Following the scandal that Kitagawa, the president and founder of Genese Office, sexually abused a number of Jr. students (boys and young children), the Weekly Wenchun, published on November 4th, once again exposed the intimate and indecent photos of four members of the popular group Lan, Satoshi Ohno, Matsumoto Jun, Ninomiya Kazunari and Masaki Aiba, and the late AV actress AYA (real name: Makinoda Cai, aged 30) who committed suicide, causing an uproar.
　　　
　　　 You are the successor of SMAP, a national group. Lan has swept all fields of arts and energy in recent one or two years. He is also the ambassador of the national "building a country through sightseeing" designated by the Japan Tourism Office, with a fan range of "all men, women and children". As a role model for the majority of Japanese teenagers, Lan has followed Satoshi Ohno’s previous "drug threesome" doubts. The close relationship between several members and AYA this time has formed a new round of impact on the outside world.
　　　
　　　 Wenchun Weekly published an article by a reporter who had a good friendship with AYA for more than three years. This reporter interviewed her many times before her death, and AYA and the reporter described in detail the fact that she had an affair with many Genese idols.

　　　 "Weekly Wenchun" reveals the intimate photos of AYA, Satoshi Ohno and other Genese artists, and reveals that "she has a physical relationship with four members of Lan except Sh? Sakurai, and has been in contact with Tomoya Nagase of TOKIO, and with KAT— TUN’s photo of Tian Zhongsheng date was also photographed by other weekly magazines in the past. And lived with Masaki Aiba for a while. ". Not only that, AYA also had contacts with Shibutani Subaru of Guan8, Tsubasa Imai of Tackey & Tsubasa, tetsuya komuro and his wife, Tomomi Kahara, Ayumi Hamasaki, Kaori Mochida, Masato Matsuura, President of Aihui, Ryuhei Chiba, Vice President, and Mr. and Mrs. Sakai, who were both arrested and punished for taking drugs.
　　　　
　　　 Wenchun Weekly reported that since the "drug-taking threesome" scandal in Satoshi Ohno, Genese Office ordered its artists not to associate with AYA any more. Since 2010, many magazines have published indecent photos of Genese idols one after another. "It is estimated that AYA released materials to the media — — In order to retaliate against Genese in disguise. ".

　　　 16-year-old Makinoda Cai stood out in the program and was joined by 14 girls in tetsuya komuro to form "L☆IS". Unfortunately, the group was dissolved two months later, and then she turned to be a model and a racing girl, but none of them showed any outstanding performance. After that, Mu Ye Tian Cai turned to be a photo artist. In 2008, she launched a bold and sexy photo album, and in 2009, she officially entered the AV industry, with a general development. On October 23, he committed suicide by jumping off a building in his apartment. It has been pointed out by insiders that AYA may not have committed suicide, but killed him. "It is not surprising that she has too many secrets in her hand and has been excluded and resented by insiders." As for the truth, it is unclear.

Overlooking West China Tianfu Hospital of Sichuan University. Photo courtesy of China Construction Third Bureau

At 8 o’clock on the morning of October 13th, the West China Tianfu Hospital of Sichuan University, located at Xinglong Lake in Tianfu New District, was crowded, and hundreds of patients waiting here became the first patients in the hospital. Different from the narrow space of traditional hospitals, Huaxi Tianfu Hospital is very spacious. Outside the outpatient hall on the first floor, there is not only a coffee shop, but also a grand piano. In the words of Kang Yan, president of Huaxi Tianfu Hospital, this is a high-value hospital.

What are the "hard core" strengths of Huaxi Tianfu Hospital? How to ensure the homogeneous management with the headquarters of West China Hospital? After sending many doctors to the medical association, how to ensure that the medical technical strength of this department will not be diluted? The reporter visited this.

The software is "hard"

Experts in this department take turns to sit in the clinic, and all clinicians are stationed by Huaxi Hospital.

"I finally’ grabbed’ the number." On the morning of the 13th, outside the orthopedic outpatient department of Huaxi Tianfu Hospital, several patients exchanged experiences in registration. A patient from Neijiang said happily that he had always wanted to hang the number of Zhou Zongke, an orthopedic expert in Huaxi Hospital, and finally "grabbed" it here.

How can Huaxi Tianfu Hospital improve its soft power and better serve its patients?

"In order to ensure the homogenization of hospital management level, the management backbone of the leadership team and administrative functional departments of Huaxi Tianfu Hospital are all stationed by the headquarters of Huaxi Hospital." At the opening ceremony, Li Weimin, president of Huaxi Hospital, introduced that all medical and health information and inspection data of Huaxi Hospital and Huaxi Tianfu Hospital run on the same platform, and the inspection results are exchanged and human resources are shared, so that the clinical path and treatment plan of patients are completely consistent. All clinicians in Huaxi Tianfu Hospital are stationed by Huaxi Hospital, and all nurses are retained after passing the standardized training in Huaxi Hospital. At the same time, through the green channel of real-time remote consultation, real-time inter-hospital consultation and two-way referral of patients, the seamless connection of medical diagnosis and treatment between the two hospitals can be realized.

In addition, according to the unified management, experts from the headquarters of Huaxi Hospital will also take turns to visit Huaxi Tianfu Hospital. The reporter learned that among the first batch of open outpatient clinics in West China Tianfu Hospital, Professor Wang Jia of Urology, Professor Fu Ping of Nephrology and Professor Hong Xiao of Pain Department, who are usually hard to find on the 1st, will visit the hospital regularly.

Hardware is more "hard"

Green ecological hospital, the roof apron opens the "air lifeline"

1,200 beds, 14 medical centers, 2,000 parking spaces, and more than 2 million people per year-in addition to these, Huaxi Tianfu Hospital has the other side of "hard core".

An apron was built on the roof of the outpatient medical technology building of the hospital. According to the person in charge of the project, this is the first new material hospital apron in Chengdu, which echoes the aviation rescue response mechanism in the province.

The elements of landscape, forest, field and lake gather together, and Huaxi Tianfu Hospital is also a green ecological hospital. It is worth mentioning that in order to improve the overall greening rate, the construction team also built a garden on the roof, forming the "air green lung" of the hospital-the garden landscape area reached 80,000 square meters, accounting for 30% of the total construction area of the project.

Hospital equipment is also "hard core". The reporter saw in the outpatient pharmacy of Huaxi Tianfu Hospital that the self-service dispensing machine operated freely. Different from the manual dispensing process, the self-service dispensing machine puts the medicine into the machine after dispensing, and sends it to the pharmacist through the special transmission belt of the pharmacy when the patient takes the medicine, and then returns it to the patient after verification. The whole process only takes one or two minutes.

Self-service blood collection machine is also a highlight of Huaxi Tianfu Hospital. For elderly patients, the blood vessel scanner matched with the self-service blood collection machine can quickly and accurately find the position of the patient’s blood vessels, so that medical personnel can carry out blood collection operations.

Through the medical pneumatic logistics transmission system, a small number of specimens can be transported directly through the system, and it takes only 3-5 minutes to transport to the corresponding site of the laboratory. "Compared with manual transportation, it takes 20 minutes, and the advantage is’ fast’, which can greatly shorten the inspection time for the rescue of emergency patients."

The radiology department is called the most valuable place in the hospital. At present, 6 CT equipments and 4 nuclear magnetic resonance instruments have been put into operation. Huang Zixing, deputy chief physician of the Department of Radiology, told the reporter that the CT equipment currently used in the hospital is worth 20 million units, which is the same as that used in Mayo Clinic and Massachusetts General Hospital, the world’s top hospitals. Compared with other CT equipment, the equipment adopts AI algorithm, which has extremely fast scanning speed, lower radiation dose and clearer imaging. Doing MRI in West China Tianfu Hospital can realize "same-day appointment and same-day inspection".

A question

Ensure that medical resources are not diluted   What should Huaxi Hospital do?

Shangjin Branch of Huaxi Hospital, Wenjiang Campus of Huaxi Hospital, Longquan Hospital of Huaxi Hospital … Nowadays, there are more and more "Huaxi Brand" hospitals. Since 2001, Huaxi Hospital has begun to innovate and explore the organizational model of medical associations. After years of practice, the leading medical association of "Huaxi Hospital+City Medical Group/County Medical Community" has gradually formed. Will so many members of the medical association dilute the medical technical strength of Huaxi Hospital?

Li Weimin, president of Huaxi Hospital, said that in accordance with the unified deployment of the sinking of national high-quality medical resources, Huaxi Hospital has been reserving human resources and expert resources since 2015 to prepare for Huaxi Doctor Group. Up to now, 758 professional doctors, backbone nurses, backbone technicians and managers have been reserved, which is an important support for human resources when Huaxi Hospital is stationed in hospitals outside its headquarters. "After unified training, the doctors of Huaxi Doctor Group were sent to the headquarters of Huaxi Hospital, branches, trusteeship (cooperative) hospitals and other places to carry out their work."

