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On October 8, the list of nominees for the Golden Broom Award was released, which aroused heated discussions among netizens.

The list announced a list of the most disappointing actors and actresses, mainly focusing on the films "Shanghai Fortress", "Little Wish", "Silent Witness" and "Zhu Xian 1".

This year’s "Shanghai Fortress", which has a lot of word-of-mouth, is not surprising. Both male and female protagonists Lu Han and Shu Qi were selected, while Wang Continental and Wei Daxun were selected for their "Little Wish". The most surprising thing is that senior actors such as Zhang Jiahui and Ren Xianqi were also selected as the most disappointing actors because of their poor performance in "Silent Witness". And the new actor Xiao Zhan’s first film "Zhu Xian" was also shortlisted.

The most disappointing female lead was Shu Qi, followed by Zhang Rongrong and Yang Zi. In addition, Li Qin and Meng Meiqi, two actresses of "Zhu Xian", were also selected.

I have to say that when this list comes out, it is estimated that the fans will be fried, especially the fans of Luhan and Yang Zi, who have been fighting for Love Dou. Yang Zi’s acting skills for many years have been loved by the audience, and he is not afraid of hardships when shooting the film. Even Ren Xianqi praised Yang Zi for his dedication.

There are also Luhan fans who believe that Luhan has fulfilled his role as an actor, and the movie itself cannot be blamed on the actors.

But these two films do have a bad reputation, and the most unsurprising one is definitely "Shanghai Fortress".

The other "Little Wish" was selected for the two male actors, one was Wang Continental and the other was Wei Daxun. Peng Yuchang, who had previously torn up the film due to the rankings, was not selected. Although the reputation of the play is polarized, Peng Yuchang’s performance is beyond doubt. It seems that Wang Continent, who has a male lead, does not know whether to cry or laugh at this moment. And he was selected for another movie "Amateur Agent", which was not as popular as "Wish". It can be seen whether the acting has made an online breakthrough in the same play, everyone can still see it.

Heat is relatively high in the selected film as well as "Zhu Xian 1", this film can be said to be the luckiest film in the film industry this year. Because the film was initially to the network specifications to prepare, investment is not much, the results of the application down the dragon label approved for release, and then on the eve of the release of the small transparent actor Xiao Zhan because "Chen Qing Ling" burst, this film can be said to occupy the right time and place, release broke 100 million, muffled and 400 million box office, as a small cost production, this is a miracle.

Of course, compared to the controversy of "Shanghai Fortress", "Zhu Xian 1" is obviously still insignificant, because this film did not have too much cross-disciplinary promotion in the early stage, but only used Weibo as the main platform, and even did not have a roadshow.

Now that the three leading actors of the male and female protagonists have been selected, it can only show that the film has earned unexpected popularity, and the quality really cannot support its attention. Xiao Zhan received such a role in the small transparent period, and it is the first time to act in a movie, so it is understandable that there are shortcomings. But as an experienced director, Cheng Xiaodong failed to play a good standard, which is the most disappointing thing.

Of course, in addition to the above few key concerns, there are also Liu Tao, Wei Chen with "Late Night Canteen", Yue Yunpeng with "Rat Gall Hero", and Dapeng with "Risky" selected as the most disappointing actors and actresses respectively. Let’s wait and see who the final awards will be.

However, as the founder of the Golden Broom Award said, good-natured criticism and sincere motivation. I hope everyone will make persistent efforts next time and strive for continuous progress.

On April 10th, the State Council Press Office held a routine briefing on the State Council policy. Relevant persons in charge of the National Development and Reform Commission, the People’s Bank of China and the General Administration of Financial Supervision introduced the implementation plan of coordinating the construction of financing credit service platform to improve the financing convenience level of small and medium-sized enterprises, and answered questions from reporters. Let’s look at it together-

A quick look at the conference:

Up to now, the national financing credit service platform has provided more than 276 million inquiry services to relevant financial institutions, with an average weekly visit of over one million.

Strengthen the "master hub" function of credit information collection and sharing of the national credit information sharing platform, collect all kinds of credit information in a unified way, and serve as the "only outlet" for providing public credit information services to financial institutions.

