yellow, brighten skin color products recommended

  After the skin care step, you can use a facial beauty instrument for facial health care to tighten the skin, optimize the facial contour, relieve tension and relieve facial muscles. You can also use a cold care ring and a hot care ring to help the skin absorb cream, reduce facial edema and improve facial luster.

  TheraFace? PRO multifunctional hand-held facial health care instrument. This device combines the three concepts of health, technology and beauty, and takes facial health equipment to a new height.

THERAFACE-PRO- Multifunctional Hand-held Facial Health Care Instrument -LED Red Light
THERAFACE-PRO-COLD

  TheraFace PRO can effectively relieve facial tension, relax facial muscles, realize deep care, and relieve the discomfort caused by migraine, headache and jaw pain. This facial health solution will change the lives of millions of people and make professional facial physiotherapy at your fingertips. The product offers six unique modes,

  We can improve facial contour, increase skin firmness and improve skin health through impulse therapy, LED light therapy, cleaning and micro-current therapy.

  Third, add elegance and agility, and recommend temperament and fragrance

  Affected by the epidemic, masks have become a necessity for everyone to go out. Yes, the mask covers the make-up. If you want to directly highlight your personality, you can use perfume to express it. In order to highlight the temperament of mothers and add elegance and agility, come and see these perfumes!

  Enhance mom’s temperament with exquisite accessories.

  Nowadays, middle-aged and elderly people are gradually becoming active users of WeChat. Middle-aged and elderly people send WeChat messages 44 times a day. At the same time, don’t think that mothers only like to forward some chicken soup for the soul and take beautiful photos of themselves and their friends, which is also a pleasant thing. But how can we make our mother a master of praise in PYQ? These exquisite accessories to enhance temperament must be essential!

  1, tiffany Tiffany chain necklace [China limited edition ]Tiffany HardWear series.

  Tiffany HardWear series design praises the fearless spirit and avant-garde energy of the city. This limited-edition work is designed with this series of iconic links, with carefully polished 18K gold and bright ruby, which is refreshing. Can be worn alone, or stacked to create a stunning shape.

  2、PANDORAWishing bone ring

  PANDORA smooth wishing bone ring (left)

  PANDORA’s bright wishing bone ring (right)

  PANDORA ring is easier to start with than expected, and it is a perfect gift for mom! The 14k gold-plated material is not worried about oxidation and fading when worn, and it looks good when worn alone or mixed.

  3. Hermès Hermes Scarf

  Twill silk "Hermès Story" 90cm square towel

Hermes-Story-scarf-90-cm-in-silk-twill

  The pattern of this square towel was designed by Jonathan Burton, showing a playful wink at social media. In the design, a circus performer stands on a fine horse at the top of a snowy mountain, holding a selfie stick, and her animal companions enter the camera in various difficult postures to jointly maintain their own balance. Behind the mobile phone is a small red heart that keeps flying.

  Twill silk "Isola di Primavera" 90cm square towel

Isola-di-primavera-scarf-90-cm-in-silk-twill

  The designer of this square towel is Matthieu Cossé, who once created a huge mural for Hermè s’ main store in Fubao Avenue, Paris. In this square towel, Matthieu Cossé presents a poetic "spring island": slow waves, warm spring breeze, and flowers and trees that flourish in the sun. With modern design and improvisational watercolor brushwork, the painting represents romantic Italian style full of fantasy.

  4. Daniel Wellington QUADRO CORAL Watch

  QUADRO STUDIO watch

  DW watches have launched a variety of new contours in recent seasons. Quadro Studio with square design uses exquisite and compact square dial to inject fashionable new ideas into classic watches. The whole series is made of polished stainless steel, which is durable and durable, and provides exquisite rose gold plating to meet the mood of wearing it every day.

  5, Chanel box sunglasses

  Sunglasses are really a good choice for mom’s gift, which can not only resist the damage caused by strong sunlight to eyes, but also exude a sense of elegance and extravagance at any time. Chanel’s new box sunglasses are made of metal and calf leather, and wearing these sunglasses to take pictures of mom is simply the most shining star!

  6. Midsummer Moon Jewelry Twinkle Moon

  stars

  The timeless combination of the stars and the moon gives people a mysterious and beautiful feeling and brings infinite fantasy. Design inspiration comes from the universe, in which we are just a blue dot, and human beings are so small that nature needs our praise. The design and modeling combine diamonds with the stars and the moon representing the operation of the universe from the planet, forming a harmonious picture of nature. Designers give jewelry a powerful force with a unique perspective. Yellow diamonds are like the existence of the sun. When the wonderful energy of the sun, moon and stars is combined, the mysterious power of the universe will soon be opened.

  waltz

  The quiet summer waltz, with the dancing music, dances gently in Erpang. The breeze blew gently, bringing fragrance of flowers. This design was inspired by the beautiful party scene in the summer garden. The design of bow ribbon makes the ears full of tenderness and grace. Designers use sapphire inlay to outline the sense of lines, which makes the ribbon unique, gentle and design sense coexist.

  Emancipating Mom’s Hands with Smart Home Appliances

  Compared with digital household appliances such as cameras and computers, mothers may prefer household appliances that can bring convenience to their lives. After all, liberating your hands is your favorite ultimate goal, isn’t it? In recent years, there are many new products that can reduce housework, and some convenient small kitchen appliances can also increase the mood of life and improve the efficiency of cooking.

  1, dishwasher

  It’s hard enough for mothers to cook for their families every day, and they have to clean the dishes after meals. If you don’t want to wash the dishes either, then an excellent dishwasher may solve this problem, which not only protects your hands but also saves time. The function of cleaning and disinfection is also to contribute to the health of your family.

  2, juicer, cooking machine

  When parents are old, they should pay more attention to health. A juicer and a cooking machine can help them enjoy their old age, improve the efficiency of cooking and make their lives healthier and greener.

  3. Sweeping robot

  Family cleaning can be said to be one of the most important tasks for mothers at ordinary times. A sweeping robot that can truly free hands and sweep and drag is almost one of the essential small household appliances in the home. Let the sweeping robot become a necessary item in your home on Mother’s Day.

  4. Eye massager

  Every night, your mother is still working overtime or preparing things for you tomorrow. In order to keep up with the society, the frequent use of various electronic product apps will also increase the duration of eye use. With the growth of age, mothers’ eyesight will gradually decline.

  The eye massager uses infrared rays to heat the eyes, which can adjust the metabolism of the eyes and improve the nutrition of the eyes nerves, which is good for restoring vision. The eye massager can also effectively relieve eye fatigue, improve eye dryness and other symptoms, and also play a role in reducing dark circles. I believe my mother will like this gift on Mother’s Day.

  5. Air fryer

  Air fryer is a popular kitchen appliance in recent years. It can make delicious dishes with little right or no oil, and it can also be used to make dried fruits. The speculation is also very simple, and anyone can make rich dishes.

  Make a gift with your hand to please your mother.

  It is better to buy a bunch of flowers than to make a bunch of flowers by hand. A bunch of handmade flowers can show my mother’s weight in my heart and give her full love.

Image source: pinterest website

  In the end, companionship is actually the longest-lasting confession. It is better to accompany your mother than to send Jinshan Yinshan. The best gift for your mother is that you take time to spend more time with your family. The days when you can accompany your parents are getting smaller and smaller every year. Take the opportunity of the festival to talk to your mother and cook her a meal, or take her out for camping and outing, chat with her more and share your daily life with her!

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Minimalist life of middle-aged people: saving money, preserving health and not having a baby.

Original insight

Author: insight ciyu

Let flowers become flowers and trees become trees.

After middle age, life seems to enter a difficult mode.

Open your eyes and be busy with trivial matters at home and difficult work, close your eyes and worry about the money in your pocket and bother your children’s studies.

40 years old is like a watershed.

You can’t be light any more, and the weight of life is hung on your body, and the years are in a mess.

But the bitterness of life, we can’t avoid it, we can only change the way of living.

Learn to start a minimalist life and manage the following three points, and life will not be too sad.

01

save money

When we were young, we pursued the idea that making money costs nothing and living is meaningless.

I didn’t understand until I was a certain age. If I don’t take money seriously, money won’t take you seriously.

Recently, after revisiting Friends, actor Joey immediately moved into a luxury apartment after becoming the main character.

The weekly salary is used by him to buy brand-name clothes, purses and jewelry.

Occasionally, he is short of cash, and he uses his fame to "brush his face" in the business.

A friend advised him that it was rare for his career to improve and he should seize this opportunity to save more money.

He didn’t agree: why do you have to live like a supporting role when you finally start playing the leading role?