"These backbone doctors reserved by Huaxi Hospital have gone through years of standardized training and reached the level of specialists or experts." Li Weimin introduced that at present, there are 741 qualified medical team leader candidates trained by West China Hospital, but there are only 500 medical team leader positions in the hospital headquarters, and 241 senior doctors can be stationed in other hospitals, so as to give full play to high-quality expert resources. "Therefore, the medical resources of the headquarters of Huaxi Hospital have not been diluted, and the doctors stationed can further develop on the new platform."   (Zhang Xinyue   Reporter   Li Huan   Zhang Minghai)

At the beginning of this year, National Medical Products Administration released the No.1 document in 2020-Guiding Principles of Real-world Evidence Supporting Drug R&D and Evaluation (Trial), which attracted great attention in the industry. Two years ago, the reporter of Economic Information Daily interviewed Fan Daiming, an academician of China Academy of Engineering. In the report "Academician Fan Daiming: Paying too much attention to the micro, medicine will go astray", Fan Daiming pushed for "real world research" and called for the reverse research of medicine.

Now, Fan Daiming is still busy, and the thinking about the development of medicine is also deepening: Why is the more modern medicine develops, the more intense it is questioned? What is the relationship between culture and medicine? How to reshape medical culture … Not long ago, Fan Daiming once again accepted an exclusive interview with the reporter of Economic Information Daily, and he solemnly proposed that culture should lead the development direction of modern medicine.

The picture shows Fan Daiming, academician of China Academy of Engineering.

Four major deviations in the development of modern medicine

Reporter: What do you think of the relationship between modern medicine and culture?

Fan Daiming: To answer this question, we must first realize the dilemma faced by modern medicine-modern medicine has greatly improved the average life span of human beings, but the question of medicine has never been so fierce as it is today.

As Roy Porter, a professor of medical history at Cambridge University, wrote: People have never lived so long and lived so healthily, and medicine has never achieved so much. However, paradoxically, medicine has never aroused people’s strong doubts and dissatisfaction as it is today.

In fact, there are four deviations in the development of modern medicine: first, medical research blindly develops to technology and penetrates to micro-level, which leads to over-differentiation of specialties, over-detailed planning of specialties and fragmentation of medical knowledge, that is, O2F1；; Second, modern medicine has become waiting medicine; Third, modern medicine has become antagonistic medicine; The fourth is medical alienation, which takes some natural processes of life and some natural changes of the body as diseases for excessive intervention.

Reporter: As for O2F1, you have elaborated it in detail when you were interviewed by us.

Fan Daiming: Yes. This situation is at least a problem caused by introducing simple research methods into medicine, that is, simply introducing science and technology into complex and variable human health care. Doctors are increasingly confined to narrow professional fields, and even can only see a certain disease, resulting in more and more drugs, but the curative effect is getting worse. I will focus on the last three biases.

Modern medicine has become waiting medicine. Modern medicine regards people’s health status as a linear process, from no illness to death due to illness. What is disease? It is to draw a line artificially according to some indicators, and when you cross this line, you are sick, and the doctor will treat you; If you don’t cross this line, the doctor won’t care.

Take stroke as an example. A person is a "good" person without a stroke, and a sudden stroke one day becomes a patient. After the onset of stroke, treatment can hardly play much role, but the money earned by patients in their lifetime is likely to be used up in the last few days.

Only at the end of the disease and the last few days of life, the curative effect is bound to be limited, and it will bring great pain to patients. This is waiting for medicine. If we work harder before we get sick, will the result be different? The "prevention of disease" advocated by Chinese medicine should give enough enlightenment to modern medicine.

Modern medicine has become antagonistic medicine. In the past, infectious diseases caused by foreign sources and a single cause were the greatest threat to human health, so it is understandable to "confront" all diseases as "enemies". However, at present, chronic diseases have become the biggest threat to human health, which is a problem in the internal balance adjustment of human body. If we still adopt the thinking of "confrontation", we are "confronting" ourselves, and we may not cure the "disease" but hurt other organs.

This "confrontational" thinking is also deeply influenced by culture. Modern medicine represented by western medicine originates from nomadic culture, and the survival rule of nomadic culture is "you die and I live"; In China’s traditional culture with thousands of years of farming society as the background, "harmony" and "you live and I live" are the mainstream. Therefore, treating cancer in traditional Chinese medicine is "treating cancer without seeing it" and how to better "survive with cancer".

There has been alienation in medicine. It is too serious to treat some natural processes of life and some natural changes of the body as diseases for excessive intervention.

For example, it is a natural process for a mother to give birth to a baby. If there are some problems during pregnancy, it is ok to check it occasionally, but now many pregnant women go for a B-ultrasound every month or two. You know, every medical examination is more or less harmful to people, but this kind of damage is within the tolerable range. But has anyone ever thought about how much long-term harm regular prenatal checkups will do to the fetus? What will be the consequences after many years? Actually, we don’t know.

Unbalanced medical culture

Reporter: What will the imbalance between medical development and culture, or the lack of culture in medical development, bring to medicine?

Fan Daiming: There are at least three consequences. First, with the help of science and technology, medical research on human body structure and even function has been advanced and thorough, reaching directly to genes, but medical knowledge of the nature of life is still far from being understood culturally, and this is the most important thing. You know, being sick is not only a physical illness, but also a life illness. The imbalance between medical development and cultural relations, or the lack of cultural medicine, makes modern medicine "out of her wits".

Second, worldwide, human culture (including medical culture) has been formed and developed for thousands of years (such as European culture, Indian culture and China culture), but now we are using a single-domain culture (such as medical ethics culture) with only a few hundred years to monopolize or even replace the global human culture for thousands of years, which seems to be somewhat "inadequate".

Third, compared with the past, the spectrum of contemporary human diseases has undergone fundamental changes, such as various endogenous senile diseases and chronic diseases, with multiple causes and multiple targets; In history, human life span has never been as long as it is now, and the biggest threat to health is often infectious diseases caused by external factors and single cause. Modern medicine is still using simple, linear and direct methods to deal with infectious diseases in vitro to deal with the complex, nonlinear, indirect and endogenous chronic diseases of human beings, so it often backfires.

From being out of her wits, to being unable to do what she wants, and then to being counterproductive, won’t this medical culture change its profession? We must make great efforts to reshape medical culture. Where medicine develops depends on what kind of medical culture to lead.

Reporter: Some people say that science and technology and humanities are the two wings of the progress of human society, and they are indispensable, otherwise they will deviate from the direction. It seems that the same is true for human health, medicine and culture.

Fan Daiming: Improper handling of the relationship between medicine and culture is not only bad for patients, but also harmful to doctors. At the memorial service, it is usually said that "the comrade died because of illness", but it is not said that "he died because of illness". In the event of an emergency, the seriously injured are sent to the hospital for rescue, and when notified, they will say "death due to injury", but they will not say "death due to injury". Also, "as long as there is one percent hope, we must use 100 percent efforts to rescue", which is right from the humanitarian point of view, but is it completely right in medical practice? This is a waste of money for some patients, a waste of effort for doctors, and a loss for society.

If "ineffective treatment", "ineffective rescue" and "medical pursuit of 100% success" have become "routine", isn’t it an excessive accusation and injury for doctors? This is also a cultural problem!

Cases of hurting doctors are endless, which is a more extreme phenomenon. Let those who hurt doctors be punished, even sentenced to death, so that the problem can be solved fundamentally and completely? No! We must think from the root of medicine, culture and values, so that we can embark on the right path.

"Four Persistences" Reshape Medical Culture

Reporter: In your opinion, what should be included in dealing with the relationship between medicine and culture?

Fan Daiming: First, we must adhere to the humanity of medicine.

Humanism is the highest realm of culture in the study of human nature, and its function is to ensure the safety, importance and dignity of life. There are two basic requirements of human nature: one is to pursue happiness, the other is to pursue immortality and hope to live forever. In fact, it is impossible for an organism to be immortal. People are the same, flowers bloom and flowers fall, the tide rises and falls, and everything is the same, which is inevitable in nature.

But the problem is that the single-domain medical ethics culture does not recognize that people will die, so they use technology to intervene in death. So there are three problems: first, the time of death has changed from unknown to known. Second, the place of death was moved from home to the ward. We used to take medicine home for illness, but now we send patients directly to the hospital to save their lives, even if we know there is little hope. Doctors in ICU and rescue room tried their best to rescue them, and family members outside tried their best to pay the money. It is likely that when the patient finally left, the family members failed to shake hands and say goodbye. The third is from natural death to technological death. An old expert in our hospital left when he was 92 years old. In the last two years, he became a vegetable, and his soul had already left this world. We still worked hard on his body and relied on a ventilator to maintain it. There are many such people, who have left this world although they are lying in hospital beds. They are covered with tubes but don’t know it. It can be said that they have no dignity at all. The doctor is looking at whether the pipe is impassable. All-pass is alive, no-pass is dead, and part-pass is part-live. Is that right? Isn’t this culture going to change professions?