According to local conditions, we will carry out pilot projects of special products of "Credit Easy Loan" and support financial institutions to launch financial products and services in sub-sectors.

Strive to achieve the growth rate of inclusive small and micro enterprise loans not less than the growth rate of various loans.

Increase the first loan and renewal loan, and increase corporate loans for small and micro enterprises.

Further improve the financing convenience of small and medium-sized enterprises without credit records.

The basic idea of "implementation plan"

The "Implementation Plan" insists on building a inclusive finance service system based on credit information, and promotes the provision of high-quality financial services for small and medium-sized enterprises in accordance with the basic idea of "four enhancements".

National Development and Reform Commission:

The first is to strengthen platform optimization and integration. Strengthen the "master hub" function of the national credit information sharing platform, and regard the national integrated financing credit service platform network as the "only export" to provide public credit information services to financial institutions. Integrate local financing credit service platforms with repetitive functions or inefficient operation. In principle, only one provincial platform is reserved in a province, and no more than one platform is set up at the municipal and county levels. All local platforms are integrated into the national integrated platform network, and inventory management is implemented to reduce redundant construction and idle waste of resources.

The second is to strengthen information collection and sharing. Further expand the scope of credit information collection and sharing, and include 17 categories and 37 items of credit information such as key personnel information, various qualification information and import and export information. Efforts will be made to increase the sharing of "total to total" at the national level and strengthen the collaborative governance of data quality.

The third is to strengthen data development and utilization. Financing credit service platforms at all levels provide basic information services to financial institutions in accordance with the principle of public welfare. Establish a joint laboratory for credit information collection and processing, strengthen the development and application of sensitive data by means of "data does not leave the domain", and combine the characteristics of local industries to launch characteristic financial products and services. Promote the policy of financial convenience and benefiting enterprises to reach the business entities directly through the financing credit service platform.

The fourth is to strengthen network security. Improve the management norms and standard system of financing credit service platform, improve the ability of security risk monitoring and early warning, and effectively guarantee data security.

National financing credit service platform

The national financing credit service platform mainly has four functions.

National Development and Reform Commission:

This platform has four major functions:

The first is credit information inquiry. At present, this platform has collected more than 78 billion pieces of credit information, providing information inquiry services to financial institutions in accordance with the principle of public welfare, and alleviating the problem of information asymmetry between banks and enterprises. Up to now, the national platform has provided inquiry services to relevant financial institutions for more than 276 million times, with an average weekly visit of over one million. Now this platform has collected 37 items of credit information in 17 categories of business entities.

The second is the docking of financing needs. Intelligently match the financing needs of business entities and financial products provided by banking institutions, and realize the full coverage of national financing supply and demand docking services. There are 22 financing service products on the "Financial Supermarket" column, which can be selected by business entities independently.

Third, the policy of benefiting enterprises is direct. Centralized display of various financial support policies for enterprises, and online application for the first batch of 35 local policies for enterprises was realized. The financial policies of Hui enterprises scattered in various government departments can be inquired on this platform, and business entities can find suitable or qualified applications.

The fourth is financing credit enhancement service. Introduce financing guarantee institutions and risk sharing fund pools, and the first batch of 20 local credit enhancement and risk mitigation services will be handled in a "one-stop" manner.

At present, relying on the national integrated financing credit service platform network, we have cultivated and formed a new model of inclusive financing based on credit information, created a comprehensive service system for whole-process financing, and provided convenient financing channels for small and medium-sized enterprises, especially private enterprises.

Strengthen the "master hub" function of credit information collection and sharing of the national credit information sharing platform.

National Development and Reform Commission:

The National Development and Reform Commission will focus on implementing relevant requirements from three aspects.

First, clear channels. Strengthen the "master hub" function of credit information collection and sharing of the national credit information sharing platform, collect all kinds of credit information in a unified way, and use it as the "only export" to provide public credit information services to financial institutions in a centralized way, with the aim of realizing centralized and efficient utilization of government data resources and making it easier and faster for business entities and financial institutions to obtain data.

