First, the insured object

In addition to the basic medical insurance for employees (hereinafter referred to as employee medical insurance), all urban and rural residents except those who enjoy other medical security systems in accordance with the regulations will implement the policy of holding residence permits, and primary and secondary school students and preschool children from other places will participate in residents’ medical insurance in their permanent residence. Encourage college students to participate in residents’ medical insurance at their school places, and implement relevant policies for participation.

Second, the payment standard

Individual payment standard, the implementation of the unified provisions of the province in 2024 residents medical insurance individual insurance payment standard, 400 yuan per person per year.

Three, special personnel insurance subsidy policy

The city’s residents’ medical insurance premiums are classified and funded by some insured individuals, and the insured funds are solved by financial funds and medical assistance funds. Insured persons who can enjoy multi-identity insurance subsidy have high or low subsidy standards and cannot enjoy the insurance subsidy policy repeatedly.

(a) poor people, orphans (including the fact that no one is raising children) to give full funding, the funds from the medical assistance fund.

(II) The minimum target is subsidized according to the quota of 240 yuan/person, and the insured funds are paid from the medical assistance fund. After enjoying the subsidy, the individual bears part of the 160 yuan/person and the insured pays it by himself.

(III) The poverty-stricken population identified by the agricultural and rural departments and the poverty-stricken population in rural areas that are easy to return to poverty (unstable poverty-stricken households, marginal poverty-stricken households, and sudden severe hardship households) are given a fixed subsidy according to 240 yuan/person. After enjoying the subsidy, some 160 yuan/person borne by individuals shall be paid by the insured.

(IV) The individual payment subsidy for eligible rural only-child parents and children under the age of 18 in this Municipality shall be implemented in accordance with the Notice on the Measures for Individual Payment Subsidies for Rural Only-child Parents in Shaanxi Province to Participate in Urban and Rural Residents’ Medical Insurance (No.36 [2023] of Shaanxi Wei Population).

Four, the insured payment and treatment to enjoy time

The centralized payment period of medical insurance for residents in the city is from September 26, 2024 to December 20, 2024. If it is necessary to extend or shorten the time of centralized payment due to special circumstances, the tax department shall notify the society after consultation with the medical insurance department, and the city shall implement it uniformly.

In 2024, residents’ medical insurance contributions will be paid back, from January 1, 2025 to March 31, 2025.

(A) the general staff insurance payment policy

The general insured shall pay the residents’ medical insurance premium during the centralized payment period, and the residents’ medical insurance benefits will be enjoyed from January 1, 2025 to December 31, 2025 after payment. Pay medical insurance premiums for urban and rural residents during the overdue period, and set a waiting period of 3 months for fixed treatment. Those who fail to pay the insurance premium in the centralized payment period or the supplementary payment period shall not enjoy the residents’ medical insurance benefits in the insured year.

(two) some special personnel insurance payment policy.

1. Workers’ medical insurance personnel

Those who need to participate in the residents’ medical insurance in the current year after the interruption of their medical insurance during the employee’s medical insurance period should apply for the registration of residents’ medical insurance in time after suspending the original insurance relationship. After the payment is completed according to the individual payment standard uniformly stipulated by the whole city, the treatment enjoyment period starts from the next month after participating in the residents’ medical insurance payment to December 31 or the date of change again.

2. Newborns

(1) From January 1, 2025, within 90 days after the birth of a newborn, the guardian shall register with the medical insurance agency at the place where the newborn is registered or where he lives, and pay the medical insurance premium of the residents in the year of birth. The treatment period is from the date of birth to December 31 of the year of birth; If the newborn fails to pay the medical insurance premium of the residents in the year of birth within 90 days, he can pay the insurance premium in accordance with the unified individual payment standard of the whole city in that year. After the payment is completed, the treatment period is from the month following the payment in the year of birth to December 31.

(2) The date of birth of the newborn is less than 90 days from December 31st of that year. If you enjoy the medical insurance benefits of the year of birth, you must pay the medical insurance premiums of the residents of the year of birth within 90 days after birth, and the period of enjoying the benefits is from the date of birth to December 31st of that year; If you enjoy the medical insurance benefits for the second year after birth, you must pay the medical insurance premium for the second year after birth within 90 days after birth, and the treatment period is from January 1 to December 31 of the following year; Failing to pay the corresponding annual residents’ medical insurance premium within 90 days, it shall be implemented according to the relevant provisions of the general staff’s insurance payment and enjoyment of treatment.

(3) If the newborn dies after birth, and the guardian pays for the insurance within 90 days from the date of birth, the medical expenses incurred after birth shall be reimbursed according to the policy.

3. College students

(1) In those years, college students who have enrolled and new college students are based on their school status and take the school (campus) as the unit. After paying the insurance premium, they will enjoy the residents’ medical insurance benefits from the date of payment completion. If you are a person who enjoys government-funded insurance, you can choose to participate in the school registration or identity recognition, and enjoy the residents’ medical insurance benefits according to regulations.

(2) The insured college students who graduated this year in the insured year will enjoy the medical insurance benefits in Shangluo until December 31st of the current year. After graduation, those who participate in employee medical insurance or move out of Shangluo City or move into other cities shall be handled in accordance with relevant regulations.

4. Others

(1) Special personnel who are not insured during the centralized payment period or the supplementary payment period, and need to be insured after the start of the treatment enjoyment period, and the policy allows them to be insured, after completing the insurance payment according to the individual payment standard stipulated by the province, the treatment enjoyment period is counted from the month after the residents’ medical insurance payment.

(2) The insured persons who enjoy classified funding for individual contributions should be insured during the centralized payment period. Those who are not insured during the centralized payment period do not enjoy the classified funding policy for individual contributions, but can enjoy the original medical insurance benefits after paying according to the individual payment standards stipulated by the province. The treatment enjoyment period is counted from the month after the residents’ medical insurance payment.

(3) Persons who change their identities dynamically during the insured year will enjoy the corresponding medical insurance benefits for their new identities after their identity changes from the next month. Persons who change their identity during the hospitalization period of different months shall be hospitalized in accordance with the principle of benefiting the treatment of the insured.

(4) Establish an incentive mechanism for serious illness insurance benefits for residents’ medical insurance continuous insured personnel and zero reimbursement personnel. Since 2025, the maximum payment limit for serious illness insurance will be reduced by 3,000 yuan for those who have been insured again; For the insured who have participated in the residents’ medical insurance for 4 years in a row, the maximum payment limit for serious illness will be increased by 3,000 yuan for each consecutive year. For the residents’ medical insurance insured with zero reimbursement from the fund in that year, the maximum payment limit of serious illness insurance will be increased by 3,000 yuan in the following year. Continuous insurance incentives and zero reimbursement incentives, the total increase does not exceed 20% of the city’s major illness insurance capping line. After the residents are reimbursed for serious illness and use the incentive amount, the zero reimbursement incentive amount accumulated in the previous period will be cleared. If you are insured again after the insurance is broken, the number of years of continuous insurance will be recalculated.