In the past, both Chinese and western sacrificial customs fully considered the sanctity and dignity of life. At present, many hospitals offer hospice care, which fully considers the feelings of family members and the hospice care of medical staff for the dead. In fact, this is also a reshaping of medical culture.

Second, we must adhere to the integrity of the human body.

We should respect life and respect it. Life exists as a whole. With the infinite division, all the parts finally exist, but what is lost is life. Conversely, the sum of all parts is not equal to a whole, because the whole of medicine must have life. A whole with life is called a whole; There is no whole life, we call it a corpse.

The existence of life must depend on the whole existence. An elephant, we know at a glance, the blind can only rely on touch. When a blind man touches an elephant’s leg, he can tell that it is an elephant, but can he still recognize it if he touches cells or even molecules? If we go to the atomic and quantum level, everything is indistinguishable, can we still identify life forms? Therefore, medicine should not be too microscopic.

Einstein has long said that science pursues clarity, accuracy and purity at the expense of integrity. Similarly, the "accuracy" we blindly pursue in medicine is at the expense of life, which is also a culture and a culture with problems.

Third, we must persist in the complexity of life.

Life has great complexity, and the local and instantaneous research results can not explain the process and essence of life, nor can they be a panacea to save lives.

We know life now, which is too simple, but in fact it is extremely complicated. The existence of life, first of all, is the role of natural forces. Otherwise, how will life be spent in millions of years or even longer without medicine? This natural force is manifested in the ability of life itself to resist diseases and harm; Second, different organs can coordinate with each other and have self-consistency ability; Third, after a certain part of the body is damaged, it can compensate for growth and has the ability of self-repair; Fourth, metabolic ability, life and physical ability blend with the outside world, and absorption of order can discharge disorderly energy; Fifth, self-balance ability, such as water and electrolyte balance, white blood cell level balance, heat balance and so on; Sixth, the ability of self-protection, which is manifested in immunity, vomiting and excretion after eating bad things; Seventh, the reaction of spirit and consciousness to the above six abilities.

There is a saying that the "three magic weapons" for doctors to treat diseases are language, medicine and scalpel. Among them, drugs and scalpels are necessary, and the power of language is the greatest. There is a famous saying in the west, "To cure sometimes, to relief oft, To comfort always". This sentence means that for patients, soothing and comforting are the most important, and healing only accounts for a small part. In fact, even if the patient is cured, in the final analysis, it is the patient’s own internal natural forces that have played a role. The doctor just helped them outside, and never take advantage of it.

Therefore, medical intervention in life and health should first ensure that the natural forces of life play a role. If medical intervention exceeds or even replaces this ability, it is called overtreatment. From the development practice of modern medicine, there are fewer and fewer medical deficiencies, but more and more medical excesses.

Fourth, we should insist on the authenticity of the research.

At present, many medical researches are not true, but only one way to the end, from macro to micro, or from structure to small structure, from long time to short time. We must go back and return to the macro level, which is what we call reverse medical research. Only when the way back is clear and a circle is formed, it is called closed-loop research, and the correct results can be obtained. Historically, many great achievements in natural sciences, especially medicine, were obtained by reverse research.

The fundamental way to change the existing clinical thinking and improve the shortcomings of evidence-based medicine in medical research is reverse thinking. Reverse thinking involves many aspects, including real-world research. Real-world research may also have its own problems. If evidence-based medicine is combined with real-world research, especially reverse research on evidence-based medicine, we will be much more likely to get correct results.

Of course, four persistences are the necessary conditions for reshaping medical culture, and it is far from enough to be satisfied with these four aspects. I hope more people can join in and lay a more solid foundation for reshaping medical culture.

Learn from the sages 2,500 years ago.

Reporter: How to choose the starting point to reshape medical culture?

Fan Daiming: Some people say that to solve many global problems today, we should go back to ancient China 2,500 years ago and learn from the wisdom of Confucius. Confucius lived in the Spring and Autumn Period and the Warring States Period. At that time, there were "three religions and nine streams" and "hundred schools of thought". A large number of outstanding thinkers, represented by Confucius, looked forward to 2500 years and thought about 2500 years later, which set up an ideological monument for Chinese civilization and even world civilization that is beyond the reach of today.

So, where is the cultural essence of the Chinese nation for 5000 years? In my opinion, it is a people-oriented holistic view and an integrated view of the unity of man and nature. This is where the roots and ideological context of holistic integrated medicine come from. On the remolding of medical culture, the organic integration of holism of traditional Chinese medicine and reductionism of western medicine should be the only way.

In China’s traditional culture, everything in the world is divided into five elements: Yin and Yang, which are rooted in each other, and the five elements interact with each other. On this basis, Chinese medicine puts forward that essence is substance, which can be detected by modern medical means, such as hemoglobin, blood lipid, etc., but qi and spirit instruments can not be detected, but Chinese medicine doctors can perceive their state level by looking, hearing and asking. This is the common expression of structure and function, and it is the understanding of medicine by ancient Chinese medicine. Even in today’s advanced science and technology, Chinese medicine still shows strong vitality and good curative effect, even far beyond the cognitive level and curative effect of modern medicine in some aspects, which is worth learning and learning from modernmedicine with an open mind.

In the development history of traditional Chinese medicine, Taoism, Buddhism and Confucianism have contributed a lot, and the reconstruction of modern medical culture can gain important enlightenment from it. For example, Buddhists emphasize the cultivation of the mind, emphasizing a "clean" word and demanding that the mind be free from distractions. It is not easy to do this. There are always many distractions in my heart. Can I be healthy? If you want to calculate others every day, can you be healthy? Another example is that Taoists stress health preservation and emphasize a "quiet" word. Mentality is always manic, can you calm down and nourish your heart? Therefore, it is necessary to be calm in order to ensure health. For another example, Confucianism stresses governing the country, managing the world and helping the people, and emphasizes the word "respect", so as to respect nature, society and etiquette.

Science itself has no purpose, and good use can benefit mankind, such as nuclear power technology; If it is not used well, it can also be used to kill people, such as nuclear weapons. Whether it is used well or not needs the guidance of culture. The same is true for medicine. The profound traditional culture of China, whose holism and integration view are integrated with the reductionism of western medicine, will form a new medical culture. Only by forming an integrated health service system, including an integrated medical education system, a medical research system, a medical service system, a medical prevention system and a medical management system, can we lead the new direction of medical development and go faster and further in implementing the healthy China strategy and caring for human health.

[Editor’s Note] This is an interview with Academician Fan for four consecutive years —— Fan Daiming, an academician of western medicine in 2017, why I support Chinese medicine in 2018, Academician Fan Daiming: paying too much attention to the micro, and medicine may go astray in 2019. Visiting Academician Fan Daiming three times: modern medicine needs reverse research, and this article will be published in 2020 with the theme ". Academician Fan has thought a lot about the integrated health service system to be built in the future. During the anti-epidemic period, he wrote a 50,000-word masterpiece "On the Correct Practice of Medicine", which was published in Medical Contention in four phases. The interview next year (the fifth year) may focus on this theme. (Reporter Wang Xiaobo reports from Qi Wang)

　　CCTV News:Seven departments, including the Ministry of Industry and Information Technology, launched the implementation plan of equipment renewal in the industrial field on April 9. The plan is clear. By 2027, the scale of equipment investment in China’s industrial sector will increase by more than 25% compared with 2023.

　　The implementation plan to promote the upgrading of industrial equipment will rely on the unified national market, guide enterprises to eliminate backward equipment and use advanced equipment according to laws and regulations, and improve production efficiency and technical level. At the same time, adhere to the integrated update of software and hardware, pay attention to the iterative upgrade and innovative application of software system while promoting the update of hardware equipment.

　　The plan is clear. By 2027, the scale of equipment investment in China’s industrial sector will increase by more than 25% compared with that in 2023. The penetration rate of digital R&D design tools and the numerical control rate of key processes of industrial enterprises above designated size will exceed 90% and 75% respectively, and the digital transformation of industrial enterprises will be fully covered by industrial provinces, cities and key parks.

　　Yu Xiaohui, president of China Information and Communication Research Institute, said that on the one hand, promoting the upgrading of large-scale equipment in the industrial field is conducive to stimulating effective investment and promoting technological progress. At the same time, it is also conducive to promoting the continuous improvement of the proportion of advanced production capacity, promoting industrial upgrading and upgrading, which is of great significance to accelerating the construction of a modern industrial system and helping to accelerate the cultivation and development of new quality productivity.

　　A number of industry-related equipment were included in the update action.

　　In the implementation of promoting the upgrading of equipment in the industrial field, related equipment in multiple industries will be included in the upgrading action.