Second, integration is in place. Merge and integrate local financing credit service platforms with repetitive functions or inefficient operation in various places, implement list management, effectively reduce the burden on business entities and banking institutions, and improve the quality and efficiency of financial services. This platform optimization and integration is not a conceptual and logical integration, but a substantive integration. First, the subject is unique, and the symbol of the completion of integration is the unique name and the only operating subject, and the so-called "interconnection", "unified export" and "unified standard" should not be used instead of integration; The second is the transfer of assets, and all kinds of assets of the integrated platform should be classified as reserved platforms; The third is data transfer, in which the information and financing effectiveness data collected by the integration platform should be transferred to the retention platform as a whole; The fourth is to clarify the responsibility. The leading departments of social credit system construction at all levels should be responsible for coordinating the integration of platforms in the region under the unified leadership of local party committees and governments.

Third, strengthen supervision. The "Implementation Plan" clearly requires all localities to complete the platform integration work before the end of December this year. It can be said that time is tight and tasks are heavy. All localities should work hard to formulate work plans and speed up implementation.

How can the financing credit service platform use advanced technology to deepen the development and utilization of credit data and improve the intelligent level of financing services for small and medium-sized enterprises?

National Development and Reform Commission:

The relevant work will be actively promoted from three aspects.

One is joint processing. The "Implementation Plan" proposes to support the financing credit service platform and financial institutions to establish a joint laboratory for credit information collection and processing. The purpose of the laboratory is to create a relatively independent and secure data environment, and to strengthen the development and application of sensitive data under the premise of ensuring data security by means of privacy computing, so as to realize "the original data does not leave the domain" and "the data is available and invisible", which provides a basis for model training and product innovation of financial institutions.

The second is the characteristic pilot. The "Implementation Plan" proposes to carry out a special pilot project of "Credit Easy Loan" according to local conditions and support financial institutions to launch financial products and services in sub-sectors. The purpose of the pilot is to fully integrate the characteristic information held by the main enterprises in the industrial chain, centralized trading places and industrial clusters with public credit information, and support financial institutions to provide more accurate financing services to characteristic industries. In the next step, we will select qualified and willing local and financial institutions to continue to expand the scope of the pilot, and develop exclusive financial products and services for market demand in combination with local characteristic industries and advantageous projects.

The third is accurate push. At present, the state and local governments have introduced many policies to benefit the people and enterprises, but the publicity and application of the policies are scattered in different departments, and the business entities sometimes don’t know whether they have the conditions to apply, who to find and how to apply. In the next step, we will guide local governments to use the platform to summarize various policies that benefit the convenience of enterprises within their jurisdiction, and accurately push relevant policies to qualified business entities through the processing and analysis of enterprise-related information, so as to promote online application and direct enjoyment of policies.

The fourth is steady opening up. Credit service institutions are an important force to participate in the construction of social credit system and to develop and utilize credit information in a market-oriented way. On the premise of ensuring information security, we will study and formulate the conditions and standards for the authorized operation of the credit information platform, steadily open data to various credit service institutions including credit reporting institutions according to laws and regulations, give full play to the professional advantages of credit service institutions, and promote the in-depth development and utilization of credit information in accordance with the principles of marketization and rule of law to better meet diversified financing needs.

Financing of small and medium-sized enterprises

Three aspects to promote the financing of small and micro enterprises

General Administration of Financial Supervision:

The General Administration of Financial Supervision will focus on the following aspects to better promote the financing of small and micro enterprises:

First, banks are required to ensure quantity, price stability and excellent structure. The guarantee is to maintain the support of inclusive credit, and strive to achieve the growth rate of inclusive small and micro enterprise loans not less than the growth rate of various loans. Stabilizing prices means stabilizing credit prices and guiding banks to reasonably determine the loan interest rate of inclusive small and micro enterprises. Banks are required to strictly regulate cooperation with third-party institutions to promote the steady decline of comprehensive social financing costs. The optimal structure is to optimize the credit structure, increase the first loan and renewal loan, and increase the corporate loans of small and micro enterprises. At the same time, we will implement the requirements of the CPC Central Committee on developing new quality productive forces, give prominence to supporting scientific and technological innovation, specialization, innovation and green and low-carbon development, and increase medium-and long-term loan support for small and micro enterprises in equipment renewal, technological transformation and project research and development. In addition to credit support, we also encourage banks to build a "credit+"service model to provide comprehensive financial services such as settlement, financial consultation and exchange rate hedging for small and micro enterprises to better meet the diversified financial needs of small and micro enterprises.