Three months later, the crew cut Joey’s role because the ratings of the series declined.

Joey moved out of the luxury apartment, and the luxury goods he bought at a high price could only be sold at a low price.

When his friend saw him again, he was holding his stomach and auditioning painfully.

It turned out that Joey was infected with hernia shortly after he left the crew. Because he had no savings, he had to find a job first, and then he could reimburse the operation expenses through labor insurance.

From spending money like water to being short of money, Joey’s story verifies Munger’s words:

"The importance of saving money lies not in how happy you are when you have money, but in how embarrassed you are when you have no money."

How many middle-aged people don’t understand this truth

In order to lose face, when a friend buys a limousine, you have to bite your teeth and change it.

For the sake of so-called exquisiteness, you should choose all kinds of famous brands to wear, and you need tens of thousands of clothes.

Earning money is like picking dirt, spending money is like pushing sand with water, and our wallets will be flat if we are not careful.

Now, I agree with an old saying more and more: soup without salt is not as good as water, and people without money are not as good as ghosts.

When is the heart the most bitter? When you treat a disease, your pocket is cleaner than your face, and your heart is the most bitter at this time.

When is the most humiliating time? When you use money, you humbly ask for help everywhere, which is the most shameful.

The writer Li Ao told a story in Money is a Good Thing.

When Sima Guang was prime minister, people often came to visit him.

When he chats with people, the most common question he asks is: "Is your family rich?"

Many people are curious about why Sima Guang asked.

Sima guang explained: if you have no money, you can’t help but bend your back for five buckets of rice; Only when you have money can you have an independent personality. You can not be an official at any time.

Money can not only keep you from starving to death, but also protect your freedom.

How well it is said, money is an amulet, a ship crossing the sea of suffering.

The money to be spent, thousands of dollars and two thousand dollars; You should save every penny of money you shouldn’t spend.

When people reach middle age, everything will rest, and only money can solve their worries.

02

health maintenance

45-55 years old is an interesting age group.

We all say it is the golden age of life.

Doctors call it: the swamp of life journey.

At this age, the body began to decline, organs began to age, and various problems occurred frequently.

Zhihu netizen @ Liyong is a doctor of cardiovascular medicine. He received a 50-year-old uncle.

This uncle is a chain smoker.

He must have three or two glasses of white wine before eating these two meals at noon and evening. If it is a family gathering or a friend’s dinner, he has to drink until he is drunk.

Smoking is even more fierce, with three packs a day. When you are busy, you can have one to relieve your fatigue. When you are free, you can smoke and relax.

Long-term uncontrolled drinking and smoking have laid many hidden dangers for his health.

This winter, once he had a stroke and fainted at home because of excessive drinking. Fortunately, his family sent him to see a doctor in time before he picked up one.

Uncle couldn’t help dying.

In case someone else is really gone, will the whole family collapse?

If he is paralyzed by a stroke, will it drag down his children and partners?

Middle-aged people are the pillar of a family, so they can’t get sick or fall down.

When people reach middle age, it is time to be healthy, not only for themselves, but also for their families.

Here, I have two suggestions for keeping fit.

One is health, health first.

Drink less, smoke less, and plug the loopholes in health from the root.

Exercise more, pay more attention to diet and nutrition, and take good care of your body.

At the same time, insist on regular physical examination every year, track and review the problematic indicators in time, and sweep away hidden dangers.

The second is health care, and it is necessary to raise the heart.

There is a proper noun called "cancer personality".

Modern medicine found that long-term anxiety, fear, sadness and other emotions, these bad emotions will affect and reduce the body’s immunity with a chronic and sustained stimulus, and increase the incidence of cancer.

An inch wider than the heart, ten feet away from illness.

Forget what you should forget, let go, and you will be safe in your heart.

Philosophers have a famous saying: keeping healthy is the responsibility of being a man.

Taking care of your health is the responsibility of middle-aged people.

When we have a good health, we are qualified to protect our families and enjoy family happiness.

03

Bujiwa

For middle-aged parents, the difficulty of life is half the hardship of making a living and half the worry of children’s education.

Especially for the latter, education is a mountain on them.

A wrong question can make them crazy, and a failure in the exam will make them worry.

This should be a word from Professor Peng Kaiping: Education is one of the most anxious places in this society.

In recent years, the news that chickens are anxious is not uncommon.

For example, a boy in Shanxi was slapped by his mother because he was unfamiliar with the knowledge of chemistry.

A pair of 985 master’s parents were so angry with their son that they always had quick-acting rescue pills.

You see, in the end, the parents are exhausted and the parent-child relationship is in jeopardy.

Blogger @ 中中中中 works as a Chinese teacher in a key primary school.

After her son goes to primary school, she will make detailed study plans for her children every day and every week.

Apart from teaching at school, she devoted almost all her time to her children’s study.

In the evening, she will accompany him to finish his homework in various subjects, supervise him to preview and review, and correct problems as soon as they are found.

On weekends, she took her children around in various interest training classes.

Who would have thought that such a chick tortured the children and drove herself crazy.

The child is tired of learning because of the pressure she exerts.

She was angry when she saw the child’s poor learning state.

Mother and son unconsciously fell into a vicious circle of "she is in charge-the child won’t listen-she gets angry-the child loses his temper and doesn’t want to study".

She had to change the way of education: give her children a relaxed learning environment and stop interfering too much.

During that time, she focused on teaching when she was busy, reading books and arranging flowers to entertain her body and mind when she was free, and asked about her children’s learning once a week.

She finally found herself annoyed less often, and her children no longer rejected learning.

Blindly following the trend will only make children depressed and make themselves anxious.

Alison Gopnik, a child psychologist, divides parents into "gardeners" and "carpenters".

The former focuses on children’s habits without excessive intervention.

The latter focuses on their own standards and requirements and transforms children step by step.

Good parents are gardeners.

They only provide soil for children to grow freely.

Let flowers become flowers and trees become trees, which is to free children and fulfill themselves.

Balzac said: In the stormy weather of life, we should learn from the captain and throw away the heavy cargo in the stormy weather to reduce the weight of the ship.

Once a man reaches middle age, he becomes a captain at the helm.

Looking at our life, one thing after another, one level after another, makes people have to rest.

But after careful combing, you will find that the most important things are nothing more than three things: money, health and children.

Halfway through life, learn to switch to minimalist mode.

When we can solve these three major events, we can actually solve our lives.

Original title: "Minimalist life of middle-aged people: saving money, preserving health and not having a baby"

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Luoyang Peony Maternity Hospital became the first member of Henan Genetic and Prenatal Diagnosis Alliance.

  Recently, the inaugural meeting of "Henan Genetic and Prenatal Diagnosis Alliance" sponsored by Henan Maternal and Child Health Hospital (Zhengda Third Affiliated Hospital, Provincial Women and Children Hospital), Henan Birth Defects Prevention and Management Center, Henan Neonatal Disease Screening Center and Henan Prenatal Diagnosis Center was successfully held in Henan Maternal and Child Health Hospital. Luoyang Peony Maternity Hospital, as the first member of Henan Genetic and Prenatal Diagnosis Alliance, participated in this grand event.

  The Alliance of Genetics and Prenatal Diagnosis in Henan Province aims to strengthen the cooperation of prenatal diagnosis institutions in the prevention and control of birth defects and prenatal diagnosis of genetic diseases, and improve the level of prevention and control of birth defects. This time, the hospital signed a contract to become an alliance unit, which will further strengthen communication with provincial maternal and child experts and improve the ability to prevent and control genetic diseases and birth defects.

  Luoyang Peony Maternity Hospital has the qualification of prenatal screening, which mainly carries out prenatal consultation, pregnancy care, non-invasive DNA blood collection, prenatal ultrasound screening, prenatal serological screening and health education to prevent birth defects and hereditary diseases.

  Enjoy free prenatal screening in Peony.

  Luoyang Peony Maternity Hospital is a designated hospital for free prenatal screening and free neonatal screening in Henan Province. It can provide free prenatal screening for couples with at least one registered household in Henan Province or pregnant women without registered household in Henan Province, but the woman has lived in this province for more than 6 months and can provide proof of residence. The details are as follows:

  NT examination: 11 -13 weeks pregnant +6 days.

  By measuring the thickness of transparent layer of fetal neck by ultrasound, the risk of abnormal chromosome and organ structure in early fetus can be investigated.

  Down’s screening:15-20 weeks pregnant +6 days

  By extracting pregnant mother’s serum and combining with software analysis, the risk coefficient of Down’s syndrome in fetus was obtained.

  Ultrasonic examination:Pregnancy 16-19 weeks +6 days

  Pregnant women who miss NT screening at 11-13 weeks +6 days of pregnancy can have a free ultrasound screening at this time.