　　In the replacement of inefficient equipment, we will speed up the elimination of backward and inefficient equipment and old equipment that has been in service for an extended period, aiming at production equipment such as industrial mother machines, agricultural machinery, construction machinery and electric bicycles. Among them, we will focus on promoting the industrial machine tool industry to update machine tools that have been in service for more than 10 years; The agricultural machinery industry will update flexible cutting, forming, welding, manufacturing and production technologies and equipment; The construction machinery industry will update hydraulic presses, bending machines, outdated production lines and online testing equipment.

　　In the action of upgrading high-end advanced equipment, enterprises are encouraged to update a batch of advanced equipment with high technology, high efficiency and high reliability for aviation, photovoltaic, power battery, biological fermentation and other production equipment. Among them, we will focus on promoting the aviation industry to comprehensively carry out the assembly integration capabilities and supply chain supporting capabilities of large aircraft, large amphibious aircraft and aero-engines; The production equipment in the power battery industry is upgraded to high precision, high speed and high reliability, with emphasis on updating ultrasonic welding machines, laser welding machines, liquid injection machines, volumetric cabinets and other equipment.

　　In upgrading test and testing equipment, in key industries such as petrochemical industry, medicine, shipbuilding, electronics, etc., a number of advanced equipment are updated around pilot verification and inspection and testing links such as design verification, test verification and process verification, so as to enhance engineering and industrialization capabilities.

　　Yu Xiaohui introduced that China has 41 industrial categories, 207 industrial categories and 666 industrial subcategories, which are the characteristics of the industry itself. Therefore, in this scheme, it is considered in different ways, including the replacement of inefficient equipment, the update and upgrade of high-end advanced equipment, and the update and upgrade of experimental testing equipment.

　　Focus on digital transformation and green transformation

　　In the implementation plan of equipment renewal in the industrial field, the characteristics of digitalization and greening will be highlighted.

　　In the implementation of digital transformation, it will promote the update of CNC machine tools, basic manufacturing equipment, additive manufacturing equipment, industrial robots, industrial control equipment, intelligent logistics equipment, sensing and testing equipment and other general intelligent manufacturing equipment. In addition, it also includes the raw material manufacturing industry to accelerate the application of new intelligent equipment such as unmanned transport vehicles, and the consumer goods manufacturing industry to promote new modes of intelligent equipment such as flexible production and personalized customization.

　　In building smart factories, it will promote the deep application of new technologies such as artificial intelligence, fifth-generation mobile communication and edge computing in manufacturing. Promote the networking of equipment and the digital link of production links, realize the connectivity of production data, flexible manufacturing and intelligent management, and build a digital workshop.

　　In terms of digital infrastructure construction, we will speed up the scale of new network infrastructure such as industrial Internet, Internet of Things, 5G and Gigabit optical networks, encourage the transformation of internal and external networks of industrial enterprises, and encourage large group enterprises and industrial parks to establish distinctive industrial Internet platforms.

　　In accelerating the green transformation of production equipment, we will promote the popularization and application of energy-saving and environmental protection green equipment in key energy-using industries and key links. The plan also includes accelerating the application of solid waste treatment and water-saving equipment, promoting industrial water saving and wastewater recycling, transforming industrial cooling circulation system and wastewater treatment and reuse system, and updating a number of cooling towers and other equipment.

　　Yu Xiaohui said that digitalization and greening are the two major directions for the development of manufacturing industry at present and for a long time to come, and they are also two major technical variables that affect the overall development and transformation of manufacturing industry and global competitive advantage. The promotion of green equipment is the direction of our efforts, and it is also the most important field for us to achieve the goal of industrial peak carbon dioxide emissions and carbon neutrality.

Focusing on the protection of industrial heritage, popularization of scientific knowledge and patriotism education, the Steel Structure Museum aims to let the audience know the development course of steel structure in the world, the rising road of steel structure in China and the unique charm of steel structure civilization.

(A) the characteristics of patriotism education

The steel structure museum shows the whole development process of China’s steel structure related technology from ancient times leading, to modern backwardness, to modern rise, and then to contemporary leading, which helps the audience to understand the history of national conditions and inspire the national spirit; Collecting and exhibiting a number of precious collections that carry red genes, unite blue power and focus on green development, and digging deep into the information and historical stories behind them will help stimulate the enthusiasm of the audience and cultivate scientific ideas; The theme is steel structure. Steel structure technology, products and works are important carriers for China to practice the "Belt and Road Initiative", build a community of human destiny and serve human welfare, and are also important starting points for telling the story of China’s revival.

(2) Free opening to the outside world.

The steel structure museum began its trial operation on May 18, 2017, and is open to the public free of charge every Tuesday, Thursday and Saturday. On May 1, 2018, it was approved by the Guangdong Provincial Cultural Relics Bureau and officially listed in the national cultural and cultural system; It officially opened on November 2, 2018, and the opening hours were adjusted to six days a week from Tuesday to Sunday. By the end of 2020, it had received more than 50,000 visitors. The museum has also set up online services such as visit reservation, self-help audio guide, panoramic display, etc., providing public services such as guide maps, convenient umbrellas, drinking water, and protection measures for the disabled, and regularly giving special lectures on popular science for children.

(3) Guangji steel structure treasures

The steel structure museum has collected more than 1,000 pieces (sets) of different kinds and shapes from home and abroad. The representative collections include: iron cables of Luding Bridge in Sichuan, rivets of Eiffel Tower, steel members of World Trade Center Building in New York, specifications for steel bridges of state-owned railways in 11 years of the Republic of China, 20-year annals of Showa Steel Works, coal and stone lamps of herringbone bridge in Yunnan-Vietnam Railway, draft recommendation letter of History of Wuhan Bridge Project, rivets and cables of Golden Gate Bridge in the United States, and 3D printed steel structure nodes. At the same time, according to the cultural industry norms, a collection warehouse with protective conditions was built for collection storage, and a collection and warehouse management system was established, and collection of collections continued.

(D) In-depth academic research

The steel structure museum has carried out in-depth research on the collection and history, published the Catalogue of Fine Collection (the first series), and written more than 40 articles on the Collection. Summarize the experience of enterprises in organizing industry museums, participate in the discussion of provincial and municipal industry norms for many times, share the experience of running museums and popularizing science at different theme activities, and publish many papers.

(five) to carry out social education.

The steel structure museum attaches great importance to the education of students and children, actively innovates and takes the initiative to plan and develop a series of research courses on how steel structures are "tempered", and has published a primary school edition, and will continue to compile a junior high school edition and a senior high school edition; A total of 15 public welfare lectures on "Opening of the Steel Structure Museum" were held, benefiting more than 15,000 people online and offline; Continuously held the volunteer service of "Little Interpreter Training" and carried out thematic research activities, benefiting more than 6,000 students. Co-organized a number of public welfare activities such as "prefabricated building citizen experience activities", "millions of citizens see Shenzhen" and "listening to the story of reform and opening up in the museum" with the relevant Shenzhen Municipal Bureau.

(six) extensive publicity and reporting

The steel structure museum has established an official website and WeChat WeChat official account, designed and produced brochures and guide maps, and developed various cultural and creative products such as steel structure theme souvenir covers and commemorative coins. As the only cultural institution, the Steel Structure Museum appeared in Shenzhen’s new edition (2020) city publicity film.

(seven) the social evaluation is good.

The construction and opening up of the steel structure museum has been widely praised by industry experts and the public. It has been awarded the "National Primary and Secondary School Students’ Research and Practice Education Base" and is a member unit of the China Museum Association, the National Federation of Industrial Museums and china national youth palace association.

　　Cctv news January 28th is the first day after the Spring Festival, and the main venue of key projects in the first quarter of 2023 in Shaanxi Province was held in the second phase of BYD New Energy Passenger Car Parts Project in Xi ‘an High-tech Zone. On the same day, 10 heavy projects covering new energy vehicles, 5G, intelligent manufacturing and other industries and business supporting fields in Xi ‘an High-tech Zone were started simultaneously.

　　It is understood that the concentrated start-up projects in the High-tech Zone as a whole have obvious characteristics such as large investment, high technology content, good economic benefits and strong employment-promoting ability. Among them, in the field of new energy automobile industry, the newly-started BYD New Energy Passenger Car Parts Phase II project has a total investment of 13 billion yuan. By purchasing equipment and optimizing the process, the automobile electronic parts production line will be upgraded and expanded. After completion, the new energy automobile parts production capacity will be increased by 400,000 sets/year, which will drive about 13,000 jobs. The national-level new energy vehicle testing center and vehicle-level semiconductor device and system R&D industrial base project aims to provide testing and verification opportunities for domestic independent semiconductors, and promote the industrialization verification and scale commercialization of domestic semiconductors. After completion, it is estimated that the average output value per mu will reach 31.25 million yuan.