(5) Since 2025, except for special groups such as newborns, the waiting period for fixed treatment after enrollment will be set at 3 months for those who have not been insured during the centralized enrollment period of residents’ medical insurance; Among them, for those who have not been insured continuously, the waiting period of variable treatment will be increased by 1 month on the basis of fixed treatment waiting period in principle, and the insured can repair the waiting period of variable treatment by paying fees, which can be reduced by 1 month for each additional year. For those who have been paid continuously for 4 years or more, the sum of fixed treatment waiting period and variable treatment waiting period after repair is not less than 6 months in principle. The payment standard is implemented according to the individual payment standard of urban and rural residents in the city.

V. Insurance registration

The tax department has no information about the newly-added personnel to be insured, or those who need to adjust their insurance payment places in the new insurance year. They must hold the valid proof of their household registration, the residence permit issued by the public security department of their long-term residence, and their valid ID cards (those with special personnel identity must carry relevant identification certificates) to go to the medical insurance agency where their household registration or residence permit is located for insurance registration.

Sixth, payment channels

(1) "Shaanxi Taxation" WeChat WeChat official account; "Shangluo Taxation" WeChat WeChat official account;

(2) Rural Credit Bank: all business outlets, self-service equipment, mobile banking, online banking, e-terminal for helping farmers, and Shaanxi Rural Credit WeChat WeChat official account;

(3) Qinnong Bank: all business outlets, self-service equipment and e-terminals for helping farmers;

(4) Alipay: the social security section of the Citizen Center and the "Shaanxi Social Security Payment" applet (you can check the payment certificate of my real name registration after payment through all channels);

(5) China UnionPay: China Unionpay Quick Pass APP (Shaanxi Social Security Payment); "Shaanxi social security payment" WeChat applet, WeChat city service-service hall-social security;

(6) Everbright Bank: WeChat city service, "social security cloud payment" APPlet, cloud payment app, and mobile banking;

(7) China Construction Bank: all business outlets, mobile banking, smart teller machines, Yunongtong financial service points, code scanning payment and Qin clerk APP；;

(8) ICBC: all business outlets, mobile banking, smart terminals of outlets, "ICBC Shaanxi Branch" WeChat WeChat official account, and ICBC e-payment QR code scanning;

(9) Agricultural Bank: all business outlets, mobile banking and scanning code payment;

(10) Bank of China: all business outlets and mobile banking;

(11) China Merchants Bank: Mobile banking.

Seven, payment bills

(1) If the payer pays the basic medical insurance premium for urban and rural residents through various channels of financial institutions, the payment shall be based on the electronic order payment voucher, the small ticket printed by self-service equipment or the Special Note for Social Insurance Fee Payment for Urban and Rural Residents in Shaanxi Province printed on the bank counter.

(2) If the payer pays the basic medical insurance for urban and rural residents through Shaanxi Tax WeChat WeChat official account, UnionPay "China Unionpay Quick Pass", Everbright Bank WeChat applet "Social Security Cloud Payment" and Alipay, the payment voucher of the electronic order can be used as the basis for payment. If paper payment bills are really necessary, please pay through the bank counter and obtain special payment bills, or go to the tax service hall of the competent tax department of the insured place to print the tax payment certificate 3 days after the payment is completed.

(3) Online acquisition method of payment voucher: After the payer completes payment through any channel for 3 days, he can select the social security payment voucher for urban and rural residents to print through Alipay-Citizen Center-Social Security; Or search "Shaanxi Electronic Taxation Bureau" and select "Certificate of Tax Payment (Fee) for Social Insurance Fees of Urban and Rural Residents" for printing.

Eight, medical insurance refund

After the insured person successfully pays the fee, he will enter the treatment enjoyment period (after January 1, 2025), and the individual payment will not be returned. Before the treatment enjoyment period, due to death, repeated payment, participation in employee medical insurance or participation in residents’ medical insurance in other overall planning areas, the personal refund can be handled at the same time when the relevant residents’ medical insurance participation relationship is terminated before the treatment enjoyment period begins.

The application for refund of the insured shall be submitted by the payer to the tax department of the original place of payment, and the refund shall be completed by the medical department of the original place of payment after the final approval of the medical department of the original place of payment.

IX. Inter-annual settlement

Cross-year medical insurance settlement for urban and rural residents who are insured continuously in the overall planning area shall be handled in accordance with the annual settlement policy of the discharge time of insured patients.

Cross-year and cross-regional insured inpatients shall be settled separately according to the settlement policies of different insured areas in the natural year.

notice is hereby given (that)

Shangluo Taxation Bureau of State Taxation Administration of The People’s Republic of China

Shangluo medical security bureau

September 25, 2024

Policy interpretation:

@ Shangluo people, the medical insurance payment for urban and rural residents began in 2024!

How to pay residents’ medical insurance fees for their families with employee medical insurance personal accounts?

Ten Questions and Ten Answers on Basic Medical Insurance for Urban and Rural Residents in Shangluo City

　　On November 11th, "Singles Day" is just around the corner, and single people have once again become the focus of social attention. Yesterday, the third issue of the series report on the status quo of single people in 2016 (hereinafter referred to as the "report") released by zhenai showed that the average monthly disposable income reached 8,000 yuan for golden singles; Guangzhou-Shenzhen women set a threshold of 10,000 yuan in salary for mate selection; Over six adults agree with "spare tire" dating; Shanghai and Hangzhou spend more than 10,000 honeymoon budgets to lead the honeymoon local tyrants list; Nanjing is the last place to live with parents after single marriage.

　　This report is mainly aimed at the online sampling survey of 100 million members in zhenai, with a total of 4,555 valid samples, which comprehensively analyzes the economic situation, spouse selection and marriage view of singles.

　　single economy

　　"Golden Singles" have more women than men.

　　In the "Chopper Party" bought by "double 11" buy buy, the consumption power of single people is not to mention, and the monthly disposable income also directly determines the quality of personal life. According to the report, over 50% of single men and women have an average monthly disposable income of 3,000-5,000 yuan, while nearly 30% have an average monthly disposable income of 5,000-8,000 yuan, and 10% have an average monthly disposable income of more than 8,000 yuan.

　　Single men and women with an average disposable income of over 8,000 yuan per month are called golden singles, with Shanghai accounting for the largest proportion of singles, followed by Beijing, Shenzhen, Hangzhou and Guangzhou. It is interesting to find in the report that the proportion of single women is higher than that of single men among people with an average disposable income of over 8,000 yuan per month. In first-tier cities, the number of single women with independent economy and high spending power is also increasing.

　　Spouse selection requirements

　　Women in Beijing demand high monthly income from their boyfriends.

　　Through the process of blind date, it can be found that income is one of the important factors for single men and women to consider when choosing a spouse. According to the report, with the development of material economy, women’s economic requirements in mate selection have also risen. More than 80% of single women think that 5,000 yuan is the starting point of men’s income, that is, the "passing line". Among them, 67.06% of single women require men’s monthly income to be 5,000-10,000 yuan, while 25.02% require their monthly income to exceed 10,000 yuan. Shenzhen, Beijing, Shanghai, Wuhan and Guangzhou rank among the top five cities in China with high demands on men’s income. However, men’s income requirements for women are generally low — — 80% of the men said that the other half would be willing to accept it if their income was less than 5,000 yuan, and there was no special requirement.