  Non-invasive DNA blood collection service of peony

  Non-invasive DNA detection is non-invasive prenatal detection of fetal chromosomes. By collecting maternal peripheral blood and detecting the free DNA of the fetus, the risk of fetal chromosomal aneuploidy diseases such as 21- trisomy syndrome, 18- trisomy syndrome and 13- trisomy syndrome can be obtained. The consultation, blood collection, examination and other links in Peony Maternity Hospital are completed in one stop, making it more convenient to see a doctor.

  Peony prenatal ultrasound screening for maternal and infant care

  Prenatal ultrasound is an important examination method for screening fetal malformation, which can effectively reduce the risk of delivery and the occurrence of neonatal birth defects. This is especially true in the era of second and third children. Experienced doctors in ultrasound department of Peony Maternity Hospital provide intimate ultrasonic diagnosis service for pregnant mothers through GE series ultrasonic equipment in the United States. From time to time, experts from the ultrasound field are invited to guide and exchange, so as to ensure the healthy growth of women, fetuses and children at all stages.

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Jiexiu in Jinzhong, Shanxi Province: Implementing Static Management in the City

  CCTV News:According to Weibo released by @ Jiexiu, on August 26th, Jiexiu City successively issued the Notice of Jiexiu City on Implementing Static Management in the City, the Notice of Jiexiu City on Carrying out Preventive All-staff Nucleic Acid Detection in the City, and the Notice of Jiexiu City Public Security Bureau on Temporary Road Traffic Control.

  According to the circular, Jiexiu City received an investigation letter from Jinzhong City, informing that the positive cases in Qingxu County and xiaodian district of Taiyuan City had an activity track in Jiexiu City. According to the current epidemic situation, in order to protect people’s life safety and health, and prevent the spread of the epidemic, the leading group for the prevention and control of pneumonia infected in novel coronavirus decided to implement static management in the city. Static management time: 13: 00 on August 26th & mdash; 24:00 on August 28th. During the period, the whole city remained silent, and it was necessary not to go out. In principle, it was necessary to stay at home. All personnel are subject to "three inspections in three days", and key personnel are subject to the original control measures.

  According to the notice, all motor vehicles are prohibited from passing on the road during the static management period (except for epidemic prevention and control, special vehicles performing tasks), and red light control monitoring equipment is enabled at all intersections in the city, and violations of the notice will be dealt with according to law.

  Notice of Jiexiu Municipality on Implementing Static Management in the City

  On August 26th, 2022, at 02:00 and 3:24, our city received the investigation letter from Jinzhong City, informing that the positive cases in Qingxu County and xiaodian district of Taiyuan City had an activity track in our city. According to the current epidemic situation, in order to protect people’s life safety and health, and prevent the spread of the epidemic, the leading group for the prevention and control of pneumonia infected in novel coronavirus decided to implement static management in the city. 

  1. Static management time: from 13: 00 on August 26th & mdash; Static management was implemented at 24:00 on August 28th. During the period, the whole city remained silent, and it was necessary not to go out. In principle, it was necessary to stay at home. All personnel are subject to "three inspections in three days", and key personnel are subject to the original control measures.

  Two, the implementation of traffic control, railway stations, train stations, bus stations, high-speed intersections to limit the flow of people, the implementation of traffic control. The city’s guaranteed supply, production, stability and epidemic prevention vehicles pass through, and the guaranteed supply enterprises "point-to-point" pick up and drop off, and social vehicles that do not meet the requirements do not run or flow.

  Three, in addition to the supermarket, pharmacy and medical institutions and other places, the rest of the business premises will be suspended offline business. Institutions, enterprises and institutions and various social organizations do not hold gathering activities.

  Four, all kinds of kindergartens, off-campus training institutions to stop offline teaching, boarding schools have started, with closed conditions, the implementation of closed management, closed-loop operation. Old-age care institutions implement closed management and do not visit unless necessary. All project sites under construction in the area shall be managed in a closed way and operated in a closed loop.

  Five, all kinds of clinics and pharmacies to suspend the "one refund and two resistance" sales. Any person with a history of living in a key epidemic-related area shall be reported to the relevant competent department immediately.

  Six, the masses do not have to leave the city, to introduce tourists to live in hotels, guesthouses, inns, homestays in silence on the spot, in accordance with the provisions of the nucleic acid testing.

  Seven, within the scope of regional control in-service party member to bright identity, on-the-spot active investment in epidemic prevention and control work, service community treatment and transshipment, nucleic acid sampling and publicity, living materials security, community service security, policy propaganda, emotional comfort, psychological counseling, order maintenance and other work.

  Eight, the city to the community (village) as a unit, to co-ordinate the establishment of nucleic acid testing sampling points, in accordance with the designated time and place to carry out all the nucleic acid testing. Please actively cooperate with the general public, follow the arrangement of the street (township) and community (village) to go to the sampling point, and complete the sampling work according to the guidance of the staff. When testing, please bring your ID card and take the initiative to show the "sampling code". Please wear a mask all the time during the collection process, and keep a distance of more than 2 meters from others, without talking or gathering.

  Nine, fever, cough and other symptoms report to the community (village) at the first time, in accordance with the relevant provisions of the epidemic prevention and control to the fever clinic, it is strictly prohibited to conceal, omit or delay the report.

  Ten, severely punish violations of laws and regulations. At present, the city has sufficient reserves of living materials. Please do not panic, make rumors, believe in rumors or spread rumors. The public security organs will investigate the relevant responsibilities of those who refuse to cooperate, disturb the order, make rumors and create troubles, and conceal, falsely report or falsify information.  

  Jiexiu novel coronavirus infected pneumonia epidemic prevention and control work leading team office

  August 26th, 2022      

  Notice of Jiexiu city on carrying out preventive nucleic acid testing for all employees in the city

  In view of the current grim situation of epidemic prevention and control, in order to effectively protect people’s health and life safety, according to the research of the Municipal Leading Group for Epidemic Prevention and Control, it is decided to conduct static management of the whole city from August 26 to August 28, and carry out preventive full-time nucleic acid testing. The specific arrangements are as follows:

  First, the static management time starts at 13:00 on August 26th, 2022. During the static management period, the people in the whole city will stay at home, so as to "stay inside, stay outside, and stay inside". In principle, they must stay at home.

  Second, the sampling range and requirements

  1. Take the village and community as the unit and the grid as the smallest unit, set up nucleic acid sampling points as a whole, and carry out all-staff nucleic acid testing at the designated time and place. In order to complete the nucleic acid detection as soon as possible, residents are requested to actively cooperate, follow the arrangement of the village and the community, go to the sampling point, bring their resident ID cards, and log in to WeChat "Jinzhong Nucleic Acid Detection Terminal" in advance to generate a sampling code (screen capture can be saved, or a paper version can be printed in advance).

  2. Please wear a mask throughout the collection process, keep a distance of more than 2 meters from others, and return immediately without talking or gathering.

  3. Those who have not been vaccinated with Covid-19 vaccine for more than 48 hours will not participate in the full-time nucleic acid test after reporting to the community (village) where they live.

  Third, matters needing attention

  1. During the whole staff nucleic acid test, temporary traffic control will be implemented in the whole city. Except for special vehicles such as police cars, fire engines, ambulances, garbage trucks and material support vehicles, other social vehicles are not allowed to drive on the road. Only three high-speed exits, train stations, railway stations and Sanxian Avenue are reserved in the referral channel, and the original mechanism and process are maintained to work normally, so that the referral personnel can collect nucleic acids on the spot. In principle, you can’t get in or out, and the rest of the staff are strictly in a static state at their current residence, and they don’t flow at home.   

  2. Except for large factories, mines and enterprises related to people’s livelihood security and production safety, other enterprises suspend production; Restaurants, entertainment and other business stores are closed. Departments in charge of various industries should promptly notify enterprises and business premises in various industries, and enterprises should make early preparations and make reasonable adjustments to the transportation of goods within the specified time and region. The necessary personnel on duty in the unit and the personnel maintaining the operation of the enterprise should ensure that they arrive at their posts or stay at home before the start of the static management period, and other personnel stay at home and wait for arrangements. The relevant units and industry authorities are responsible for the normal staff, and the list of personnel and vehicles should be reported to the Municipal Prevention and Control Office in advance. After the summary, the Municipal Prevention and Control Office will report to the public security traffic police and issue passes.

  3. Teachers, students and employees in closed management schools shall be isolated and controlled centrally, and people with disabilities, bedridden and other mobility difficulties shall be arranged to conduct on-site nucleic acid sampling in a unified manner.