The second is to optimize the three regulatory systems. We will revise the supervision and evaluation system of financial services for small and micro enterprises in commercial banks, further improve the evaluation index system, enrich the evaluation dimensions, highlight the evaluation of service effects, and improve the supervision and coordination mechanism. Revise the loan risk classification method for small and micro enterprises, and improve the differentiated classification standards according to the loan characteristics of small and micro enterprises. Optimize the due diligence exemption system for credit granting to small and micro enterprises, further refine the identification standard of due diligence exemption, further improve the combination of due diligence exemption and bad tolerance system, and better protect the enthusiasm of due diligence credit personnel.

The third is to improve the good environment for banks to serve small and micro enterprises. We will continue to cooperate with the National Development and Reform Commission, the People’s Bank of China, the State Administration of Taxation and other departments to deepen the sharing of credit information related to enterprises, continue to expand the scope and depth of information sharing, optimize information sharing methods, and better solve the problem of information asymmetry between banks and enterprises. We will also cooperate with the Ministry of Finance and the State Administration of Taxation to implement policies such as exempting interest income from value-added tax for loans of small and micro enterprises and individual industrial and commercial households. Build a good service environment and effectively transform the financial resources instigated by policy dividends into the development momentum of small and micro enterprises.

Further expand the registration scope of the unified registration and publicity system for movable property financing

People’s Bank of China:

By the end of March 2024, the unified registration and publicity system for movable property financing had handled a total of 34.455 million registrations of movable property and rights guarantee, providing 210 million inquiries; The accounts receivable financing service platform has contributed to a total of 512,000 financings. It should be said that it has achieved remarkable results in supporting movable property financing and supply chain finance.

In the next step, the People’s Bank of China will thoroughly implement the spirit of the Central Economic Work Conference and the Central Financial Work Conference, practice the concept of "credit for the people" and continuously improve the functions and services of the database. First, comprehensively collect financial credit information in accordance with the law, deepen the development and application of credit information, further improve the quality and efficiency of services, and support financial institutions to establish and improve long-term mechanisms that dare to lend, are willing to lend, can lend and will lend. The second is to study and promote the sharing and application of payment capital flow information of small and medium-sized enterprises, form a service pattern complementary to credit information, and further enhance the financing convenience of small and medium-sized enterprises without credit records. The third is to further expand the registration scope of the unified registration and publicity system for movable property financing, increase the popularization and application of the accounts receivable financing service platform, and help small and medium-sized enterprises to obtain financing by using movable property.

Encourage banks to optimize credit evaluation models and increase credit loans in small and micro enterprise loans.

General Administration of Financial Supervision:

The General Administration of Financial Supervision will actively cooperate with the National Development and Reform Commission and other departments to deepen the sharing of credit information, guide banking institutions to make good use of credit information in accordance with laws and regulations, and improve the efficiency of sharing applications.

One is to participate in the construction. We will actively cooperate with the integration of financing credit service platforms and guide financial institutions to maintain service stability during the platform integration.

The second is to deepen the application. We encourage banks to actively connect with financing credit service platforms at all levels, inquire about enterprise credit information and credit reports, and effectively apply them in credit processes such as customer screening, pre-loan investigation, loan approval and post-loan management. Encourage banks to organically combine accumulated internal financial data with external credit information, actively use big data, artificial intelligence and other technical means, fully tap the value of data elements, accurately "portrait" enterprises, optimize credit evaluation models, improve risk management level, develop online loan products, improve the service efficiency of small and micro enterprises, actively innovate credit loan products, and increase the amount of credit loans in small and micro enterprise loans.

The third is risk prevention and control. We require banks to attach great importance to data security, inquire, obtain and keep customers’ credit information in compliance with laws and regulations, and achieve safe closed-loop management of the whole life cycle of information.