　　In addition to income, there are many factors to consider when choosing a spouse. According to the survey, 42.78% of women think it is very important to be suitable in marriage, while 90.17% of single men think that feelings are more important when they enter marriage, and a good family is not a necessary condition.

　　Choice of spouse vision

　　178cm for men and 163cm for women are the most popular.

　　People who are difficult to take off their orders are often considered to be demanding and too picky. And is this the case? According to the report, it is not only men who are "visual animals", but nearly 70% of single women think that their partner’s appearance is "very important" when choosing a spouse, and they have higher requirements for men’s height and body shape. In contrast, less than 40% of single men attach great importance to each other’s appearance and height and size.

　　The single men and women interviewed also gave their most expected height range, among which men with 178cm, 180cm and 175cm were the most popular among women, while men preferred women with 163cm, 168cm and 160cm in height.

　　In terms of age, 80% of single men tend to find a partner younger than themselves, and 65% of them want the other half to be less than 7 years younger. Among women, more than 90% said that the other half must be older than themselves in the future, and 85.7% of them had an ideal age difference of less than 7 years. As can be seen from the data, the age difference in mate selection is within 7 years.

　　Characteristics of mate selection

　　Over 60% of adults approve of spare tire dating.

　　In the process of choosing a spouse, most single men and women think that it is not wrong to date more than one person at the same time before the formal relationship is established. The data shows that 64.23% of single men and women think that they can date 2-3 people at the same time before determining the relationship, and then make a comprehensive understanding before making a decision.

　　With the increase of divorce rate, the number of divorced singles is also increasing. Traditionally, divorced people are hard to find a partner, especially for divorced single women. However, the survey in zhenai showed that over 70% of single men and women said they didn’t mind that the other person was remarried.

　　As the touchstone of marriage, cohabitation before marriage is increasingly accepted by society. According to the survey in zhenai, 73.79% of the single men and women interviewed said that they accepted cohabitation before marriage, especially for men, and over 80% of single men thought cohabitation was necessary. However, as far as women are concerned, only 60% of women accept premarital cohabitation, among which post-80s women have the highest acceptance, followed by post-70s women, while post-90s women have less than 50% of people who accept premarital love, preferring to have their own independent space rather than being tied to family life prematurely.

　　honeymoon trip

　　More than half of men and women prefer to travel overseas.

　　The survey shows that the longing for honeymoon trip is the most anticipated part of the wish to leave the order. 58.17% of men and women think that they will choose to go overseas to make their honeymoon trip more memorable, even though they have more time to travel in China. Among them, the proportion of women who choose overseas travel is as high as 72.15%. As for the location, Australia is loved by 45.6% of young men and women because of its characteristics of "romantic island country" and "natural scenery". The second place on the wish list is Northern Europe. Nearly 30% of single men and women think that Nordic countries such as Switzerland and Denmark are full of fairy tales, and honeymoon trips should be as wonderful as fairy tales. The third place is the domestic honeymoon trip, and the reasons for choosing the domestic tour are closeness in human geography, convenience in language communication, safety and suitable consumption level.

　　According to the report, the honeymoon spending list is similar to the monthly average disposable income list: 70% of single men and women in Shanghai and Hangzhou said that they are willing to spend more than 10,000 yuan per person on honeymoon trips, followed by Beijing, with a budget of over 60%. However, in cities with relatively frugal honeymoon budgets, single men and women in Changsha, Xi ‘an and Jinan admit that they will not spend too much on honeymoon trips.

　　Family relations

　　Nanjing is the last place to live with parents after single marriage.

　　According to the survey, although most single men and women don’t mind living with their parents, it is undeniable that more than 40% of single men and women expect to go their separate ways with their parents after marriage. Among them, Nanjing has the highest proportion of single men and women, reaching 63.63%, followed by Jinan and Shenzhen, showing their attitude towards living independently after marriage.

　　According to the survey, 81.06% of single men and women want to have one or two children after marriage, but although the country has opened up a second child, there are still more single men and women who tend to have one child than those who have two children. In addition, girls seem to become more popular, and more than 60% of single men and women prefer to have girls.

CCTV News:On April 14th, Shu Yuting, spokesperson of the Ministry of Commerce, said that since the beginning of this year, China’s foreign trade has withstood the pressure and started well on the whole, laying a good foundation for achieving the annual target.

Shu Yuting said that in the first quarter, China’s total import and export volume reached 9.42 trillion yuan, a year-on-year increase of 10.7%. However, we should also be soberly aware that the environment for foreign trade development is becoming more severe and complicated, and we are facing many risks and challenges.

From an international perspective, the bottleneck of global supply chain has not been alleviated, inflationary pressure has risen, monetary policies in major economies have tightened, and the growth rate of global economy and trade has declined. On April 12th, the WTO lowered its forecast of global economic and trade growth in 2022 by 1.3 and 1.7 percentage points respectively.

From the domestic point of view, local epidemics have occurred frequently recently, and the production and operation of some foreign trade enterprises have been affected, logistics and transportation have been blocked, the supply chain in the Yangtze River Delta and the Pearl River Delta has been sluggish, and the comprehensive cost of enterprises has remained high.

At the same time, however, China’s foreign trade industry has a solid foundation, and the long-term positive fundamentals have not changed. There are still many favorable conditions to achieve the goal of maintaining stability and improving quality in imports and exports.

Shu Yuting, spokesperson of the Ministry of Commerce:The Ministry of Commerce will continue to pay close attention to the changes in the situation, do a good job in the implementation of the policies that have been introduced to stabilize foreign trade, study effective new policies, open up blocking points, solve difficulties and eliminate pain points, fully ensure the stable and smooth supply chain of the foreign trade industry chain, help foreign trade enterprises solve difficulties, and strive to keep foreign trade running in a reasonable range throughout the year.

Cctv newsOn the morning of September 9, the National Health and Wellness Commission held a press conference to introduce the progress and effectiveness of international cooperation and exchange on health and wellness since the 18th National Congress of the Communist Party of China. It was introduced at the meeting that in the past ten years, China has actively participated in international organizations and regional cooperation mechanisms in the field of health and shared China’s experience. Actively participate in and host international conferences at ministerial level and above, and successfully co-host the 9th Global Health Promotion Conference with WHO in 2016; At the World Health Assembly, he promoted and passed many resolutions such as safe medication for children and traditional medicine, and took the lead in holding side events on health system, health and poverty alleviation; Five emergency medical teams in China have been certified by WHO; Successfully passed the WHO malaria elimination certification, and China’s malaria prevention and control experience was included in the WHO technical guide; Traditional medicine has been formally incorporated into the latest International Classification of Diseases, which provides a Chinese plan for promoting global health.