  4. Residents and friends who have symptoms such as fever and cough, please don’t go to the sampling point, report to the local community in time, and on the basis of personal protection, go to the fever clinic of the People’s Hospital for treatment and collect nucleic acid.

  5. If there are special circumstances such as critically ill patients seeking medical treatment and pregnant women giving birth, please call 120 emergency number in time.

  6. This full-time nucleic acid test is a preventive test and a concrete measure to implement the requirements of "four mornings". Please actively cooperate with the urban and rural residents, and do not panic, spread rumors, believe in rumors, spread rumors, or stay and watch.

  7. Please take the initiative to participate in the inspection, otherwise it will affect the decoding and transcoding of personal "red code" and "yellow code" in the later period.

  8. For residents who do not participate in the full-scale nucleic acid test without justifiable reasons, I will bear corresponding legal responsibilities in accordance with the Law of People’s Republic of China (PRC) on the Prevention and Control of Infectious Diseases and other relevant regulations. Those who refuse to cooperate, do not support the nucleic acid detection work, disturb the order, conceal, lie or falsify information will be strictly investigated for legal responsibility according to law.

  Safe rest, thank you. Sincerely thank the residents and friends for their understanding, support and cooperation!

  Jiexiu COVID-19 epidemic prevention and control work leading team office

  August 26th, 2022   

  Notice of Jiexiu Public Security Bureau on Temporary Road Traffic Control

  The general public and driver friends:

  According to the requirements of the epidemic prevention and control leading office of COVID-19 City, Jiexiu City, from 13: 00 on August 26th, 2022 to 24: 00 on August 28th, 2022, the whole city will implement temporary global static management. During the static management period, all motor vehicles will be prohibited from passing on the road (except special vehicles for epidemic prevention and control and performing tasks). At the same time, all intersections in the city will be enabled with red light control and monitoring equipment, and violations of this notice will be dealt with according to law.

  notice is hereby given (that)

  Jiexiu bureau of public security

  August 26th, 2022

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Is the price in the northeast really so outrageous?

Xiaopi, as a Northeastern, recently suddenly discovered that the whole network is envious of the price in Northeast China. I thought it was some internet hype routine until I saw the feelings of foreign friends in my circle of friends …

I wonder if these are all normal operations? As a result, this friend from Hangzhou not only lamented the good quality and low price of watermelons in his circle of friends, but also secretly praised me again and again …

Is the price in Northeast China really so cheap?

Boy, just open an app and turn it over. The Northeast Morning Market seems to be the spiritual hometown of a new generation.

What can 20 yuan eat in the morning market in Northeast China? 》

How low is the price in Northeast China that shocked southerners? 》

"Visiting the Northeast Morning Market, it’s so affordable! 》

……

If it’s just for breakfast, it’s only 10 yuan, which will definitely make you go in hungry and hold the wall out.

Corn flour pancake, 4 for 1 yuan.

Salted bean curd, 1.5 yuan a bowl.

Big fruit longer than the face (southern fried dough sticks), 1 yuan each.

Fire spoon with beef and onion stuffing, 8 cents each.

A bowl of glutinous rice noodles is full of 4 yuan.

Bloggers reported the price of the local morning market to the people of the whole country, and the feeling of being surrounded by food was simply too safe.

"Even if you earn 1,000 yuan a month, you can live in Tieling."

Aside from these carbohydrate snacks, fruits and vegetables in the northeast morning market are also horribly cheap.

Three catties of kiwi fruit for 10 yuan, five catties of big apples for 10 yuan, and sugar oranges for 2 yuan a catty …

The white-collar workers sitting in the office of Beishangguang looked at the fruit and vegetable salad they bought for dozens of pieces. Did the few kiwifruit and apple slices in the bowl leave envious saliva?

Visiting the morning market in the northeast, you must be good at math. Facing the vendor’s quotation, "4 for 3 yuan, 7 for 5 yuan, and 10 for 7 yuan" …

The southern friends who visit the morning market always repeat a few words in their mouths all the time:

"Oh, it’s so cheap!" "Oh, such a big one!" "Oh, that’s too much!" "Oh, that’s a good deal!"

With ultra-low prices, rare specialties and enthusiastic shopkeepers, the Northeast Morning Market attracts food bloggers from all over the country to punch in.

No one can resist the temptation of the steaming morning market, just as no one can resist the warm call of the northeast aunt, "Come and buy some, boys!"

Young people may not get up in the morning market. But in summer, who can’t help but stir up the ice cream?

If you have ever rushed into a convenience store on a hot afternoon and grabbed an ice cream from the freezer to pay directly, the number displayed on the screen-with a high probability of double digits-may give you a head-on blow as a reckless young man:

Why is ice cream so expensive now? Is it made of gold?

The northeast ice cream has maintained an incredible "childhood price" until now.

Take the classic "Bigfoot" as an example. The chocolate crispy skin is covered with dense melon seeds, which are fragrant and crisp when bitten.

But its price is only 1 yuan for one, and you can get another one if you buy 10.

Even ten dazzling ones are cheaper than a online celebrity ice cream, which makes people wonder whether the factory can return to its original cost.

If you ask the owner of an ice cream stand, "How much is this ice cream?" He will probably say to you, "Look on the whiteboard."

Looking at the whiteboard, boy, orange, honey beans and an egg are basically the prices in 1 yuan.

3 yuan is the most expensive "Baroque Crispy Tube" with a noble name.

As we all know, you can usually enjoy the wholesale price when you buy ice cream in the northeast.

Generally speaking, if you buy more than 10 pieces at the northeast ice cream stand, the boss will let you choose one or two as a friendship gift.

Go to the ice cream stand with twenty or thirty dollars, and you can easily return with a full load.

And the same amount is out of the northeast, maybe you can only buy two ice creams to "eat lightly". Northeast ice cream easily "shocked southerners for a whole year" with its generous attitude.

Of course, if it’s only cheap, I’m afraid northeast ice cream is not enough to make people miss it.

But at the same time, the price is low, and there are many kinds of flavors, not only regular mung beans, red beans, chocolate, milk fragrance …

There is even a limited flavor of sesame sauce and cold dog (milk sesame flavor) in the north.

It is said that every small partner who came out of the northeast once cried in the middle of the night because he missed the sesame sauce ice cream.

Even the daily fruit flavor with milk fragrance can match unexpected effects.

A piece of fresh fruit time is not only visually colorful, but also full of sandwiches to make it sour and sweet.

A cup of lemon yogurt with a few cents is rich in milk flavor, and lemon and yogurt are just right. A square cake filled with red beans and glutinous rice costs only two yuan.

In addition to good quality and low price, "fun and interesting" is also the magic weapon to win the Northeast ice cream.

After all, who doesn’t have the memory of eating "doll head" ice cream with friends from three to five when he was a child?

What you must do before eating is to compare the expression of the villain who is the most ferocious after opening the bag.

The magic cup ice cream with "digital baby" can be deducted from the bottom, and how many children in Northeast China can buy happy memories with a dollar in childhood?

However, the most popular is the simplest and simple old popsicle. The simplest formula and simple shape constitute the happiest memories of summer.

Even with the soaring prices, online celebrity ice cream emerges one after another, and the average price of ice cream in Northeast China has not risen by 3 yuan.

Faced with the price of online celebrity ice cream of tens of yuan, it seems that only Northeast ice cream is still "Do not forget your initiative mind", helping people realize their desire to eat ice cream.

In the dazzling ice cream market, Northeast ice cream is made of real raw materials and sold at reasonable prices.

It is the best tribute to the summer in the Northeast.

In the northeast, look for these ice cream brands!

Northeast ice cream has a history of decades or even hundreds of years. Zhongjie was born in 1946, and Mattel was born in 1906. Harbin’s famous Antarctic cold drink hall is 74 years old.

The right time, the right place and the right people, the northeast ice cream also lived up to expectations, winning half of the domestic ice cream industry in one fell swoop.

# Northeast Snow Cake Map #

Liaoning Shenyang Zhongjie Daguo

From Zhongjie Daguo to Zhongjie 1946, it is no exaggeration to call it Tianwang Ice Cream. The famous Zhang Zuolin is the first "image spokesperson" of Zhongjie Daguo. The most classic is the taste of sesame sauce (not dark at all)!

Harbin Madiel, Heilongjiang

Madiel in Harbin Central Street. Founded in Harbin in 1906 by French Jew Casper, it was originally named "modern" and transliterated as "Madiel". Not only does milk taste heavy, but it bites solid.