BYD New Energy Passenger Car Parts Phase II Project

　　In the field of 5G industry, the West High-tech and Defense Phase II with a total investment of 3.3 billion yuan — The 5G Communication Industrial Park Project (South Zone) will devote itself to the research and development, production and manufacturing of 5G communication electronic products, and build facilities such as data room, production plant and assembly plant of R&D headquarters to help enterprises further seize the market share of 5G communication; The construction project of Xi ‘an Science and Technology Industrial Park Phase III, 5G Digital Factory and Science and Technology R&D Building, with a total investment of 1.87 billion yuan, mainly focuses on the research and development, production and sales of power electronic equipment such as inverters, flexible DC, SVG equipment and energy storage. After completion, it is estimated that the average output value per mu will be 26.79 million yuan.

West High-tech Days and Defense Phase II — 5G Communication Industrial Park Project (South Zone)

　　In the field of intelligent manufacturing, the project of Jixian Electronic Intelligent Manufacturing Industrial Park, which started in Xi ‘an High-tech Zone, has a total investment of 1.6 billion yuan, mainly building comprehensive office centers, multifunctional intelligent production workshops, intelligent logistics storage centers and other facilities, and will attract upstream and downstream high-tech enterprises including electronic equipment manufacturing, automobile integrated service industry, intelligent equipment industry and electronic information industry to settle in. After the project is completed, it is estimated that the average output value per mu will be 12.28 million yuan, which will drive about 5,000 jobs.

　　In addition, the newly-started business supporting projects such as Ziwei Yunduhui and Gaoxin Tianjing R&D Office Business Complex will further improve the regional business supporting facilities, enhance the regional competitiveness and optimize the "high quality and high technology" energy level.

　　"I’ll accept your homework if you can find one or two angles to demonstrate the rationality of your late submission." Recently, a classmate of East China University of Political Science and Law failed to hand in his homework in time for some reason, and wrote an article to demonstrate the rationality of "late handing in homework". I didn’t expect his teacher — — Ma Yinxiang, an associate professor at the School of Law, wrote an analysis of the classification method of "late homework cases" and promised students back and forth that the wonderful "debates" between teachers and students became popular on the Internet. In the end, Mr. Ma Yinxiang accepted the late assignment. He told the Beijing Youth Daily reporter that the reason why he "replied" was that he hoped students could understand the awareness of rules and apply the legal knowledge they had learned to their lives.

　　Students miss the time to hand in homework.

　　Want to ask the teacher to "share the risk"

　　Xu is a sophomore at East China University of Political Science and Law. This year is the first time that she has taken the criminal law case course of Ma Yinxiang. Xu told the reporter of Beiqing Daily that Mr. Ma’s class was arranged on the evening of 15th, with four consecutive classes. At the beginning of the first class, Mr. Ma said that he would hand in his homework between classes. "I began to think that the teacher would say it again during a certain class, and then everyone would hand it in."

　　Unexpectedly, in the next few classes, Teacher Ma didn’t mention handing in homework. After class, Xu left with other students. "I thought I might hand it in next class." Xu said that she didn’t know that the other students had handed in their homework until she discussed the next homework with other students.

　　According to Mr. Xu, Mr. Ma’s score in the criminal law case class is produced by the average score of several usual assignments. Therefore, a failure to hand in homework will affect the final score. On the 18th, after discovering that only he didn’t hand in his homework, Xu asked Mr. Ma if he could hand it in late in the course group. Mr. Ma replied that he couldn’t hand it in late because he had been reminded many times. Xu explained: "We have differences on the expression of handing in homework between classes. Can we share the risks in view of such a major misunderstanding?"

　　Students write papers to demonstrate "rationality"

　　The teacher replied with professional knowledge of law.

　　After Xu proposed "risk sharing", Ma Yinxiang replied in the WeChat group: "There are 192 students in the class, and you are the only one who wants to misunderstand me. From the probability of occurrence, the obvious system is too abnormal, which is an abnormal intervention factor, enough to rule out the rationality of your late homework, so let me carry this cauldron. ‘ Male and female servants can’t do it ’ 。” However, Ma Yinxiang later mentioned that if Xu could find an angle to demonstrate the rationality of his late submission, he would accept Xu’s homework.

　　Xu told the reporter of Beiqing Daily that because this assignment was really written with my heart, I just couldn’t pay it because I went to the bathroom. "I feel a little distressed and want to die again." In order to write this article well, Xu also asked other students, and everyone gave her a lot of angles. Finally, she finished writing this article "On the Rationality of Late Homework" in more than three hours.

　　The reporter of Beiqing Daily noticed that Xu discussed that it was reasonable to hand in her homework late from the perspectives of civil law and criminal law, and submitted multiple evidences to find several students to help her testify. At about 10 o’clock that night, Mr. Ma Yinxiang replied to an article "Analysis on the Case of Late Homework" in the group, using the classification analysis method in the criminal law to demonstrate whether the supplementary behavior is reasonable and whether it can accept Xu’s homework, and finally came to the conclusion that "in terms of supplementary homework behavior, it is objectively unreasonable in form, but it does not violate the principle of fairness in essence. Therefore, the supplementary homework is regarded as effective, and this grade is not affected."

　　Teachers and students argued that the popular network was praised.

　　Netizen commented that "although things are small, they are not light."

　　The wonderful debate between teachers and students about late handing in homework quickly became popular on the Internet, and netizens praised this vivid law class in succession. Some netizens commented: "Very good, this is the most reasonable way of education and thinking." Some netizens commented: "Although the matter is small and unreasonable, as a law student, we should have enough respect for the rules."

　　Xu told the reporter of Beiqing Daily that he was particularly nervous when he saw Mr. Ma reply to himself. "My hands are shaking." Because the first half of Ma Yinxiang’s reply demonstrates that the late submission of homework is not formal rationality, "like checking the results in middle school, I don’t know what the result will be." When it was found that Mr. Ma not only accepted his homework, but also did not deduct any grades, Xu was particularly surprised and was moved by Mr. Ma’s intentions.

　　conversation

　　Ma Yinxiang: The problem is to test, reply and respect.

　　After teaching for four years, Ma Yinxiang said that his teaching philosophy is equal dialogue between teachers and students. This time, in the face of the difficult problems thrown by the teacher, Mr. Xu not only did not flinch, but seriously demonstrated from a professional point of view. As a teacher, he has the responsibility to reply to his classmates. At the same time, he hopes to improve students’ awareness of rules and learn to apply legal knowledge to daily life through this example.

　　Beiqing Daily: Why do you want students to find an angle to demonstrate the rationality of late homework?

　　Ma Yinxiang: This classmate didn’t say that he didn’t write it at first, but later he wanted to write it up and hand it in. If so, it certainly doesn’t meet the requirements. However, this classmate also said that she had finished her homework and brought it to the classroom, but she didn’t hand it in because of negligence. I think this is understandable. I just want to give her a chance to put forward some legitimate reasons for her late handing in her homework, and also to see if she can apply what she has learned to defend herself.

　　Beiqing Daily: Have you ever thought of this classmate’s reply?

　　Ma Yinxiang: I initially imagined that there would be two outcomes. The first is that after I throw out the question, students may feel that they are unreasonable and give up automatically. But this classmate is still tough. After I threw a difficult question, she took it, but I didn’t expect her to write so long.

　　Beiqing Daily: Why did you reply to this classmate in a legal way?

　　Ma Yinxiang: Because she was also in a large group with more than 300 classmates at that time, and she wrote very long, I think it may have a very negative impact if this matter is not handled properly. After thinking about it, I think it is better to explain this problem with the principle of legality in criminal law that I talked about in class, which is also the way to apply legal knowledge to life. Of course, the starting point is to protect the legitimate rights and interests of students, and finally, it has made a favorable treatment for students. Now it seems that most of them can understand.

　　Beiqing Daily: Some people think that it is necessary for both sides to write such a long article to discuss such a small matter as making up homework.

　　Ma Yinxiang: I think this is a common process in our teaching process. Teachers also hope to examine students’ understanding and application of a certain knowledge in this way, and teachers respond to students out of respect. Xu’s article is very long and professional in form. In this case, it is disrespectful to the students to send her away in a simple sentence or two, and there is no way for other students to understand why I accepted her homework again.

　　Beiqing Daily: Besides examining students’ mastery of knowledge, are there any other considerations?

　　Ma Yinxiang: In addition to examining students’ mastery of knowledge, I think this reply is also to cultivate students’ awareness of rules. I also clearly pointed out in my reply that this classmate didn’t pay attention to observing the rule of submission time. Even if you write well, it is also a violation from the procedural and behavioral rules. We teach law, and the core of the rule of law is the system of rules, so that students can understand how rules are implemented in our lives and how to use them to fight for their legitimate rights and interests. I think this is better than telling cases that are far away from students in class.

　　Beiqing Daily: Will this practice be adhered to in the future teaching process?