From 2014 to 2015, China sent more than 1,200 clinical and public health experts to fully assist countries in West Africa to control the Ebola epidemic and successfully achieve the goal of "winning the battle and zero infection". Since the outbreak of the COVID-19 epidemic, China has maintained close communication with WHO and relevant countries and regions, shared information such as Covid-19’s gene sequence as soon as possible, announced the diagnosis and treatment plan and prevention and control plan as soon as possible, promptly and openly reported the epidemic information, held technical exchange activities with more than 180 countries and more than 10 international organizations around the world, sent anti-epidemic medical experts to 34 countries, and shared China’s experience in fighting the epidemic with all parties without reservation. Over the past decade, we have carried out pragmatic cooperation with countries and international organizations around the world, and carried out pragmatic cooperation projects such as joint prevention and control of malaria and dengue fever and maternal and child health in neighboring countries. Over the past ten years, we have continuously sent China medical team members to countries in need to provide assistance, cooperated with 46 hospitals in 41 countries in Africa, and conducted free clinics for cataract recovery and heart surgery in more than 30 countries, treating 22 million patients and saving countless lives. More than 2,000 medical team members have won national honors at home and abroad. In addition, we also support Hong Kong and Macao to integrate into the overall situation of national health and healthy development, actively implement various policies of benefiting Taiwan in the field of health and health, and work together with Hong Kong, Macao and Taiwan to fight the COVID-19 epidemic and protect the health and well-being of all people.

Group photo of guests

People’s Daily Online, Beijing, March 19 (Wang Xiaohua) This year’s government work report puts forward that "people-centered development ideas should be adhered to, and efforts should be made to safeguard and improve people’s livelihood, and the people’s sense of gain has been continuously enhanced." Since the first three-year "Action Plan for Further Improving Medical Services" was officially launched in 2015, hospitals at all levels have made positive achievements in innovating service measures and improving people’s medical experience in view of the "bottleneck" problem of medical treatment. With the launch of the new round of improving medical service plan, how to make "seeing a doctor more comfortable, providing more considerate services and increasing people’s sense of obtaining medical treatment"?

During the two sessions of the National People’s Congress in 2018, People’s Daily Online and People’s Health jointly organized a series of roundtable forums on "Healthy Chinese". In the special session of "Further Improving Medical Services" held on March 15th, five guests from government agencies and medical institutions gathered at People’s Daily Online to discuss the beneficial measures of "Further Improving Medical Services".

Innovating medical service mode and improving patients’ accessibility to medical treatment

Jiao Yahui, deputy director of the Medical Administration and Hospital Authority of the National Health and Family Planning Commission, said that after the expiration of the first three-year "Medical Service Improvement Plan", patients’ access and satisfaction were improved through the extensive application of information technology, improvement of service quality, acceleration of sinking of resources and continuous improvement of medical services.

Jiao Yahui introduced that since China launched the first three-year "Action Plan for Further Improving Medical Services" in 2015, the service process has been optimized by means of Internet informationization, which has alleviated the long-standing problem of "three long and one short" (long waiting time for medical treatment, long payment time, long time for taking medicine and short time for seeing a doctor). Through the innovative service model, the number of patients going to and from the hospital, repeated queuing in the hospital, the whole waiting time for outpatient service and the average length of stay were effectively reduced.

According to the data of 5.87 million valid questionnaires of real-time online satisfaction survey, the overall satisfaction of outpatients and inpatients in tertiary hospitals in China reached 90.7 points and 93.9 points; The analysis of 28.83 million pieces of information related to medical services on the Internet shows that netizens’ overall feelings about medical services are positive, which fully reflects the positive results achieved in improving medical services in the past three years.

Building emergency specialist alliance and opening up the "green channel" for emergency patients

Li Weimin, deputy to the National People’s Congress and president of west china hospital, said that this year, Huaxi Hospital will focus on optimizing the medical treatment mode and improving the satisfaction of emergency patients. At the same time, through the construction of emergency specialist alliance, the information triage before emergency admission can be realized, and the rescue and treatment resources can be dispatched in time, so as to truly open a green channel for emergency patients to check and be admitted to hospital.

Li Weimin introduced that since the establishment of the telemedicine network in West China Hospital in 2001, more than 640 hospitals in 20 provinces and cities across the country have joined the telemedicine network, providing telemedicine education and multidisciplinary joint consultation for difficult cases in remote areas and ethnic minority areas, which not only enables grassroots patients to get timely diagnosis and quality treatment programs, but also improves the local medical service level.

Take effective measures to promote the appointment and medical association system

Feng Guosheng, chairman of Beijing Chaoyang Hospital affiliated to Capital Medical University, introduced the effective measures taken by Beijing Chaoyang Hospital in improving medical services in recent years. He pointed out that in terms of appointment diagnosis and treatment, since 2012, Chaoyang Hospital has adopted various forms to carry out appointment registration services to facilitate patients to see a doctor. In the process of diagnosis and treatment, the appointment time, including the examination time, is accurate to 15 minutes, which greatly reduces the waiting time of patients in the hospital and obviously improves the medical environment.

In terms of vigorously developing the construction of medical associations, in 2012, Chaoyang Hospital established a medical association with Chaoyang Hospital as the core and secondary hospitals and community medical centers as participants under the guidance of the government. Through the standardized operation within the medical association, more patients with common diseases and chronic diseases can enjoy the high-quality medical resources of large hospitals at their doorsteps.

Feng Guosheng said that Chaoyang Hospital has also realized telemedicine through information technology, and further strengthened the innovation of outpatient services, such as setting up symptom clinics and special disease clinics to facilitate patients to seek medical treatment.

Extend the service to the grassroots level and let more children enjoy health.

Ni Xin, dean of Beijing Children’s Hospital affiliated to Capital Medical University, pointed out that Beijing Children’s Hospital has implemented a comprehensive appointment system for non-emergency patients since June 2015. Through a variety of ways, patients are guided and facilitated to make appointments and time-sharing visits, so that the waiting time of patients is shortened, the peak flow of outpatients is reduced, and the medical experience is significantly improved. These methods mainly include: dynamically adjusting staff and improving service space; Implement centralized appointment for large-scale examinations to reduce patients’ running back and forth; Increase voluntary service and improve the online and offline guidance system; Open professional outpatient service and expert team outpatient service to make the process of treating intractable diseases more convenient.

Ni Xin introduced that in order to facilitate children to seek medical treatment nearby, Beijing Children’s Hospital and Children’s Research Institute took the lead to promote the common development of pediatrics in 16 municipal general hospitals in Beijing. By hosting three children’s hospitals, the medical level of local hospitals has been further improved. Beijing Children’s Hospital and 23 provincial children’s hospitals across the country set up a cross-provincial specialist alliance to achieve the goal of "doctors move and patients don’t move". In the next step, we will use artificial intelligence to comprehensively improve the level of medical services, extend services to the grassroots, increase support for poor areas, and let more children enjoy health.