Coupled with the European style of the Central Street and the snowy weather, people will automatically bring in idol dramas immediately ~

Heilongjiang Daqing Ruby

"The famous brand has fallen to the dregs, and the packaging seems to be a little outdated", which was the evaluation of the northeast big board before it caught fire. With the price advantage of 2 yuan each and the advantage of milk source, Ruby’s Northeast Daban is deeply loved by er in the south.

Heilongjiang Jiamusi Baijiade

Another seed player of Northeast Ice Cream F4-Baijiade, you must know Sophia Rum sorbet in online celebrity bowl! That’s what a hundred schools of thought come up with! I suggest you try their wafer ice cream. It’s delicious!

Jilin Siping Hongbaolai

Humboldt has never lost in creating online celebrity products. Their family’s eight-treasure porridge, peanut sauce, litchi soda … runs through the childhood of every Jilin child.

There are also the legendary Tsar jujube, coffee ice cream, double yellow egg ice cream, grilled yogurt ice cream and so on. Humboldt really keeps pace with the times.

It is always said that the ice cream of the northeast people is not understood by the southerners. I wonder if the southerners understand it after reading this article? Want to eat ice cream in the northeast?

In a word, it is more like an exit than an ice cream. Take you away from the heat and anxiety for a short time and comfort you: don’t worry, take your time.

▽ Hey, who’s the Piss Travel? ▽

The high travel team in that world,

Committed to the in-depth experiential travel of young people.

Deep exploration throughout the process,

Take you to experience the unknown joy and passion.

Original title: "Is the price in Northeast China really so outrageous? 》

Read the original text

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Interpretation of the Notice of the Development and Reform Commission of the Ministry of Industry and Information Technology of the Ministry of Finance on the Financial Subsidy Policy for the Promotio

Recently, the Ministry of Finance, the Ministry of Industry and Information Technology, the Ministry of Science and Technology and the Development and Reform Commission (hereinafter referred to as the four ministries) jointly issued the Notice of the Development and Reform Commission of the Ministry of Industry and Information Technology of the Ministry of Finance on the Financial Subsidy Policy for the Promotion and Application of New Energy Vehicles in 2022 (Cai Jian [2021] No.466, hereinafter referred to as the Notice), which is now interpreted as follows:

First, about the background of the "Notice"

In accordance with the decision-making arrangements of the CPC Central Committee and the State Council, since 2009, the Ministry of Finance and relevant departments have strongly supported the development of new energy automobile industry. Thanks to the joint efforts of all parties, the technical level of new energy vehicles in China has been continuously improved, and the product performance has been significantly improved. The production and sales scale has ranked first in the world for six consecutive years.

In April 2020, the four ministries and commissions jointly issued the Notice on Improving the Financial Subsidy Policy for the Promotion and Application of New Energy Vehicles (Cai Jian [2020] No.86), which clarified that "in principle, the subsidy standards for 2020 -2022 will be reduced by 10%, 20% and 30% respectively on the basis of the previous year, and the vehicles that meet the requirements in the public transportation field will not be reduced in 2020. In 2021, the new energy automobile industry still achieved substantial growth in the face of adverse effects such as global epidemic spread and chip shortage, and the industrial development trend was good. In 2022, the subsidy policy will continue to decline in an orderly manner according to the established arrangements, creating a stable policy environment. The four ministries and commissions jointly issued the Notice in the near future, clarifying the relevant requirements of the financial subsidy policy.

Two, about the new energy vehicle purchase subsidy standard in 2022

According to document No.86 [2020] of Caijian, the subsidy standard for purchasing new energy vehicles in 2022 will be reduced by 30% on the basis of 2021; For new energy vehicles that meet the requirements in urban public transport, road passenger transport, rental (including online car rental), sanitation, urban logistics and distribution, postal express delivery, civil aviation airports and official fields of party and government organs, the subsidy standard in 2022 will be reduced by 20% on the basis of 2021. According to this, the "Notice" clarifies the subsidy standards for different types and different fields of vehicle products, and will be implemented as of January 1, 2022.

III. Requirements for technical indicators of new energy vehicle products in 2022

In recent years, under the guidance of subsidy policy, the supply quality of new energy automobile products in China has been continuously improved, the technical level has been significantly improved, and the practicality of products has been greatly improved. According to document No.86 [2020] of Caijian, "In principle, the technical indicators will be generally stable in 2021-2022", the purchase subsidy policy in 2022 will keep the thresholds of technical indicators such as energy density, driving range and energy consumption of the power battery system unchanged, and stabilize enterprise expectations.

Four, on the clear purchase subsidy deadline node

According to the requirements of Caijian [2020] No.86 document, the implementation period of financial subsidy policy for the promotion and application of new energy vehicles will be extended to the end of 2022, taking into account factors such as technological progress and scale effect. Considering the development plan of new energy automobile industry, market sales trend and the smooth transition of enterprises, in order to maintain the good development momentum of new energy automobile industry and stabilize the expectations of the industry and consumers, the Notice clarifies that the subsidy policy for new energy automobile purchase will be terminated on December 31, 2022, and vehicles that are licensed after December 31 will no longer be subsidized.

V. On Further Strengthening Product Safety Supervision

The safety of new energy automobile products concerns the vital interests of consumers and is an important guarantee for the healthy and orderly development of new energy automobile industry. In recent years, new energy vehicle products with intelligent networking characteristics have been gradually applied to the market, and the problems such as data security and network security have become important concerns. Fires and safety accidents of new energy vehicles still occur from time to time in China. In order to further strengthen product safety supervision, ensure vehicle quality and information safety, and effectively protect the interests of consumers, the Notice clearly puts forward measures such as improving the safety supervision system of new energy vehicles and further compacting the main responsibilities of new energy vehicle manufacturers. At the same time, an inter-departmental information sharing mechanism and a vehicle accident reporting system will be established around vehicle fires, major accidents, etc. For enterprises that conceal accidents and do not cooperate with the investigation, the vehicle subsidy qualification will be suspended or cancelled according to the seriousness of the case.

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In 26 years, the impact factor is six times longer, and the domestic academic journal Cell Research has created a miracle.

The cover of the first issue of Cell Research)2016 published the latest research on the origin of dogs by scientists in China.

Since its publication 26 years ago, the impact factor has increased from about 2 to 14.812, and the international academic journal CR (Cell Research) from China is considered to have created a miracle.

On June 13th, the Intellectual Property and Technology Division of Thomson Reuters released the latest Journal Citation Reports? (JCR) in 2016, which provided various annual journal metrics including Journal Impact Factors (JIF). The report covers 11,365 academic journals in 234 disciplines in 81 countries and regions around the world.

The higher the impact factor, the greater the influence of academic journals.

According to the report, in the field of life sciences composed of biochemistry, molecular biology and cell biology, the Scientific Citation Index (SCI) has collected 423 international academic journals in the world, and Cell Research ranks 10th in terms of impact factors, and it is also the first academic journal in the life sciences in the Asia-Pacific region.

In this report, Cell Research is defined as an academic journal in the field of cell biology, but in fact, it is a comprehensive journal in the field of life science.

In the aforementioned ranking of life sciences, there are only three comprehensive journals ranked before Cell Studies, namely, internationally renowned academic journals Nature Medicine, Cell and Nature Cell biology (Nature and Science), which are comprehensive publications, including not only life science papers, but also astronomy.

This is also the first time that the influencing factors of Cell Research have surpassed the internationally renowned academic journals, such as MC (Molecular Cell) and NSMB (Nature Structural & Molecular Biology).

If only from the numerical comparison, among all disciplines, Cell Studies is the academic journal with the highest impact factor in China at present (in the actual ranking, it is only compared within the scope of classmates and the same field).

On the afternoon of June 15th, Pei Gang, an academician of China Academy of Sciences and president of Tongji University, told The Paper (www.thepaper.cn) that Cell Research was moving towards the top international academic journals. Its rise benefited from the rapid development of life science research in China, and it was also helping China scientists in the field of life science win more and more right to speak.

On the afternoon of June 15th, Pei Gang, editor-in-chief of Cell Research and academician of Chinese Academy of Sciences, was interviewed by the media.

Chinese and foreign scientists contributed equally.

Cell Research is a monthly magazine, which was founded in 1990. In 2006, Pei Gang began to be the editor-in-chief. At that time, the influence factor of Cell Research was 2.161.

Pei Gang revealed that graduate students of the Chinese Academy of Sciences need to publish good and high-impact papers after graduation. In the past, in order to support the development of Cell Research, the Chinese Academy of Sciences gave a regulation that if a paper was published in Cell Research, they could also graduate. At that time, people were invited everywhere to contribute articles, but now, they can’t send them through the back door.