　　Ma Yinxiang: I have always insisted that teachers and students should talk on an equal footing, but the specific form may not necessarily adopt this kind of literal expression. My teaching philosophy is to have an equal dialogue on the controversial issues under the premise of respecting students, so as to solve them reasonably.

　　Beiqing Daily: Some online buzzwords have appeared in the communication with students. Is this intentional?

　　Ma Yinxiang: Now many freshmen and sophomores are close to the post-00 generation, and their lives are more entertaining. If I use the teaching methods of my teacher when I was a student to teach the current students, the effect may not be so good. Therefore, I wanted to find a common language with my students. Later, I found that introducing some online buzzwords can arouse students’ enthusiasm and teach them the boring knowledge in a more interesting way. Before this reply, I also specially selected a song to send to the students. After the serious argument, I also added a dividing line to write some relatively lyrical content.

　　This group/reporter Li Tao Intern Zhang Yue Meng

With the popularity of financial services and the rise of Internet lending, many people are exposed to loans, credit cards and other related products. However, it is not uncommon to ask late questions, which is followed by severe collection measures, including lawyers’ letters. Today, we discuss the topic of "saying that I sent a lawyer’s letter to me overdue", and analyze the root causes, legal consequences, solutions and the importance of personal credit management.

Many people rely more and more on loans and credit cards for consumption and financial management, but the overdue questions are also on the rise. Once I accidentally defaulted on a credit card bill and received a serious lawyer’s letter. This letter not only puzzled me, but also made me realize the seriousness of the question-saying that I sent me a lawyer’s letter overdue. What went wrong?

The causes of overdue questions include poor personal financial management. Many people lack planning, fail to budget their expenditure and income reasonably, which leads to their inability to repay on time. Unexpected events may also lead to overdue, such as sudden decrease in income or increase in family economic pressure, but financial institutions will not cut their requirements for individual reasons, and those who are overdue will be recovered.

The fact that I sent me a lawyer’s letter overdue reflects a bigger question, which is the bank or the loan platform, and the attitude towards overdue behavior is getting tougher and tougher. This situation not only affects personal credit, but also may become a hidden danger in economic life.

Behind "saying that I sent me a lawyer’s letter overdue" is the serious attitude of the law. In our country’s law, financial contracts are legally binding. If individuals sign repayment agreements with banks or other institutions, they will be responsible for their own credit behavior. Once the overdue situation occurs and the repayment obligation is not fulfilled on time, the financial institution can take recovery measures in accordance with the terms of the contract and relevant laws.

A lawyer’s letter is a formal legal document, which is usually sent by a law firm. Its purpose is to urge the debtor to repay as soon as possible. The fact that I sent a lawyer’s letter to me overdue shows that I have entered the stage of legal intervention. A lawyer’s letter usually lists the amount owed, the breach of contract and the legal consequences, and may misappropriate the penalty clause in the contract to increase the debt.

If the overdue person fails to solve the question after receiving the lawyer’s letter, the consequences may become more serious, including case litigation, property freezing, credit record damage and so on. Saying that I sent a lawyer’s letter overdue is not only a paper threat, but an actual legal pressure, which should not be underestimated.

When faced with the situation of "saying that I sent me a lawyer’s letter overdue", it is particularly important to deal with it correctly, and never choose to escape. In this case, active communication and solution are the key to avoid legal consequences.

The first step is to calm down and carefully examine the contents of the lawyer’s letter to confirm whether the amount owed is correct. If there is any mistake, you should contact the other party in time to solve the problem; If it is correct, a repayment plan should be made as soon as possible. Many financial institutions allow repayment by installment or negotiation, so as to avoid further legal proceedings.

Explaining your financial situation is also an effective strategy. Saying that I sent me a lawyer’s letter overdue actually reflected the pressure of collection. If you can provide proof to financial institutions or law firms, such as reduced income and family emergency expenses, you may win a certain degree of tolerance.

In any case, don’t ignore the lawyer’s letter as a legal document. Delay in handling will not only lead to more complicated legal disputes, but also seriously damage personal credit. It should be warned that I sent a lawyer’s letter to me after the deadline, so that I can learn to deal with and guard against it.

After dealing with overdue questions, it is more important to avoid similar situations from happening again. Saying that I sent me a lawyer’s letter overdue made me deeply aware of the importance of personal credit management.

We should develop good financial planning habits. Make a budget every month, define the ratio of income to expenditure, and ensure that the repayments are covered by sufficient funds. If you can’t avoid loans, you must choose an appropriate amount and do what you can.

Pay attention to the change of credit history. After saying that I sent me a lawyer’s letter overdue, I went to inquire about my personal credit report and found that the historical overdue had been recorded. Credit records directly affect the ability to apply for loans and other financial services, so we should always pay attention to them.

Keeping communication channels open is also an important means. The experience of saying that I sent a lawyer’s letter to me overdue made me understand that when the economic pressure is great, I should communicate with financial institutions as soon as possible, and strive to solve the problem as soon as possible to avoid worsening the problem.

Saying that I sent me a lawyer’s letter overdue taught me a profound lesson. This is not only a simple reminder, but also a warning in many aspects such as law, credit and financial management. By analyzing the root causes, legal consequences, coping strategies and personal credit management, we can more deeply understand the importance of financial contracts and how to abide by commitments in economic behavior.

Everyone may encounter times of economic stress, but the key is how to face and solve the problem. Learning from the experience of "saying that I sent me a lawyer’s letter overdue", we can better manage our finances in the future, avoid falling into similar difficulties, and at the same time safeguard our personal credit and move towards a more stable economic life.

Original Hou Bingbing Jing Wong Inspection Medical Network

Author: Hou Bingbing Jing Wong

SETTING: Shijiazhuang Traditional Chinese Medicine Hospital, Hebei Province

After the peripheral blood smear was stained with Wright’s stain, the normal red blood cells were pale pink (the center of the cell was a lightly stained area with a diameter of 1/3), and the size was uniform (6.7-7.7um). There were no other abnormal structures in the cells, and red blood cells were scattered at the junction of the body and tail of the blood smear. Various reasons may lead to changes in the morphology and structure of red blood cells, such as abnormalities in the size, shape, dyeing, structure and arrangement of red blood cells (note: human factors, such as production and dyeing, should be excluded first). The pictures in this article are mainly taken from Shanghai Clinical Laboratory Quality Control Center in previous years.

Macroerythrocytes

Macrocyte (diameter > 15um), macrocyte (diameter 10-15um). Erythrocyte volume changes are mostly seen in megaloblastic anemia caused by folic acid or vitamin deficiency, and also in hemolytic anemia or MDS and other diseases.

Target red blood cell

Red blood cells are larger in diameter, deeply stained in the center, lightly stained around and deeply stained at the edge of cells, such as shooting targets. It is more common in thalassemia. Such as timely drying and fixing when smearing can also cause similar changes.

Spiny red blood cell

The length, width and spacing of protrusions on the surface of red blood cells are different (pay attention to distinguish them from blunt sawtooth red blood cells). It is more common in β -lipoprotein deficiency (acanthocyte can reach 80%), and can be seen after splenectomy, alcoholic liver disease, uremia and so on.

Blunt sawtooth red blood cell

That is, shrunk red blood cells, the length, width and spacing of cell surface protrusions are the same (pay attention to distinguish them from blunt sawtooth red blood cells). More common in hypertonic environment or improper production.

cabot ring

Purple-red thin coil structure appearing in red blood cells, sometimes wound in a figure of eight. Its nature is not clear at present, and it is thought that it may be the residue of nuclear membrane or spindle or the product of lipoprotein denaturation in cytoplasm. Common in patients with megaloblastic anemia, hemolytic anemia, leukemia or lead poisoning.

Mouth red blood cell

The pale area in the center of red blood cells is a narrow crack, the center of the crack is narrower than both ends, and the edge of the crack is clear, similar to a slightly open fish mouth. A small amount of oral red blood cells can also be seen in normal people’s peripheral blood, which is generally 3%-4%. If it exceeds 4%, it can be considered abnormal. When it increases, it is more common in hereditary oral polycythemia, which can be seen in DIC, alcoholism, hemolytic anemia and liver disease.

Helmet red blood cell

The shape is irregular, with 2 to 3 sharp corners in helmet shape, which is more common in disseminated intravascular coagulation, microangiopathic hemolytic anemia, cancer metastasis and so on.

Teardrop red blood cell

Red blood cells are teardrop-shaped, pear-shaped, cudgel-shaped, etc., which are most common in myelofibrosis and hemolytic anemia.

schizocyte

The cells are irregular in shape, different in size, and have asymmetric pointed protrusions, which are red blood cell fragments or incomplete red blood cells. Usually irregular triangle, thorn or helmet shape. A small amount of erythrocytes can also be seen in normal people’s peripheral blood, which is generally less than 2%. If it exceeds 2%, it can be considered abnormal. It is a fragment of red blood cells caused by mechanical injury or endogenous abnormality, which is mainly found in DIC, microangiopathic hemolytic anemia, megaloblastic anemia, severe burn and so on.