Carry out the comprehensive upgrade of information system for the construction of smart hospitals

Jiang Lihong, deputy to the National People’s Congress and president of the First People’s Hospital of Yunnan Province, said that in the past three years, the First People’s Hospital of Yunnan Province has actively implemented the improvement of medical services, mainly focusing on two themes, and has achieved certain results: First, the construction of smart hospitals. The hospital information system has been upgraded in an all-round way, and the people’s appointment registration rate has increased from about 30% to more than 91% after the new system goes online. The hospital implemented the one-card service, and invested in the construction of 126 self-service machines. Patients can register for ID cards or medical insurance cards.

The second is the construction of medical association and graded diagnosis and treatment. People in Yunnan Province, especially in mountainous areas, live in scattered areas, and fewer patients in Yunnan Province are transferred to other provinces for medical treatment. The demand for medical associations and graded diagnosis and treatment is more urgent. The First People’s Hospital of Yunnan Province and 215 state (city) and county hospitals in the province formed a medical association, and 3-5 specialists were selected from 33 state-level hospitals to form a specialist alliance. At the same time, 6 provincial-level expert grass-roots workstations and 66 secondary hospitals and community expert teams were set up to build a "joint laboratory for precision medicine and eugenics" with the hospitals in the medical association, forming a multi-level assistance mechanism such as hospitals, specialist alliances and expert teams.

?　　Foreword　　

In 1993, Belgian scientists discovered a new antibody-nano-antibody (VHHs) in camel serum, which is different from the traditional antibody structure and only consists of heavy chain variable regions. Compared with traditional antibodies, nano-antibodies have the advantages of stable physical and chemical properties, low immunogenicity, strong tissue permeability, and can recognize epitopes that traditional antibodies cannot recognize, which makes them a strong and beneficial supplement to traditional antibodies.

Nano-antibody is only composed of heavy chain variable region, with small molecular weight and simple structure, which enables it to realize stable expression in various expression systems. So far, VHHs has been expressed in many expression systems, from prokaryotic cells, yeast, fungi, insect cells, mammalian cell lines to plants. This paper mainly introduces the expression of nano-antibody in different expression systems, and the present situation and development trend in the field of this system.

Prokaryotic expression system　Prokaryotic expression system is the earliest mature protein expression system studied. Obtaining foreign proteins through prokaryotes can obtain gene expression products in a short time, and the cost required is relatively low. The expression system mainly includes Escherichia coli expression, Bacillus subtilis expression and Streptomyces expression. Among them, Escherichia coli system is the most widely used, and the prokaryotic system generally refers to the expression of Escherichia coli.

Escherichia coli expression system　Escherichia coli expression system is the most important expression platform of recombinant protein in laboratory environment, and the expression is controlled by lactose operon. The host of Escherichia coli system has the advantages of fast growth, simple culture, low price, clear genetic background and high protein expression. However, it can not modify the expression product after translation, and the expression product contains a lot of endotoxin and is easy to form inclusion bodies.

Common host bacteria of Escherichia coli expression system

Periplasmic space, as the only compartment with oxidation environment in Escherichia coli, is the most commonly used expression system of nano-antibodies containing specific disulfide bonds. In addition to aerobic environment, there are many partners and isomerases in the periplasmic space, which can promote the correct formation of disulfide bonds and help protein fold. Nano-antibody protein is first produced in the cytoplasmic space, and then secreted into the periplasmic space through Sec pathway, SPR pathway or Tat pathway. After signal peptide is removed by signal peptidase, the target protein can be obtained [1].

Up to now, many VHHs have been successfully expressed in periplasm, some of which can reach tens of milligrams per liter, but there are still a lot of VHHs with low yield. This is because many fusion proteins can not be effectively secreted in the periplasmic space, and cytoplasmic expression seems to be the only expression mode of such fusion proteins [8].

The cytoplasm is a reduced compartment, so that the proteins expressed through the cytoplasm can not be folded correctly, and most of them are inclusion body proteins. The proteins are protected from the degradation of intracellular enzymes and are easy to be separated in high purity and concentration. However, there are many kinds of proteins in cytoplasm, and it is difficult to purify them. At the same time, nonfunctional inclusion proteins need to be completely denatured and refolded to be recovered from these inclusions, but the recovery of VHHs is usually inefficient [1]. In order to solve the problem of cytoplasmic expression, Xue X and others designed a new dialysis-dilution device in 2016. Using this device, researchers refolded VHHs and achieved a recovery rate of 85%, while the conventional dialysis and dilution methods only reached 13%[9]. Bacterial cytoplasm can be an effective compartment to produce correctly folded nanoparticles when expressed by recombinant vectors with sulfhydryl oxidase and disulfide isomerase activities. Larger volume and wider cytoplasm of chaperone/folding enzyme can achieve high yield of nano-antibody [6]. At the same time, double mutants with defects in thioredoxin and glutathione pathways have been developed. Some of these strains have been sold commercially in recent years, such as Origami (Novagen), Rosetta-gami (Novagen) and SHuffle?T7 (New England Biolabs) [10]. Among them, Shufflet 7 overexpresses a critical periplasmic isomerase DsbC, which can effectively catalyze the isomerization of disulfide bonds. Some studies have found that,The activity of isomerase DsbC can increase the yield of functional recombinant protein in periplasmic research [11].　　

Kavousipour Soudabeh and other modified vectors added four different signal peptide sequences to guide the secretion and expression of nano-antibodies, and found that TrBC signal peptide had the best effect [5]. Jianli Yu et al. used repetitive amino acid sequence motifs (GAGAGS) found in silk fibroin (SFP) as a new fusion tag (SF-tag) to enhance the expression of nanosomes in E.coli.. The transcription level of labeled protein is 2.3-7.0 times that of unlabeled protein, and the yield is increased by 2.5-7.1 times [27]. Xi Xie and others tried to select antifreeze protein AXX, and obtained its reverse transcription protein XXA by synthesizing XXA gene, which was used to develop new soluble fusion tags. It was found that the solubility ratio of fusion protein expressed by XXA fusion tag reached 86%, which was much higher than that of other tags [12].

Other prokaryotic expression systems　Lactic acid bacteria are the most common intestinal probiotics, which are generally considered to be harmless to human body and are very suitable for the production host of therapeutic molecules. However, the existing expression data show that the yield of VHHS produced by lactic acid bacteria is low, about 1-3mg/L, which is much lower than that of Escherichia coli [13,14]. Lactobacillus rhamnosus DSM14870, as a normal flora in human vagina, can express HIV antibody in the form of soluble or cell wall anchor fixation, and is a suitable expression host for HIV antibody [2]. When Bacillus brevis choshinensis was used for 3L fed-batch fermentation, the yield was as high as 3g/L[15]. This system is easy to manipulate genes, has no endotoxin and shows weak protease activity, so it is a very noteworthy system.

Eukaryotic expression system　

Due to the defects of prokaryotic expression system, such as difficult purification of inclusion body protein and incomplete protein modification, people began to use eukaryotic expression system to study genes. At present, eukaryotic expression systems commonly used in genetic engineering research include yeast expression system, insect cell expression system and mammalian cell expression system.