In 2006, Pei Gang introduced Li Dangsheng, Ph.D. in molecular biology, who was then the deputy editor of the top international academic journal Cell, back to China, and asked him to be the executive deputy editor. Since then, the influencing factors of Cell Research have started to climb year after year.

On the afternoon of June 15th, Li Dangsheng, executive deputy editor of Cell Research, was interviewed by the media.

Li Dangsheng told The Paper (www.thepaper.cn) that some people did want to publish papers through the back door a few years ago, but now there is no more. Having been rejected several times, they knew the style of Cell Research. At present, the magazine receives about 1600 articles each year, and less than 100 articles can be selected for publication.

Cheng Lei, director of the editorial department of the magazine, said that Chinese and foreign scientists contributed 50% of the articles and published about the same proportion.

Academic research attaches importance to originality, and whoever publishes the paper first is often the owner of the scientific research results. Cell Research is regarded as the "fast lane" for the publication of high-quality scientific research achievements in China.

Li Dangsheng said that only top papers and high-quality scientific research results can enhance the grade and influence of Cell Research. Therefore, papers that want to be published through the back door must not work. The secret of improving the impact factor of Cell Research lies in "finding the missing", and two kinds of papers are favored by it. One is that they have not been published in top international academic journals such as Nature, and the other is that top scientists are willing to support the papers of Cell Research. To pull such a paper, first, it depends on the eye, and second, it depends on the "relationship." Editors should be very knowledgeable, in order to build a strategic position and give professional opinions and suggestions, and the editorial department should also respond quickly, provide good service and review quickly, so as to win the trust and respect of scientists.

On the afternoon of June 15th, Dr. Li Dangsheng, executive deputy editor of Cell Research, introduced the journal.

Two cases of "missing"

In this regard, Luo Zhenge, a researcher at the Institute of Neuroscience, Chinese Academy of Sciences, has a deep understanding.

Diseases caused by Zika virus can often heal themselves, but pregnant women infected with Zika virus may cause microcephaly in newborns. However, the direct evidence of microcephaly caused by the virus has been lacking, but only the relevant data based on epidemiological investigation.

At the beginning of 2016, imported cases of Zika virus first appeared in China, and scientists in China isolated the related virus strain SZ01.

Based on this virus strain, in April, Luo Zhenge’s research group proved for the first time that Zika virus can cross the placental barrier, resulting in the decrease of lateral ventricle cavity and the obvious decrease of cerebral cortex area in offspring mice.

This is the first discovery in the world, and it is the direct evidence that Zika virus causes microcephaly. The animal model can be used in the follow-up research and development process such as vaccine and drug testing.

Because of the obvious experimental phenomenon, Luo Zhenge submitted his research paper to an internationally renowned academic journal for the first time, but the international reviewers put forward more stringent requirements for the paper. Luo Zhenge, who was well aware of the fierce competition in this research field, immediately transferred the paper to Cell Research, and submitted it on April 24. Within 72 hours, two international reviewers gave good comments. After a short supplementary experiment, the paper was accepted on May 2 and published online on May 13.

Almost at the same time, several other similar studies were published in top international academic journals such as Nature, Science and Cell Stem Cells.

Another case is that in 2008, the research team led by Zhang Chenyu, a professor at Nanjing University, found a stable small RNA in the blood, which opened a new research field, but its paper was frustrated when it was reviewed by academic journals such as Nature, and it was delayed to be published. After learning this situation, Li Dangsheng won the paper over and finally published it in Cell Research. Up to now, according to the statistics of SCI core database, this paper has been cited more than 1500 times. This citation exceeds most research papers.

Let China’s high-quality scientific research achievements be discovered and recognized

On the afternoon of 16th, Luo Zhenge told The Paper that although China’s life science research has made great progress, in the international academic circle, China scientists whose English is not their mother tongue are still at a disadvantage in the competition. In particular, editors of many international academic journals are more familiar with foreign scientists than China scientists. However, Cell Research provides an opportunity for China’s high-quality scientific research achievements to be discovered and recognized by the international community.

At present, Cell Research has 6 editors, each of whom handles about 300 research papers every year.

Li Dangsheng said that in addition to the huge workload, another challenge faced by editors is that knowledge is updated quickly, and life sciences include many fields such as immunity, stem cells, developmental biology, structural biology, etc., and they need to study frequently to have the ability to review related papers. 30% of the papers in Cell Research are available for open access (free download), and the remaining 70% need to be paid.

Cheng Lei revealed that, except for government-funded funds, Cell Research basically achieved a balance of payments by collecting subscription fees from foreign institutions.

Jia Hepeng, former editor-in-chief of Science News magazine of Chinese Academy of Sciences and former head of China region of British Science and Development Network (SciDev.Net), told The Paper on the evening of 16th that there are many periodicals, but few good ones. Compared with start-ups, the establishment of high-quality academic publications is not burning money, but it still needs stable support so that the editorial department does not have to rack its brains for money. In particular, scientific communication is very important to improve the citation rate of individual papers and the influencing factors of journals. Some China journals have been unable to do it for many years, and the reason is that they have not done enough in scientific communication. They have always been urged by the government to do it, but they will not do it until the official gives money. However, in this respect, Cell Research has further introduced the high-quality scientific research achievements of China scientists by cooperating with springer-Nature and relying on the latter’s scientific communication ability.

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Huawei Yu Chengdong bombarded "friends" and Xiaomi openly "fought". What happened between the two sides?

The patent dispute was once again staged between Xiaomi Group and Huawei. On December 12, Xiaomi Group issued a statement saying that recently,Mr. Yu Chengdong made false statements against the company’s "keel shaft" technology for no reason, which was seriously inconsistent with the facts.

The dispute stems from the speech made by Yu Chengdong, managing director of Huawei, CEO of terminal BG and chairman of BU, a smart car solution, at the Huawei Pollen Annual Meeting in 2023: "Don’t respect us very much.(Huawei)Intellectual property rights, take it and just make up a name and say your own. Double-rotating water drop hinge directly becomes keel hinge, and keel does not exist. " 

It is worth noting that both the "double-rotating water drop hinge" and the "keel hinge" are the key components of the folding screen mobile phone, which is the key to determine the completion of the folding screen mobile phone product. In the context of sluggish demand in the terminal market, the "dark horse" of folding screen mobile phones has a considerable market in the future. Moving towards folding screens has become a tacit strategic direction for mobile phone manufacturers.

First, Xiaomi Group publicly clarified

At noon on December 12th, the reporter of national business daily learned from Xiaomi Group that the spokesman of Xiaomi Company released a clarification message through Weibo, saying that recently, Mr. Yu Chengdong made false remarks against the company’s "keel shaft" technology for no reason, which was seriously inconsistent with the facts. Please ask Mr. Yu Chengdong to follow the basic rules of "science and rigor" and stop discrediting his peers and misleading the public.

Image source: Sina Weibo

This "war" originated from the speech made by Yu Chengdong, managing director of Huawei, CEO of BG and chairman of BU, a smart car solution, at the 2023 annual pollen conference. At that time, he once "bombarded" friends and merchants for plagiarism: "Don’t respect us very much.(Huawei)Intellectual property rights, take it and just make up a name and say your own. Double-rotating water drop hinge directly becomes keel hinge, and keel does not exist. " 

This remark attracted Xiaomi’s "return".

According to Xiaomi Group, the "keel shaft" is a new generation of folding shaft developed by Xiaomi Group, and it is the first three-level rod group structure in the industry. No matter the design idea or the mechanical structure, the "keel shaft" is completely different from the "double-rotating water drop hinge" declared by Mr. Yu Chengdong.

Xiaomi said that after studying the technical information and published patent information disseminated by Mr. Yu Chengdong’s company, and after actual disassembly and verification, the "double-rotating water drop hinge" adopts the design scheme of "2-level rod group, 3 components and 4 low pairs"; The mechanical structure of Xiaomi’s self-developed "keel shaft" adopts the innovative design of "3-level rod group, 5 components and 7 low pairs".

At the same time, Xiaomi also took a number of screenshots in the social media comment area, saying that the company’s self-developed "keel shaft" applied for a patent on September 18, 2020 and was granted a patent on January 5, 2021; August, 2023 in Xiaomi MIX Fold.(Mobile phone model)On the first application. The "double-rotating water drop hinge" claimed by Mr. Yu Chengdong applied for a patent on December 13th, 2019 and was published on June 18th, 2021. Yu Chengdong’s company’s patent application for the three-level bar group was filed on October 29th, 2021 and made public on May 5th, 2023. So far, there is no information to confirm the authorization, and it has not been commercialized.

Judging from the attitude of Xiaomi Group, this response can be described as sharp: "Please ask Mr. Yu Chengdong to follow the basic rules of’ science and rigor’, and don’t discredit his peers and mislead the public."