How to ensure that the collected information is of sufficient quality to support bank lending?

National Development and Reform Commission:

Credit information is the basis of credit financing. In order to further improve the quality of credit information collection and sharing, we will focus on the following four aspects:

The first is to expand the scope. In 2021, the General Office of the State Council issued the Implementation Plan of Strengthening the Application of Credit Information Sharing to Promote the Financing of Small and Medium-sized Enterprises, which proposed to focus on collecting 14 categories and 37 items of credit information urgently needed by financial institutions. On the basis of fully completing the previous collection tasks, and according to the credit information demand of financial institutions for "accurate portrait" of enterprise credit status, this Implementation Plan puts forward 17 new categories and 37 new credit information, and clarifies the specific contents and methods of collection and sharing. This is a long-term work. We will update the credit information collection and sharing list in a timely manner according to the needs, and constantly enrich and improve this list to facilitate financial institutions to provide credit financing services to business entities.

The second is the best way. For the credit information data that have been centralized managed by the relevant state departments, it is necessary to increase the "total-to-total" sharing, reduce the workload of repeated collection in local areas, and improve the efficiency of information sharing. At present, at the national level, the People’s Bank of China has a credit information system and the National Development and Reform Commission has a credit information sharing platform. These two platforms are the top-level credit information collection platforms in our country, and these two platforms will also be connected in two directions in the future. Now the credit platform has been opened to banks.

The third is strong governance. Strengthen collaborative governance of data quality, unify data collection standards, improve information update and maintenance mechanism, focus on solving problems such as insufficient data sharing frequency, insufficient interface call capacity, and insufficient information sharing of some public utilities, and ensure that data is true, accurate and complete.

The fourth is re-evaluation. The National Development and Reform Commission will take the lead in timely evaluating the quality and efficiency of credit information sharing in various localities and relevant departments, continuously improve data quality, and activate the potential of small and medium-sized enterprises in financial services with high-quality credit data governance.

In 2022, no new cities will cross the trillion-dollar threshold, while the alternate cities standing outside the threshold are mainly the third-tier cities in the eastern region.　

Economic data of 2022 are released one after another in various places. Judging from the cities with published data, the ranking of 24 cities with GDP trillion will not change much this year, but the two cities that attract people’s attention are Chengdu and Chongqing: one has crossed the threshold of 2 trillion, and the other has surpassed Guangzhou to become the "fourth city".

In 2022, no new cities will cross the trillion-dollar threshold, while the alternate cities standing outside the threshold are mainly the third-tier cities in the eastern region, showing the differences between the eastern, central and western regions.

Chengdu-Chongqing Gemini is eye-catching

In 2021, the GDP of Chengdu has exceeded 1.99 trillion yuan, only a stone’s throw from the threshold of 2 trillion yuan. In 2022, Chengdu’s regional GDP reached 2,081.75 billion yuan, an increase of 2.8% over the previous year at comparable prices, under the adverse impact of several rounds of epidemic shocks and high temperature power cuts last year.

Chengdu has thus become the seventh city to cross the threshold of GDP2 of 2 trillion. At present, four echelons, namely, 4 trillion, 3 trillion, 2 trillion and 1 trillion, have been formed in the city clubs with GDP trillion. Shanghai and Beijing crossed 4 trillion in 2021, Shenzhen crossed 3 trillion in 2021, and Chongqing, Guangzhou, Suzhou and Chengdu were 2 trillion echelons.

Among the top ten cities, Wuhan is expected to surpass Hangzhou. According to the work report of Wuhan Municipal Government, it is estimated that the GDP of Wuhan will reach about 1.9 trillion yuan in 2022. According to the data released by the Hangzhou Municipal Bureau of Statistics, the regional GDP of Hangzhou in 2022 was 1,875.3 billion yuan. Affected by the epidemic, Wuhan will fall behind Hangzhou in GDP ranking in 2020.

Compared with the ranking changes of Wuhan and Hangzhou, the ranking competition between Chongqing and Guangzhou attracts more attention. Chongqing and Guangzhou successively released economic data for 2022: in 2022, the regional GDP of Guangzhou was 2,883.900 billion yuan, up by 1.0% year-on-year; Chongqing achieved a regional GDP of 2,912.903 billion yuan, an increase of 2.6% over the previous year. Chongqing surpassed Guangzhou by about 29 billion yuan.