Yeast expression system　Yeast system has clear genetic background, simple operation, easy genetic operation, perfect eukaryotic protein expression control system and advantages of both prokaryotic and eukaryotic expression systems. Yeast eukaryotic protein expression systems include methanol yeast expression system, Saccharomyces cerevisiae expression system, Schizosaccharomyces expression system and Kluyveromyces expression system [17].

Saccharomyces cerevisiae is the first yeast fermented by human beings, which has no specific virus and low cost. At present, it is the largest yeast expression system in shake flask culture, with the output exceeding 100mg/L[16]. Some amino acids in VHHs can participate in the recruitment of molecular chaperones in endoplasmic reticulum, thus narrowing the difference of molecular chaperones between Saccharomyces cerevisiae and mammalian cells, which is beneficial to the folding kinetics of nano-antibodies and improving the yield of nano-antibodies in Saccharomyces cerevisiae [17]. The protein expressed by Saccharomyces cerevisiae is prone to hyperglycosylation, and a large number of endogenous proteins are produced during fermentation, so the secretion efficiency of the target protein is low [1]. Considering the above problems, Saccharomyces cerevisiae is gradually replaced by methanol yeast represented by Pichia pastoris.

Pichia pastoris expression system is an efficient expression system of foreign proteins. This microorganism does not accumulate toxic ethanol, but only secretes a few endogenous proteins, and its glycosylation degree is the same as that of mammalian cells, so its immunogenicity is weak, so it is the most commonly used eukaryotic expression system. Pichia pastoris has a strictly regulated methanol inducible AOX1 promoter, which is suitable for high expression of foreign proteins [1]. But methanol is a highly toxic and dangerous chemical product. The GAP promoter without methanol induction is used instead of AXOI, and the carbon source does not need to be changed during the culture process, so the operation is simpler and the time for foreign proteins to reach the peak level can be shortened. The yield and affinity of nanoparticles produced by this system are similar to those produced by methanol-induced expression. It has been studied that the yield of nano-antibody expressed by this system in shake flask is 51.71mg/L[18] and 16mg/L[19].

Fungal expression system　

Some filamentous fungi, such as Trichoderma and Aspergillus, can secrete a large number of foreign proteins in the culture medium. However, the fungal system not only expresses protein of interest, but also produces many proteases, which affects the yield. Joosten et al. obtained only 1.5 mg/L VHHs in Aspergillus awamori medium. After adding 0.25% BSA, it reached 7 mg/L. It is reported that more than 80% of VHH is degraded or adhered to the cell wall compared with endogenous xylanase secreted efficiently in this system, and researchers believe that the low secretion efficiency of VHHs is the bottleneck of fungal expression [20]. In order to overcome this limitation and protect VHHs from degradation, other researchers fused VHH with the high amylase A signal sequence (sTAA) of Rhizopus oryzae lipase (N28) and the N-terminal 28 amino acid fragment (N28), so that the highest yield of VHHs expressed in Aspergillus oryzae reached 73mg/L, which was 300-800 mg/L lower than that of Escherichia coli [21]. The final yield of GlaB-VHH fusion protein in Aspergillus oryzae can reach 610mg/L, which provides the possibility for high expression of nano-antibody, but its stability needs to be verified [22]. In addition, VHH[23] was expressed by maize head smut in unconventional secretion pathway.

Insect cell expression system　

Insect cells are a widely used eukaryotic expression system, and recombinant baculovirus vectors (such as AcMNPV) can specifically transfect insect cells. Its survival in nature is short, and the strong promoter is inactivated in mammals and cannot infect vertebrates, so the recombinant baculovirus is safe for human beings. Proteins with complex structures under the control of strong promoters may not be able to form correct folding and post-translation modification, which may lead to the aggregation of target proteins and reduce antibody production, so the expression yield of VHHs in this system is much higher than that of other types of antibodies [17].

Gómez-Sebastián and others used the improved baculovirus expression system (IBES? technology) to express VHHs for the first time. The chigger larvae were inoculated with different recombinant baculovirus inoculation methods. The yield of VHH extracted from larvae is 257 mg/L, and the recovery rate after purification is 50%[7]. When expressing anti-endothelial cell selection protein, Drosophila cell SC-2 secreted 12-14mg/L, but the target protein was not detected when expressed in Escherichia coli at the same time, which may be related to the processing and modification ability of insect cells [26].

Mammalian cell expression system　Mammalian cells are the best expression system for therapeutic antibodies, because the produced antibodies have the weakest immunogenicity. At present, the main cell lines include CHO, NS0, Sp2/0, HEK293 and per C6 [17]. Among them, CHO cells grow rapidly and adapt to serum-free suspension culture, which is the most popular host. They can express VHHS up to 100mg/L in shake flask [24]. HEK293 cells are more commonly used in the laboratory because of transient transfection and semi-stable expression, because they require less time and labor. However, monoclonal antibodies approved for the treatment of human diseases are only produced by CHO, NS0 and SP2/0. So far, HEK293 cells have not been used to produce VHHs, and there are few reports about producing antibody fragments by this method [17]. In most literatures, CHO is used to produce antibody fragments. Up to now, 50% of the therapeutic proteins produced in industry are still produced by CHO [1]. The production costs associated with mammalian cell lines are much higher than those associated with any other laboratory research platform.

Common host cells of mammalian expression system

Plant expression system　Compared with other expression systems, plant production platform (stable and transient expression system) is cheap, safe, capable of folding and assembling complex proteins and post-translation modification, easy to expand, and unaffected by human pathogens and diseases. It is an ideal protein expression host and is usually used as an alternative method for mammalian expression systems. In addition, plant expression products can be concentrated in specific organs, such as leaves or seeds, and can be taken orally directly. Tobacco leaves are the most common hosts for expressing VHHs, while the proteins expressed in Arabidopsis and rice seeds have attracted much attention because of their direct oral input of VHHs[1]. The stable transformation methods commonly used in plant system expression have some problems, such as the recombinant gene escaping to nature or the time-consuming transformation. Therefore, some studies have proposed the transient expression system of plant virus expression vector as an alternative method, and the nano-body content with correct conformation reaches 0.45% of the total soluble protein [25].

Present situation and development of nano-antibody expression　

Escherichia coli expression system is the most commonly used expression system of nano-antibody, which has two expression modes: periplasmic expression and cytoplasmic expression, each with its own advantages and disadvantages. Some oxidation engineering strains have been modified, but more experimental support is needed. In addition, various methods of modifying vectors, such as adding labels or signal peptides, have been put forward and have been verified by experiments. Compared with Escherichia coli, Pichia pastoris has excessive glycosylation, which may lead to immunogenicity and ultimately affect its clinical application. The expression systems of fungi, insects, plants and mammals are much more complicated than prokaryotic and eukaryotic expression systems, and are generally not easily adopted after considering the production time, cost and laboratory conditions.

Escherichia coli system is fast, convenient and cheap, and it is the first choice for VHH expression under most laboratory conditions. When some types of VHHs can’t be successfully produced in E.coli, other systems will be used instead.