As of press time, Huawei has not responded to the above statement of Xiaomi Group.

Second, the patent dispute between the two parties is not the first time.

In the face of this "Mihua patent dispute", many netizens expressed their opinions in the comment area.

National business daily reporter noticed that many netizens talked about the different types of patents involved in Xiaomi and Huawei. According to the information disclosed by Xiaomi, the patent type of the company’s "hinge, display module and terminal equipment" is "utility model"; Huawei’s patent type of "folding mechanism and folding electronic equipment" is "invention application".

Some netizens’ opinions Image source: social media screenshot 

However, some netizens pointed out that,Xiaomi’s patent for "hinge, display module and terminal equipment" also involves "double application in one case" when applying.

According to the analysis of a person in the industry who did not want to be named, the above case of Xiaomi may involve "double application in one case". Paragraph 1 of Article 9 of the current Patent Law stipulates: "Only one patent right can be granted for the same invention-creation. However, if the same applicant applies for both a patent for utility model and an invention patent for the same invention-creation on the same day, and the patent right for utility model obtained first has not been terminated, and the applicant declares to give up the patent right for utility model, the invention patent right may be granted. "

According to public information, the "keel hinge" technology is used on Xiaomi’s flagship folding screen mobile phone Xiaomi MIX Fold 3 released this year. Lei Jun, chairman of Xiaomi, once said that Xiaomi keel shaft contains 198 parts, 14 movable joints and 3-level linkage structure, which can provide better screen protection while realizing thinness.

Xiaomi MIX Fold 3 (right) Image source: Xiaomi official website screenshot

The "double rotating water drop hinge" was first proposed by Huawei in 2021. At that time, Yu Chengdong said at the press conference that Huawei’s water drop hinge is an exclusive patent, and other companies must use Huawei’s patented technology if they want to realize seamless folding screen.

Huawei Mate-x folding screen mobile phone Image source: national business daily (data map) 

It is worth mentioning that,This is not the first time that Huawei and Xiaomi have had differences on intellectual property issues.On January 17th this year, China National Intellectual Property Administration accepted the patent infringement case brought by Huawei, the claimant, against Xiaomi. Judging from the contents of the patents, the above four patents involved in disputes are respectively: method and device for sending control signaling, method for feeding back ACK/NACK information during carrier aggregation, base station and user equipment, method and terminal for acquiring panoramic images, screen locking method and mobile terminal.

On March 1, Xiaomi responded: "The two sides are actively negotiating on patent licensing." Since then, Xiaomi has successively initiated requests for invalidation of four patents involved in Huawei’s case, and China National Intellectual Property Administration conducted oral trials after accepting them. In September this year, China National Intellectual Property Administration declared that "the patent right will remain valid".

On September 13th this year, Huawei and Xiaomi announced a global patent cross-licensing agreement, which covers communication technologies including 5G. When talking about whether the signing of the new agreement will affect the previous patent disputes, Xiaomi Group once responded exclusively to the reporter of national business daily: "The previous legal procedures will be resolved according to this agreement."

By the end of 2022, Huawei had more than 120,000 valid authorized patents in the world, and was in a leading position in many mainstream standard patent fields such as mobile communication, short-range communication and codec. In 2022, Huawei’s patent licensing revenue was about 560 million US dollars.

Third, the competition for folding screen mobile phones is becoming increasingly fierce.

Both the "double-rotating water drop hinge" and the "keel hinge" are key components of the folding screen mobile phone:It is an important mechanical "joint" to support the flexible screen, control the rotation range and realize the shape change of the mobile phone; At the same time, it is also the key to determine the completion of folding screen mobile phone products, which tests the technical accumulation of major mobile phone manufacturers.

In this context, the "dark horse" of folding screen mobile phones has become a cluster of flames in the winter of mobile phone consumption. From the appearance, the innovative and personalized appearance of the folding screen mobile phone relieves consumers’ aesthetic fatigue of the traditional straight mobile phone; Different folding methods, such as left and right folding, up and down folding, internal folding and external folding, also bring new experiences to consumers.

According to Counterpoint’s forecast, the shipment of folding screen mobile phones in China will exceed 5 million units in 2023, and it is expected to explode in 2024, reaching 10 million units. In 2025, the folding screen market in China will reach 17 million units. Omdia predicts that by 2026, the global shipment of folding screen smartphones will reach 61 million units, with a compound annual growth rate of 46.6% from 2021 to 2026.

In the face of the rare incremental market, almost all major mobile phone brands except Apple have entered the folding track.Going to the folding screen has become a tacit strategy for mobile phone manufacturers, especially those who compete for high-end share.

As for the current market share of each company, the report released by IDC, an international data company, shows that the market shipment of folding screen mobile phones in China reached 1.96 million units in the third quarter, up 90.4% year-on-year.

In terms of manufacturers, Huawei ranked first in the market share in the first three quarters of this year, reaching 31.7%; OPPO ranked second with a share of 17.9%; Samsung ranked third, accounting for 15.4% of the market; Glory gained 15.1% market share, ranking fourth; Vivo ranked fifth, with a share of 12.7%, and X Flip continued to sell well for half a year. Xiaomi’s market share is 5.2%, and the first sale of MIX Fold3 is obviously better than that of the previous generation.

This article comes from WeChat WeChat official account:Headline of each warp (ID: nbdtoutiao)Author: Yang Hui, Jing Wong, Editor: Cheng Peng, Zhang Haini, Du Hengfeng.

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How to diagnose and treat ANCA-related vasculitis? This article is too comprehensive.

Original Socrates’ afternoon tea medical rheumatism immunity channel

* For medical professionals only.

AAV is a systemic necrotizing vasculitis involving multiple organs and systems.

Recently, a summary of clinical practice on the diagnosis and treatment of ANCA-associated vasculitis (AAV) was published in Rheumatology. Let’s take a look at what dry goods are available ~

Figure 1: Screenshot of this overview.

Performance of AAV

AAV is a group of systemic vasculitis characterized by the detection of ANCA in serum, which mainly involves small blood vessels. It is characterized by full-thickness inflammation, necrosis and granuloma formation in small blood vessels.

Common symptoms can be manifested as fever, joint pain, myalgia, fatigue, weight loss, etc. When lung, kidney, gastrointestinal tract, nervous system and five senses are involved, corresponding clinical manifestations will appear. Musculoskeletal symptoms of the whole body are not specific, but they are common; The following clinical manifestations can also occur alone or in combination: chronic recurrent sinusitis accompanied by nasal scab, hollow pulmonary nodules, rapidly progressive necrotizing oligoimmune complex glomerulonephritis, multiple mononeuropathy, pericarditis or myocarditis and obvious purpura, while respiratory and renal failure at the same time is called "pneumorenal syndrome", which is an acute and severe manifestation of AAV.

Generally speaking, multiple organs and systems involved at the same time and obvious inflammatory reaction are often the key clues to diagnose AAV.

How to diagnose?

1, patient evaluation and diagnostic evaluation

When the diagnosis of AAV is suspected, a comprehensive clinical evaluation should be conducted to assess whether all the organs that may be involved are involved (see Table 1).

Table 1: Patient Assessment and Diagnostic Assessment

Routine blood tests should be carried out, and alveolar hemorrhage should be highly suspected if there is a continuous decrease in hemoglobin level.

Urine analysis is essential in finding hematuria, proteinuria and urine culture to eliminate infection, and the detection of proteinuria needs to be evaluated by quantitative urine protein/creatinine ratio.

All patients underwent chest X-ray examination. When respiratory involvement (such as alveolitis, pulmonary infiltration or nodules) is suspected, chest CT examination should be conducted in time.

When ENT involvement is suspected, CT examination of paranasal sinuses must be performed and evaluated by ENT experts (including nasal and laryngeal fibroscopy, etc.).

Electromyography was performed when peripheral nerve involvement was suspected.

In a word, it is suggested to carry out multidisciplinary examination according to the organ system involved.

2. The value of ANCA screening

It is strongly recommended to screen ANCA, and the detection of protease 3(PR3)-ANCA and myeloperoxidase (MPO)-ANCA is highly specific.

In the meta-analysis of evaluating the value of ANCA, the sensitivity and specificity of anti-PR3 antibody were 80% and 93%, while the sensitivity and specificity of anti-MPO antibody were 58% and 96%. The specificity of ANCA was different between granulomatous vasculitis (GPA) and microscopic polyangiitis (MPA), with PR3-ANCA positive accounting for 78%-87% in GPA and MPO-ANCA in MPA.