In fact, in recent years, Chongqing’s GDP has continued to grow and is approaching Guangzhou. In 2019, the gap between the two was only 2.3 billion yuan. In the first half of 2020, Chongqing’s GDP surpassed Guangzhou for the first time, which triggered a heated debate on the "fourth city" dispute between Chongqing and Guangzhou. However, with the effective control of the epidemic in that year, Guangzhou narrowly beat Chongqing with a slight advantage of 1.6 billion yuan by the end of the year and regained the fourth position.

In 2021, Guangzhou didn’t give Chongqing another chance, and its quarterly GDP remained the fourth city in the country, which widened the gap with Chongqing’s GDP and expanded its leading edge to 33.8 billion yuan. In the first quarter of 2022, Guangzhou expanded its leading edge over Chongqing to 35.3 billion yuan. However, in the first half of 2022 and the first three quarters of 2022, Chongqing overtook Guangzhou and maintained its leading position throughout the year.

From the specific indicator data, in 2022, the added value of industrial enterprises above designated size in Guangzhou increased by 0.8% year-on-year; The city’s investment in fixed assets decreased by 2.1% year-on-year; The total retail sales of social consumer goods in the city was 1,029.815 billion yuan, a year-on-year increase of 1.7%; The city’s total foreign trade import and export value was 1,094.84 billion yuan, a year-on-year increase of 1.1%.

The added value of industrial enterprises above designated size in Chongqing increased by 3.2% over the previous year; The investment in fixed assets in the whole city increased by 0.7% over the previous year; The total retail sales of social consumer goods reached 1.39 trillion yuan, down 0.3% from the previous year; Chongqing’s total import and export value reached 815.84 billion yuan, a record high, up 2% over the previous year.

Is Chongqing’s overtaking Guangzhou only a temporary lead under special circumstances, or does it indicate the complete subversion of the ranking pattern of the two cities?

Yi Xiaoguang, president of Chongqing Comprehensive Economic Research Institute, told CBN that in the medium and long term, it is a trend that Chongqing’s economic aggregate exceeds Guangzhou, and Chongqing’s land space is far greater than Guangzhou’s. Although the eastern cities started early and developed rapidly, with the development of the western region and the Yangtze River Economic Belt, the basic conditions for the development of western provinces and cities have been greatly improved.

However, Yi Xiaoguang also said that although Chongqing surpassed Guangzhou in terms of economic aggregate, China’s economy still showed a gradient development pattern as a whole. There is still a gap between Chongqing and Guangzhou in output intensity, industrial structure and industrial system matching. It is still the first step to catch up with the economic scale, and Chongqing still has to catch up with it in terms of development level and per capita wealth income.

There are obvious differences between the eastern, central and western regions

The performance of Chengdu and Chongqing is relatively conspicuous, which has enhanced the influence of cities in the central and western regions, but the pattern of the eastern, central and western regions has not changed. Judging from the distribution of club cities with GDP trillion, especially the distribution of alternate cities, the regional development differences between the eastern, central and western regions are still obvious.

Judging from the distribution of city clubs with GDP of one trillion, there are four trillion cities in Jiangsu, namely Suzhou, Nanjing, Wuxi and Nantong, three in Guangdong, Shenzhen, Guangzhou and Foshan, and two in Zhejiang, Shandong and Fujian. Together with Beijing, Tianjin and Shanghai, there are 16 cities in the eastern region with GDP exceeding one trillion.

The cities with GDP exceeding one trillion in the central and western regions include Chongqing, Chengdu, Wuhan, Zhengzhou, Changsha, Hefei and Xi ‘an. Except Chongqing, which is a municipality directly under the central government, the rest are all provincial capital cities that make efforts to develop and implement the strategy of strengthening the province. In addition, there is no second GDP trillion city in these provinces, and there is an obvious gap between the provincial sub-central cities and the provincial capitals and eastern cities.