List of nano-antibody expression

The number of diabetic patients in the world continues to grow. Relevant data show that there is one diabetic in every eight adults in China and one pre-diabetic in every two adults in China.

Diabetes is not terrible, but its complications, such as cardiovascular and cerebrovascular diseases, renal failure, diabetic foot and retinopathy … These chronic complications have gradually become the main cause of death for diabetics.

Dangerous chronic complications of diabetes mellitus

Diabetes is a group of lifelong metabolic diseases caused by multiple causes and characterized by chronic hyperglycemia. The key to lowering the blood sugar level in the body is insulin, which helps glucose from food to enter cells from the blood to generate energy. When insulin is not well produced or utilized, the blood glucose level will rise, and when it rises to a certain extent, diabetes will occur.

Elevated blood sugar is not the end point of diabetes. Long-term high blood sugar damages the body, causing pathological changes in various important organs of the human body. With the extension of the course of disease and poor blood sugar control, diabetic patients will gradually develop chronic complications. Complications will have serious consequences in the later stage, such as blindness, renal failure, myocardial infarction, heart failure, stroke and amputation, which will seriously affect the quality of life of patients.

Chronic complications of diabetes are generally divided into macrovascular complications, microvascular complications, neuropathy and diabetic foot.

I. Cardiovascular diseases

Atherosclerosis is one of the main causes of cardiovascular diseases, and insulin resistance and hyperglycemia are the main factors leading to cardiovascular complications in diabetic patients. Studies have shown that diabetic patients have an increased risk of heart failure and/or cardiac dysfunction, and long-term hyperglycemia can also lead to various cardiac dysfunction, including arrhythmia and sudden cardiac death.

1. Symptoms and manifestations

There may be no symptoms in the early stage, and with the progress of the disease, discomfort symptoms such as chest pain, chest tightness, palpitation, shortness of breath and arrhythmia may appear after work. Some patients may have no obvious pain even when myocardial infarction occurs because of the influence of hyperglycemia on cardiac autonomic nerves.

2. How to screen

For diabetic patients, ECG and echocardiography should be performed at the time of diagnosis, and at least once every six months.

Hyperglycemia increases the risk of stroke. A comprehensive analysis of 102 prospective studies found that compared with non-diabetic patients, the risk of ischemic stroke increased by 2.3 times and the risk of hemorrhagic stroke increased by 1.6 times. This correlation is not only related to the incidence of cerebrovascular disease, but also related to the prognosis and functional status of the disease.

Second, cerebrovascular diseases

1. Symptoms and manifestations

If diabetic patients have symptoms such as dizziness, black eyes or blurred vision, slurred speech, numbness and weakness of one limb, they should be on high alert for possible cerebrovascular diseases and seek medical advice in time.

2. How to screen

If diabetic patients have danger signs of stroke, they should immediately have brain CT or magnetic resonance (MRI) and other related examinations.

Third, kidney disease

Diabetic nephropathy is a common microvascular complication of diabetes, which affects about 25% of diabetic patients. It has become the main cause of chronic kidney disease and end-stage renal disease.

1. Symptoms and manifestations

There are usually no obvious symptoms in the early stage, and some patients may have increased urine foam, renal function damage, hypertension and edema. When the disease develops to the advanced stage, severe renal failure and uremia may occur, and dialysis treatment is needed.

2. How to screen

Generally speaking, patients with type 2 diabetes have a urine test every six months to one year to detect the content of microalbumin. If the index rises abnormally, it is recommended to seek medical examination.

Fourth, retinopathy

Diabetic retinopathy is one of the common complications of diabetes and one of the main causes of blindness.

1. Symptoms and manifestations

There may be no symptoms in the early stage, but with the progress of the disease, symptoms such as blurred vision, visual field defect, decreased vision at night, and floaters may appear. In the late stage, it may develop into serious situations such as retinal hemorrhage and retinal detachment.

2. How to screen

It is recommended that diabetic patients have an annual fundus examination, including optometry, intraocular pressure measurement and fundus examination. Fundus examination can observe the retina by dilating the pupil.

V. Neuropathy

Diabetic neuropathy refers to the damage of diabetes to the nervous system, including the involvement of peripheral nerves and autonomic nerves.

1. Symptoms and manifestations

Common symptoms include paresthesia (such as pain, tingling and numbness), impaired motor function, digestive system problems (such as delayed gastric emptying and constipation) and sexual dysfunction.

2. How to screen

Diabetic patients should have regular nervous system examination, including foot examination, electrophysiological examination and autonomic nervous function test.

6. Diabetic foot

Diabetic foot is one of the serious and costly chronic complications of diabetes, which can lead to amputation and death. In China, the incidence of new foot ulcers in diabetic patients over 50 years old is 8.1% within one year, and the incidence of new foot ulcers in cured diabetic patients is 31.6% within one year.

1. Symptoms and manifestations

In the early stage, numbness and abnormal temperature sensation of the foot may occur, and then redness and skin breakage may occur, which will gradually increase.

2. How to screen

All diabetic patients should have their feet examined regularly.

Check the foot skin for abnormal cyanosis and ulceration;

Check whether the pain, temperature and touch of extremities are normal;

Check whether the pulsation of dorsal foot artery and posterior tibial artery is weakened;

If you suspect vascular diseases, you can check the vascular ultrasound of lower limbs.

"Misunderstanding" of Diabetes

The complications of diabetes are closely related to the degree of blood sugar control. Only by paying attention to the changes of blood sugar can we prevent and control the acute and chronic complications of diabetes. In this regard, there are some misunderstandings that need special attention.

1. Is there no problem without symptoms?

Answer: Wrong!

Many patients often neglect the treatment and management of diabetes in the early stage of diabetes because the symptoms are not obvious, which leads to long-term substandard blood sugar and poor control, which further affects all systems of the whole body and increases the risk of complications.

Once you are diagnosed with diabetes, whether you have symptoms or not, you should insist on regular, scientific and reasonable treatment. Only in this way can we effectively control blood sugar and reduce complications.

Experts remind that the severity of diabetes can not be judged only by the severity of symptoms.

2. Can I stop hypoglycemic drugs without authorization?

Answer: Wrong!

Diabetes is a lifelong disease, and it can’t be cured at present. Just because the symptoms disappear and the blood sugar drops to normal after regular treatment does not mean that the diabetes has been cured, and the drug treatment can be stopped immediately.

The vast majority of patients still need to continue to receive medication after their condition is stable. If the drug is stopped at will, the blood sugar will fluctuate. At this time, the original dosage may not achieve the ideal hypoglycemic effect, and it may be necessary to increase the dosage or even use a variety of hypoglycemic drugs in combination, which will also cause certain damage to the body.

Experts remind: strictly following the doctor’s instructions for drug treatment is the key to control blood sugar and reduce complications.

3. If the blood sugar control is normal, can you relax your diet management?

Answer: Wrong!

In the treatment of diabetes, diet management is very important, which is called one of the "five carriages" of diabetes treatment. Others include exercise, medicine, blood sugar monitoring and self-management education. Failure to control diet is likely to lead to large fluctuations in blood sugar, which is not conducive to maintaining a stable metabolic state and weight.