Money-shaped red blood cells

The arrangement of red blood cells, like copper coins strung together, indicates that the blood viscosity is high, and abnormal proteins appear in plasma, which reduces the negative charge of red blood cells, changes the plasma charge balance, and reduces the repulsive force between red blood cells, thus facilitating the formation of money-like aggregation and accelerating the erythrocyte sedimentation rate. More common in multiple myeloma, hyperglobulinemia, hyperfibrinemia and so on.

spherocyte

The lightly stained area in the center of red blood cells disappeared, and the whole cells were deeply and evenly colored. Under normal circumstances, a small amount of spherical red blood cells can also be seen in peripheral blood, generally less than 3%. The increase in the proportion of spherical red blood cells is more common in hereditary spherocytosis (often more than 25%, sometimes reaching 100%), autoimmune hemolytic anemia, abnormal hemoglobinopathy, liver cirrhosis, hypersplenism, chronic infectious diseases, globin body hemolysis, neonatal hemolysis and hemolytic diseases caused by erythrocyte enzyme deficiency.

Polychromatic erythrocytes

The whole red blood cell or a part of its cytoplasm is grayish blue (due to the coexistence of intracellular RNA and hemoglobin), which is called polychromatic red blood cell. Under normal circumstances, a small amount of polychromatic erythrocytes can also be seen in peripheral blood, which is generally less than 1.5%. The increase of polychromatic erythrocyte ratio is more common in hemolytic anemia or acute hemorrhagic anemia, which indicates that bone marrow proliferative ability is active.

Basophilic stippling erythrocytes

Small blue particles with different sizes and scattered distribution can be seen in red blood cells, which is a relatively naive red blood cell. It may be due to the degeneration, aggregation and precipitation of basophils remaining in the cytoplasm after heavy metal damage to cells and the formation of particles. Under normal circumstances, basophilic spotted red blood cells (about 1/10000) are rarely seen in peripheral blood, but they are more common in heavy metal poisoning (such as lead, mercury, bismuth, etc.).

Howell-Jolly corpuscles

Red blood cells contain 1-2um purplish red round corpuscles with different sizes and numbers. This corpuscle may be the nuclear chromatin remaining during the division of young red blood cells. Common in hemolytic anemia, megaloblastic anemia, splenectomy, erythroleukemia or other proliferative anemia.

Oval red blood cell

Red blood cells are oval or rod-shaped, with a length of 3-4 times greater than the width, a maximum diameter of 12.5μm and a transverse diameter of 2.5 μ m.. This kind of red blood cell is placed in hypertonic, isotonic and hypotonic solution or normal human serum, and its oval shape remains unchanged, but neither young red blood cell nor reticulocyte is oval. Under normal circumstances, oval red blood cells are rarely seen in peripheral blood (about 1%, not more than 15%). In the blood smear of patients with hereditary ovalocytosis, the proportion of such red blood cells can reach 25% or even as high as 75%, and the proportion of oval red blood cells can also increase in thalassemia, megaloblastic anemia, myelosclerosis and iron deficiency anemia.

Nucleated red blood cell

Under normal circumstances, nucleated red blood cells can not be seen in adult peripheral blood, but a small number of nucleated red blood cells can be seen in neonatal peripheral blood within one week of birth. When nucleated red blood cells appear in adult peripheral blood, they can be seen in various proliferative anemia (hemolytic anemia, acute hemorrhagic anemia, megaloblastic anemia and severe hypopigmentation anemia can also appear), malignant tumor or metastasis of hematopoietic system, splenectomy and severe hypoxia.

Crescent red blood cell

Red blood cells are pale, incomplete and crescent-shaped (note that they are differentiated from sickle-shaped red blood cells). Mainly seen in some hemolytic anemia (such as PNH).

Red blood cells are infected with plasmodium (ring)

The nucleus of plasmodium ring is located on one side of the worm, which is shaped like a ring inlaid with precious stones. It is found in the peripheral blood of patients infected by plasmodium.

[References]

1. Wu Xiaoman. Basis of Clinical Laboratory [M]. 1st Edition. Wuhan: Huazhong University of Science and Technology Press, 2013.

Read the original text

District and county (city) people’s governments, municipal government departments and directly affiliated units:

The "Hangzhou comprehensive implementation of the basic medical insurance municipal overall implementation plan" issued to you, please earnestly organize the implementation.

Hangzhou Municipal People’s Government

November 16, 2021

(This piece is publicly released)

Hangzhou has fully implemented basic medical insurance.

Municipal overall implementation plan

In order to comprehensively implement the municipal overall planning of basic medical insurance, further improve the basic medical insurance system, enhance the operational efficiency and risk resistance of the basic medical insurance fund, and improve the service level of medical security, this implementation plan is formulated according to the relevant requirements of the state and the province on deepening the reform of the medical security system, combined with the actual situation of our city.

I. Objectives and tasks

Since January 1, 2022, in accordance with the standards of unified system and policy, unified fund collection and expenditure, and integrated management and service, we will realize municipal-level overall planning of basic medical insurance and accelerate the construction of a more fair, sustainable and high-quality basic medical security system.

Second, the basic principles

(1) Adhere to fair enjoyment and coordination. In accordance with the requirements of "do your best and do what you can", improve and unify the city’s basic medical insurance policy, deepen the "three-medical linkage" and "six-medical overall planning", and realize the insured’s legal insurance payment and fair enjoyment of basic medical security.

(2) Adhere to overall fund planning and risk sharing. The implementation of the basic medical insurance fund municipal unified revenue and expenditure management, unified accounting, overall use, strict implementation of fund revenue and expenditure budget management, establish and improve the city and district, county (city) two levels of fund risk responsibility sharing mechanism, improve the overall level of fund risk resistance.

(three) adhere to the system, clear rights and responsibilities. In accordance with the requirements of "municipal overall planning and hierarchical management", balance the interests of all parties, clarify the division of responsibilities between the city and the district and county (city), and establish an incentive and restraint mechanism linked to management performance.

(4) Adhere to smooth convergence and serve the convenience of the people. Carefully adjust the medical security policy to ensure that the overall treatment level of the insured does not decrease; Optimize the handling process of "city-wide general office" to promote the wisdom and convenience of medical security public services.

Third, the main measures

(1) Unified system and policies.

In accordance with the notice of Hangzhou Municipal People’s Government on printing and distributing the measures for basic medical security in Hangzhou (Hangzhou Zheng [2020] No.56, hereinafter referred to as the "Measures") and other municipal medical security policies and relevant regulations, the city implements unified basic policies such as basic medical insurance for employees (including maternity insurance, hereinafter referred to as employee medical insurance) and basic medical insurance for urban and rural residents (hereinafter referred to as urban and rural medical insurance). Implement a unified medical insurance payment method and establish a hierarchical management mechanism; Implement a unified basic medical insurance drug list and medical service items (including medical materials) list, medical service prices, medical equipment bidding and procurement policies.

1. Insurance payment policy.

(1) Low-level personnel support the insurance. The medical insurance premiums for urban and rural residents who hold the "Minimum Living Security Marginal Family Certificate" shall be uniformly adjusted to be fully subsidized by the government.

(2) Employee medical insurance payment base. The total wages of the employees of the employing unit are determined according to the sum of the wages paid by the insured employees of the unit, and the base of the wages paid by the on-the-job employees is determined according to the average monthly salary of the previous year. If the employee’s payment wage is lower than the average monthly wage of employees in the whole social unit in Zhejiang Province in the previous year (hereinafter referred to as the provincial flat wage) by 60%, it shall be determined according to the provincial flat wage in the previous year; If it is higher than 300% of the provincial average wage in the previous year, it shall be determined according to 300% of the provincial average wage in the previous year.

2. Treatment waiting period policy.

(1) on-the-job employees. If the employees interrupt the insurance, they will enjoy the medical insurance benefits for employees in the third natural month from the payment month after re-handling the insurance payment procedures. If the employer fails to pay the employee’s medical insurance premium in full and on time, the insured shall suspend the employee’s medical insurance benefits from the second natural month; The tax authorities shall order the employer to pay the supplement within a time limit, and the time limit for paying the supplement within a time limit shall generally not exceed 60 days from the date of making the decision. If the employer pays the employee’s medical insurance premium in full within the time limit, the insured person will resume enjoying the employee’s medical insurance benefits from the second natural month of full payment, and the medical expenses incurred during the period from suspension to restoration of the employee’s medical insurance benefits will be reimbursed by the basic medical insurance fund. If the employer fails to pay the supplementary employee medical insurance premium within the time limit, the employee medical insurance benefits that the insured shall enjoy shall be borne by the employer from the second natural month after the unpaid insurance premium.