No new cities entered the GDP trillion club last year. Changzhou and Yantai, which ranked 25th and 26th in urban GDP in 2021, did not cross the trillion-dollar threshold. In 2022, the regional GDP of Changzhou reached 955.01 billion yuan, an increase of 3.5% over the previous year; Yantai’s GDP was 951.586 billion yuan, up 5.1% year-on-year.

Changzhou and Yantai are the fifth city in Jiangsu’s economic aggregate and the third city in Shandong, respectively, and are expected to enter the GDP trillion club this year. However, many capital cities in the central and western regions and northeastern cities are still far from the trillion threshold. Dalian, Shenyang and Kunming are the top cities in the northeast and central and western regions outside the trillion-dollar threshold, and their total economic output is still at the level of 700 billion.

It can be seen that this gap between the eastern and western regions is more obvious in the distribution of alternate cities. With the powerful major provincial capital cities in the central and western regions listed in the GDP trillion club, the cities queuing to cross the trillion threshold are still dominated by eastern cities.

In 2021, the cities with regional GDP below one trillion yuan and above 700 billion yuan include Changzhou, Yantai, Tangshan, Xuzhou, Dalian, Wenzhou, Shenyang, Kunming, Changchun, Xiamen and Weifang. In addition to Changzhou and Yantai mentioned above, Xuzhou ranks sixth in Jiangsu, third in Wenzhou, third in Zhejiang, third in Xiamen and fourth in Weifang.

Yi Xiaoguang said that the distribution of trillions of cities reflects the differences of regional economic development in China. On the whole, it is still a gradient development pattern of the east, the west and the east, and there is a clear gap between the central and western regions and the eastern region; Regionally, the imbalance of regional development within the central and western provinces is also obvious. Of course, with the implementation of major regional policies and the improvement of the industrial development foundation in the central and western regions, the development potential of cities in the central and western regions is still great, which will gradually promote the change of the whole pattern.

source map

"Judging from the results of this evaluation, the satisfaction of cadres and the masses with our work style construction has reached 100%." Recently, an organ in the north conducted an assessment of the rectification of work style. The assessment results at the briefing meeting made Xiao Han, who works in the subordinate institutions of the organ, disagree: "How can it be 100% satisfied? I was going to give some advice, but I was led ‘ Please ’ Go to a serious education. What is the significance of this satisfaction evaluation with water? "

At the end of the year and the beginning of the year, all kinds of year-end satisfaction evaluation work are concentrated. As a way to feedback the annual work effect, satisfaction evaluation is an important reference index, but some places and departments have some bad phenomena such as suggestive guidance, persuasion in turn, giving gifts and awarding prizes, which affects the credibility of the evaluation work.

Satisfied, some of them are earned.

"The same conditions ultimately enjoy different poverty alleviation policies. Can we be satisfied?" A villager in a poor village in a southwest province complained about the evaluation of people’s satisfaction. "We don’t see cadres coming to our homes at ordinary times, but every time we evaluate them, the cadres in the town and the village will take turns to persuade us, hoping that we can fill in a ‘ Satisfaction ’ 。”

"Now poor counties want to take off their hats. In the third-party evaluation criteria, an important indicator is that the satisfaction of the masses must reach more than 90%." A grassroots cadre said frankly: "In order to look good, sometimes cadres will be arranged in advance to work in villages and households, and they will try their best to get a ‘ Satisfaction ’ 。” "We don’t want to offend the cadres in the village, so we just fill it in." A villager in a county in southwest China said.

"Every time the evaluation form is issued, the leaders emphasize that everyone wants to fill it out, which is obviously something in the words." An official cadre said, "Many colleagues give full marks directly, which makes me feel pressured to score 98."

Satisfied, some of them are bought.

Individual localities and departments also give gifts to "change" satisfaction.

As soon as the evaluation stage is reached, some village cadres are arranged to carry out large-scale visits with "gifts" such as towels and garbage bags; Some promise to be selected by telephone, and they will be rewarded with praise; Individual grassroots cadres even take inclusion in the list of condolences at the end of the year as a "reward". "Some cadres sometimes make some promises and give some benefits, just for fear that they will get it carelessly ‘ Dissatisfied ’ 。” A grassroots cadre in a western province said. "Cadres take turns to come to the door so earnestly, and there are many such evaluations and forms. It feels like going through the motions and just picking out the good ones." A villager in the county said.