ANCA was not detected in the blood of about 10% patients with GPA and MPA, reminding us that there may be other biomarkers that have not been found when considering the diagnosis of AAV.

Besides AAV, ANCA is occasionally found in some patients with infection, other autoimmune diseases and other vasculitis.

3. When will the biopsy be performed?

Biopsy of kidney, lung, nose, nerve and muscle tissue can provide reliable evidence for the diagnosis and differential diagnosis of diseases.

The diagnostic rate of pathology may vary significantly with different biopsy sites. For example, renal biopsy has a high diagnostic rate, while paranasal sinus biopsy often suggests nonspecific inflammation.

Although biopsy is the gold standard and strongly recommended, in clinical practice, when the clinical manifestations are consistent with ANCA detection, biopsy can be omitted. In the latest classification standards of American Rheumatology Association (ACR) and European Union Against Rheumatism (EULAR) in 2022, when other diseases simulating vasculitis are excluded and diagnosed as vasculitis, biopsy is not a mandatory standard.

In short, biopsy (especially renal biopsy) should always be considered for patients suspected of active disease to evaluate the condition.

4. Classification criteria of MPA and GPA

At present, there is no diagnostic standard for AAV, so clinical manifestations, histological and laboratory data are very important for diagnosis.

Figure 2: GPA classification standard updated by 2022 ACR/EULAR

Figure 3: MPA classification standard updated by 2022 ACR/EULAR

The total score ≥5 points can diagnose GPA or MPA.

Treatment

1. Glucocorticoid

When the diagnosis of AAV is suspected, GC should be started, and the initial measurement is 1mg/kg prednisone (or equivalent) per day, or 500-1000mg methylprednisolone intravenously for 3-5 days.

PEXIVAS research shows that for critically ill patients who initially received methylprednisolone shock therapy, the GC dosage is reduced faster than that of the traditional regimen, that is, prednisone is reduced to 20mg per day within 7 weeks after starting treatment and 5mg per day within 19 weeks, which is as safe and effective as the standard dosage. The research shows that the risk of serious infection is low within one year.

LOVAS study showed that the initial remission of AAV (inanimate/severe organ involvement) was induced by GC of 0.5mg/kg/ day. As RITAZAREM study showed, the incidence of hypogammaglobulinemia (IgG<5g/L) was halved during the follow-up period.

It is mentioned that GC should be gradually reduced after induction of remission, and may be stopped gradually within the first year after diagnosis. At present, there is no high-quality evidence to support the need to maintain the optimal dose and duration of GC for AAV remission, so GC treatment should be individualized.

2. Immunosuppressive drugs that induce remission

① severe AAV

GC combined with cyclophosphamide (CTX) or rituximab is the standard scheme to induce severe disease remission at present, although more and more evidence shows that in some subgroups of patients, such as PR3-ANCA positive patients and patients with disease recurrence, rituximab is better than CTX to maintain fertility.

CTX can be administered intravenously or orally, and the dosage should be reduced in elderly patients with renal insufficiency. The dosage of 15mg/kg is selected according to the most widely used CYCLOPS regimen in Europe. Compared with the daily oral regimen (2mg/kg/d), the cumulative dosage of CTX can be reduced by 50%, and the remission rate is similar, while the end-stage renal disease, adverse events or survival time have not increased, but the risk of disease recurrence has increased in the long run.

The two regimens usually stop taking drugs 3-6 months after remission, and then start maintenance treatment.

Rituximab (375mg/m2 per week, four times in total or 1000mg twice every two weeks) is not inferior to CTX in inducing remission, and it is more advantageous in PR3-ANCA positive or recurrent patients.

There is little evidence to compare CTX with rituximab in patients with low glomerular filtration rate (< 20 ml/min/1.73m2). According to the suggestion of KDIGO guidelines in 2021, in addition to the first and third intravenous use of 15mg/kg CTX, such patients can also choose to use 375mg/m2 of rituximab combined with CTX for four consecutive weeks. However, this combination may bring additional risk of infection, and a recent retrospective study showed that rituximab alone may be as effective as CTX in inducing remission in patients with eGFR<30ml/min/1.73m2.

In all patients, compound sulfamethoxazole should be taken orally for at least 3 months after the last use of CTX to prevent pneumocystis carinii pneumonia (atrovaquinone or pentamidine aerosol should be used in case of intolerance/allergy) until B cells are rebuilt after rituximab treatment.

② Non-severe AAV

For non-serious disease-induced remission, rituximab is more effective than conventional immunosuppressants, and MTX and MMF can be used as substitutes when rituximab or CTX cannot be used. Studies have shown that MTX and MMF are not inferior to CTX in the remission rate of 6 months, but the recurrence rate during follow-up is higher than CTX, especially in PR3-ANCA positive patients.

3. Immunosuppressive drugs to maintain remission

After CTX or rituximab combined with low-dose GC induction therapy, rituximab (500 mg every 6 months) is superior to azathioprine in the maintenance and remission of GPA and MPA. It has been proved that the maintenance treatment of rituximab (1000mg once every 4 months) is safe and effective in patients with recurrence. For patients with contraindications to rituximab, AZA or MTX can be considered as alternative therapy.

On the other hand, the use of rituximab may lead to hypogammaglobulinemia and increased risk of infection, so it is suggested to use low-dose rituximab to maintain remission. In clinical practice, not only drug safety but also the risk of disease recurrence should be considered.

AZA(2mg/kg/ day) and MTX(0.3mg/kg increased to the maximum of 25mg/ week) have similar effects on maintaining remission of AAV, and they are second-line drugs for maintaining remission. Patients with impaired renal function (eGFR<45ml/min) should avoid using MTX.

At present, EULAR recommends maintaining treatment for at least 2 years, and recent studies using rituximab or AZA regimen show that immunosuppressive treatment for more than 2 years can reduce the recurrence rate of the disease.

4, plasma exchange and complement C5 receptor inhibitors

PEXIVAS research shows that routine plasma exchange treatment for severe GPA/MPA patients with glomerulonephritis (eGFR<50ml/min/1.73m2) or alveolar hemorrhage has no benefit. This result is contrary to the previous MEPEX1 study, which may be due to the stricter inclusion criteria of the latter [creatinine (> 5.8mg/dl) and glomerulonephritis confirmed by biopsy are required]. The subgroup analysis of PEXIVAS study showed that plasma exchange did not benefit significantly in these subgroups.

Meta-analysis published recently shows that plasma exchange at the age of 12 months in patients with severe renal disease may be beneficial to the prognosis of kidney if the infection rate is high.

Therefore, even with severe renal disease, the use of plasma exchange is still controversial, and it is not recommended as a routine treatment.

It is worth noting that the position of international guidelines on plasma exchange of AAV is quite different. The KDIGO Alliance recommends plasma exchange for patients who need dialysis or whose creatinine increases rapidly > 500 mol/L (> 5.8 mg/DL), or for patients with severe hypoxemia and alveolar hemorrhage, while the 2021 ACR guidelines suggest that plasma exchange is not recommended for patients with active AAV glomerulonephritis or alveolar hemorrhage. EULAR 2022 suggested that plasma exchange should be considered in patients with rapid increase of creatinine > 300μmol/l, but there is no evidence that routine plasma exchange can treat alveolar hemorrhage.

Recently, in addition to CTX or rituximab, avacopan, an oral complement factor C5 receptor inhibitor, has been approved and licensed for the induced remission and maintenance treatment of severe AAV, in order to replace or limit the dosage of GC.

So which patients will benefit the most from this new treatment, especially considering the cost of the drug, is still worth discussing.

According to the study of its mechanism of action, avacopan seems to be the most useful for patients with severe kidney disease and alveolar hemorrhage, as well as patients with high risk of GC-induced comorbidity, including the elderly.

summary

When the patient is highly suspected of AAV, further ANCA detection is needed, and all organs are evaluated, and if necessary, tissue biopsy is performed to make a definite diagnosis.

Clinical treatment strategies should vary according to the severity, age, weight, complications and prognosis of AAV.

Recent studies support rituximab as the first choice to induce and maintain remission.

In addition, compared with the conventional scheme, a small amount of GC is equally effective and safer in inducing remission.

There is insufficient evidence to support the routine use of plasma exchange for treatment.

References:

Baptiste Chevet, Divi Cornec, Marta Casal Moura, Emilie Cornec-Le Gall, Diagnosing and treating ANCA-associated vasculitis: an updated review for clinical practice.[J] Rheumatology.

This article is the first channel of rheumatism immunity in medical field.

The author of this article is Socrates’ afternoon tea.

This article reviews Chen Xinpeng, Deputy Chief Physician.

Responsible editor, cassette tape

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