(2) Flexible employees. Flexible employment personnel who participate in the medical insurance for employees in this Municipality for the first time shall enjoy the medical insurance benefits for employees from the second natural month of registration. If the flexible employment personnel interrupt the insurance, they will not enjoy the medical insurance benefits for employees during the interruption of the insurance; If normal payment is resumed, employees will enjoy medical insurance benefits in the third natural month from the normal payment month.

(3) Urban and rural residents. Urban and rural residents’ medical insurance insured fails to go through the procedures for participating in (continuing) insurance payment within the time specified in the Measures, and can apply for paying the annual medical insurance premium for urban and rural residents, and enjoy the medical insurance benefits for urban and rural residents in the remaining months of the settlement year from the third natural month of the payment month.

(4) others. In addition to the above circumstances, if the insured person needs to bear the waiting period of treatment according to the provisions of the Measures after changing the medical insurance coverage or handling the transfer and connection procedures, it will be uniformly adjusted to enjoy the medical insurance treatment corresponding to the new insurance coverage from the third natural month of the new insurance payment month.

3 employee medical insurance personal accounts included in the measures.

The personal account funds of on-the-job employees and flexible employees are uniformly allocated according to the standards of Hangzhou urban area. The personal account funds of retirees who have applied for medical insurance before December 31, 2021 shall be uniformly allocated according to the amount of retirement transfer approved in 2021; After January 1, 2022, the quota standard for personal account transfer of new medical insurance retirees was determined according to the personal account transfer policy of the original medical insurance management area in 2021. Unless otherwise provided by the province, such provisions shall prevail.

4. Outpatient treatment policy.

(1) Chronic disease clinic. The insured person’s outpatient medical expenses for chronic diseases in a settlement year meet the payment scope of the basic medical insurance fund and should be borne by the individual, and are included in the payment scope of the serious illness insurance fund. The management scope of chronic diseases shall be implemented according to the relevant provisions of the province and the city.

(2) Outpatient dialysis of chronic renal failure. Will suffer from chronic renal failure to outpatient dialysis treatment of the insured into the city’s special medical assistance. For outpatient dialysis expenses that occur in dialysis designated medical institutions and meet the requirements, employees’ medical insurance insured individuals bear 5%, and urban and rural residents’ medical insurance insured individuals bear 10%; The rest of the medical expenses that should have been borne by individuals after the settlement of basic medical insurance and serious illness insurance according to regulations shall be paid by medical assistance funds. The scope of fund payment and settlement management measures shall be uniformly implemented in accordance with Hangzhou urban policy.

5. Medical treatment management policy.

The city unified the grading diagnosis and treatment system in accordance with the policy of Hangzhou city. Give full play to the regulatory role of the medical community in the structure of diagnosis and treatment and the structure of medical expenses inside and outside the county, and promote the treatment of diseases, rational examination and rational use of drugs. The implementation of a unified management policy for medical treatment in different places, the insured in principle should be directly settled by my valid medical certificate. Medical treatment in different places in the province shall be exempted from filing, and the medical treatment shall be implemented according to the relevant regulations of Hangzhou. The medical expenses of maternity insurance that cannot be directly settled shall be paid in full by the individual and settled by the medical insurance agency according to the regulations. Medical treatment in different places outside the province is generally implemented according to the policy of temporary going out for medical treatment in Hangzhou. After eligible insured persons go through the procedures of referral filing and permanent residence filing in other places, medical treatment is implemented according to the relevant provisions of Hangzhou.

(2) Unified collection and expenditure of funds.

1 unified fund budget and final accounts management. According to the relevant provisions of the budget management of social insurance funds, the draft budget and final accounts of employee medical insurance and urban and rural residents’ medical insurance funds shall be compiled in a unified way, which shall be examined and approved by the whole city and then implemented according to the procedures. Implement the supervision of the whole process of budget and final accounts to enhance the binding and seriousness of the fund’s budget and final accounts.

2. Unified fund revenue and expenditure management. Clarify the subject of fund collection, adjust the income level, and unify the rules of income transfer, fund use and payment management. The implementation of municipal funds unified revenue and expenditure, unified accounting, account management.

3 unified fund transfer and deposit. In the basic medical insurance municipal co-ordination, to Tonglu County, Chun ‘an County and jiande city medical insurance fund to carry out special audit, clear over the years debt, arrears and fund balance and transfer methods, establish and improve the fund balance deposit management mechanism.

4. Unified responsibility sharing mechanism. In accordance with the principle of "unified fund revenue and expenditure, graded responsibility, and reasonable gap sharing", we will establish and improve the responsibility sharing mechanism at the city, district and county (city) levels, so as to realize the equality of rights and obligations, the matching of financial rights and administrative powers, and the combination of incentives and constraints.

The detailed rules for the implementation of the unified revenue and expenditure of the basic medical insurance fund shall be formulated separately by the municipal medical security department in conjunction with the departments of finance, taxation and auditing.

(3) Integration of management and services.

Further promote the "streamline administration, delegate power, strengthen regulation and improve services" reform in the field of medical insurance, create an efficient and convenient medical insurance service system, and effectively improve service efficiency and service level.

1. Unified protocol management. Formulate and implement unified measures for the agreement management of designated medical institutions, improve the dynamic management mechanism of access and exit, implement unified conditions, evaluation rules and working procedures for designated medical institutions, sign unified agreements and implement unified assessment methods.

2. Unified handling services. Unify the layout of handling outlets, make use of the advantages of cooperative outlets such as banks, insurance companies and medical institutions to create a "30-minute medical insurance service circle" and strive to build a "15-minute medical insurance service circle". Unified handling service standards, realize the standardization of site setting, handling process and service image. Unify the management mode of handling, establish and improve the hierarchical and classified management system, and realize the "separation of handling, one network handling, one window handling and the whole city handling" of medical insurance handling business. Unified handling platform construction, in accordance with the requirements of the province’s "smart medical insurance" information system construction, build a unified medical insurance handling service platform.

3 clear division of labor between the city and the district and county (city). Actively explore a medical security management system that is consistent with the actual situation in our city and compatible with the municipal overall planning of basic medical insurance. The municipal government and its relevant departments are responsible for formulating and adjusting the city’s medical security policies, guiding and managing various medical security services, building and maintaining medical security information systems, making overall plans for the supervision and management of funds, and organizing and implementing the assessment of districts and counties (cities). District, county (city) governments and their relevant departments are responsible for implementing various medical insurance policies, and completing tasks such as enrollment expansion, fund revenue and expenditure, and medical insurance business handling.

Fourth, organizational guarantee

(1) Strengthen organizational leadership. It is an important content of deepening the reform of medical security system to comprehensively implement the municipal overall planning of basic medical insurance, which is related to the vital interests of the majority of insured persons and the overall situation of reform, development and stability. All districts and counties (cities) should earnestly raise awareness, strengthen leadership, meticulously organize and solidly promote the implementation of various policies. It is necessary to continuously improve the medical security system, strengthen the construction of personnel and information systems, and ensure that it is compatible with the development of medical insurance in the new era.

(2) Strengthen departmental coordination. The medical security department should take the lead in the specific implementation, properly carry out the smooth convergence of municipal overall policies, do a good job in fund supervision and actuarial balance, and put forward suggestions for policy adjustment in a timely manner according to the operation of the fund to ensure the smooth operation of the fund and improve the efficiency of management services. The financial department should strengthen and improve the management of the fund’s financial accounts, and implement various government subsidies according to regulations. Health departments should strengthen the comprehensive supervision of medical institutions within the municipal overall planning system and do a good job in the construction of graded diagnosis and treatment system. The tax authorities shall perform the duties of collecting and paying the basic medical insurance premiums according to law, and do a good job in the adjustment of collection levels and related collection work. The audit department should strengthen the audit supervision of the city’s basic medical insurance fund before and after the municipal overall planning. Other relevant municipal departments and district and county (city) governments shall do relevant work according to their duties, study and solve problems encountered in the process of work implementation in a timely manner, and report for instructions according to regulations if it is difficult to solve.

(3) Pay attention to publicity and guidance. Strengthen positive publicity and public opinion guidance, thoroughly and accurately interpret the municipal overall planning policy of basic medical insurance, respond to the concerns of the masses in a timely manner, actively guide the insured to seek medical treatment in a reasonable and orderly manner, and effectively enhance the awareness, recognition and satisfaction of all sectors of society on relevant policies.

This implementation plan shall come into force as of January 1, 2022, and the Municipal Medical Security Bureau shall take the lead in organizing the implementation. Unless otherwise stipulated by the state or province, such provisions shall prevail. If the previous documents are inconsistent with the provisions of this implementation plan, this implementation plan shall prevail.

Notice of Hangzhou Municipal People’s Government on Printing and Distributing the Municipal Overall Implementation Plan for Comprehensive Implementation of Basic Medical Insurance in Hangzhou. pdf