"The collected watches are full of satisfaction and 100 points. Many people don’t take the evaluation seriously." A staff member who participated in the organization evaluation said helplessly that the satisfaction of "Eight Immortals Crossing the Sea" would not only make the people really satisfied, but also reduce their points in the hearts of the people.

Satisfied, it must be done.

Satisfaction evaluation is only a reference. Whether the masses are really satisfied or not depends on whether cadres at all levels can really sink to the grassroots level and really want to work with the masses. Experts said that it is inevitable for some units to carry out evaluation work for themselves, and the relevant supervision mechanism needs to be further improved and implemented.

The Commission for Discipline Inspection of Luoping County, Qujing City, Yunnan Province has included the evaluation of people’s satisfaction in one of the key areas of supervision and inspection, and has severely investigated and dealt with all acts of fraud and deception in the evaluation. At the same time, it has broadened the investigation channels such as anonymous and online evaluation to avoid the evaluation being interfered by external forces such as human feelings, unblock the channels of people’s demands and better listen to the voices of the people. "Refused to work hard, just thinking about ‘ Sharpen a gun in the cold ’ How can the masses be truly satisfied? " The relevant person in charge of the county commission for discipline inspection said.

After editing

The satisfaction of the masses is a barometer of the effectiveness of work, and the satisfaction mixed with water becomes a "smoke bomb" and cannot reflect the true feelings and public opinion. After the 19th National Congress of the Communist Party of China, the General Secretary of the Supreme Leader emphasized that the rectification of "four winds" cannot stop, and the construction of work style is always on the road. A good style of work is inseparable from a real word. Only by advocating hard work and truly putting the masses in their hearts can we win the real satisfaction of the masses.

Special topic: picture channel

Profile picture: Birds that died in December 2007.

Seagulls that died in this incident.

　　International Online Special: A large number of dead birds fell from the sky in western Australia recently. This is the second time in seven months that such a strange phenomenon has appeared. The appearance of a large number of dead birds has caused extreme panic among local people about health and safety. The cause of the mysterious death of birds is still under investigation.

　　The mysterious death of seagulls is a mystery

　　This week, more than 200 seagulls died mysteriously in Woodman and Henderson, the most popular seaside resorts in Perth, an Australian coastal city. Experts dissected and tested the gull’s body, but found nothing suspicious. The local government investigated the nearby factories and found no signs of chemical pollution.

　　The staff of the environmental protection department believe that a large number of seagull deaths may be caused by the leakage or pollution of some chemical substance. It is reported that there is a large shipbuilding factory near Woodman. Experts have taken samples of seawater near the factory and are currently conducting inspection.

　　5000 birds were poisoned last year.

　　In December 2007, 5,000 dead birds fell from the sky in Reims, Espe, 500 kilometers southwest of Perth. After investigation, these birds were poisoned by a toxic chemical. After the appearance of dead birds, the Australian government once declared Reims, Espe as a disaster area.

　　The dead birds are mainly yellow-throated warblers, Dutch honeyfinches, etc., and there are also a few crows, pigeons and eagles. According to eyewitnesses, these birds were in great pain before they died, and their bodies kept twitching. Australian wildlife officials called it a "catastrophic event." After the incident, the staff of relevant departments conducted random inspections on local residents and found that there were potentially harmful elements in their blood.

　　Death is limited to seagulls.

　　Kevin Morrison of the environmental protection department said in an interview with the Australian Broadcasting Corporation that compared with the massive death of birds in December last year, it seems that the seagull who died this time did not experience too much pain, but died quickly and peacefully. Morrison said: "Before they died, these birds began to walk unsteadily. They sat on the ground and died after 10-15 minutes. What puzzles me is, why are all seagulls killed this time? "

　　A few days ago, Woodman Beach has been blocked. The local government hopes to find out the cause of seagull death as soon as possible. (Ru Zhi)

Editor: Feng Ye

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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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.

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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