Experts remind that diet management should run through the whole process of diabetes treatment, so don’t let your guard down just because the blood sugar results are normal, so as to avoid serious consequences due to the unpredictable risk factors such as inaccurate blood sugar monitoring results and drug taboos.

Do all diabetics have complications?

Not all diabetics will have complications.

At present, in clinic, there are many patients whose blood sugar, blood lipid, blood pressure and other indicators have reached the standard, and the course of disease is as long as 30-40 years. It can be seen that diabetic patients should pay attention to the control of blood sugar and cannot ignore the condition.

At the same time, we should follow the doctor’s instructions for drug treatment, and we should not stop taking drugs at will. Diet management is also very important in the treatment of diabetes, even if blood sugar control is normal, diet management can not be relaxed. In addition, not all diabetic patients will have complications, and following the standard treatment can reduce the risk of complications.

1. Control blood sugar, blood pressure and blood lipid.

Achieving the standard of blood sugar is the key to prevent complications in diabetic patients. The general ideal targets are: fasting blood glucose 4.4 ~ 7 mmol/L, postprandial blood glucose ≤10mmol/L, glycosylated hemoglobin (HbA1c)<7.0%, depending on the patient’s age and complications.

Even for patients with well-controlled blood sugar, blood sugar should be monitored 2 ~ 4 times a week. For patients with high blood sugar fluctuation or high blood sugar, blood sugar should be monitored 7 times a day, and treatment should be adjusted in time.

The control of blood pressure and blood lipid plays an important role in reducing the complications of diabetes and the risk of heart disease. Blood pressure should be monitored every time you visit a doctor, and blood lipid and electrocardiogram should be checked at least once a year.

Step 2 change your lifestyle

Reasonable diet, low fat and less oil, small amount of meals, regular quantitative meals. Quit smoking and limit alcohol, exercise properly, work and rest regularly, and control weight.

Step 3 check regularly

Diabetic patients should go to the hospital regularly for relevant examinations, which is not only beneficial to blood sugar control, but also can actively prevent complications and strive for early detection and early treatment. Screening mainly includes blood biochemical examination, glycosylated hemoglobin, urine routine, microalbuminuria, electrocardiogram, fundus examination, neuropathy screening, vascular B-ultrasound, etc., so as to achieve early detection and early treatment.

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In order to ensure the seriousness of government statistical activities, the National Bureau of Statistics, in accordance with the Statistics Law and the Interim Measures for the Administration of Departmental Statistical Investigation Projects, carries out examination and approval and record management of statistical investigation projects carried out by government departments. As of December 31, 2022, the catalogue of statistical investigation projects of government departments within the effective time limit after formal examination and approval and filing is hereby publicized.

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The approved departmental statistical investigation project is an integral part of government statistics, which requires all kinds of social units, organizations and citizens to accept the investigation and maintain its implementation in accordance with the provisions of the Statistics Law. The statistical investigation items of departments not listed in the catalogue belong to illegal or illegal statistical investigations, and all kinds of social units, organizations and citizens have the right to refuse to fill in and report to the administrative organ.

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The National Bureau of Statistics conducts real-time management of statistical investigation projects of various government departments, and has set up a column of "Examination and Approval of Departmental Investigation Projects" on the website of the National Bureau of Statistics for public inquiry.

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Catalogue of statistical investigation items of government departments

(As of December 31, 2022)

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Postal industry statistical investigation system

Topic: picture channel

　　Mariah Carey, 38, and Nick Cannon, 27.

　　Sohu Entertainment News On April 30th, 38-year-old Maria Kelly and 27-year-old Nick Cannon entered the wedding hall. Mariah Carey’s last marriage was 15 years ago, in 1993, when she married Tommy Mottola, a record company executive, and the marriage lasted for five years. The lightning marriage with my little boyfriend who is 11 years younger than me is really surprising. I sincerely hope they can have a happy marriage. Although "sister-in-law love" is a very common thing at present, it is always more attractive in the entertainment industry. Here, let’s take a look at several famous pairs of "sister-in-law love" in Hollywood:

　　Jennifer Aniston (39) and John Meyer (30)

　　

　　Jennifer Aniston and John Meyer

　　Not long ago, they were photographed touching each other by the pool. According to an insider, John Mayer flew to the crew of Jennifer Aniston’s new film Marley & Me, and they spent five sweet days together. The insider said that the two had been in contact with each other by email before. "Aniston really likes John, and the age gap of 9 years old is not an obstacle. For her, this sister-in-law relationship is obviously not a joke. "

　　Kim Cattrall(50) and Alan Wyse (28)

　　

　　Kim-Cattrall-&-Alan-Wyse

　　"Of course I care about the other person’s age, otherwise he is too young to get a driver’s license, and I don’t want to pick him up by car!" Kim Cattrall, the actor of Samantha in Sex and the City, joked that her boyfriend is 22 years younger than her and is a chef.

　　Madonna (49) and Guy Ritchie (39)

　　

　　Madonna and Geric.

　　"Guy always makes me laugh." Madonna said: "He is very talented and smart. Yes, he is ten years younger than me, but I think we are equal. It is difficult to detect the age gap between us."

　　Demi Moore (45) and Ashton Kucher (30)

　　

　　Demi Moore and Ashton Kucher.

　　"Age has never been a problem for me, but it is a big problem in many parts of the world." Demi Moore said that her ex-husband was a famous actor Bruce Willi. Now her married life with Ashton Kucher is very happy, and Ashton Kucher and Demi Moore get along well with their three daughters born by their ex-husbands.

　　Harry Berry (41) and Gabriel Aubry(32)

　　

　　6 Harry Berry and -Gabriel-Aubry

　　The two met while shooting a print advertisement for Versace. On March 16th this year, the crystallization of their love-daughter Nahla Ariela came to the world.

　　Eva Longoria (33) and Tony Parker (25)

　　

　　Eva Longoria and Tony Parker

　　The heroine of Desperate Housewives described her husband, the star player of the Spurs, as a "romantic, considerate and responsible person."

Editor: Liu Lulu

1905 movie network news Recently, a romantic comedy film directed by Li Kelong and starring Xu Shendong, Wang Wei, Liao Weiwei, Quan Rui, Chen Youjun, Gneki and Feng Jiali released a preview and poster, and announced that it will land in the national cinema on November 11th. The film mainly tells the story that Xu Yunfei, an older man, was forced to participate in a "big data love matching experiment" designed by an intelligent marriage company under the pressure of urging marriage. Under the guidance of Xiao Jia, an AI intelligent robot, he constantly met girls with different personalities. In the process of finding the right girl, the trajectory of life has turned a thousand times, and I have passed by the hostess Li Qiuyue constantly, thus staged a journey of finding love under the background of big data.

The film Love Call Waiting focuses on the love in the near future artificial intelligence era, and it is a brand-new urban imagination by director Li Kelong. In recent years, the problem of marriage and love among older young men and women has become a new social pain point, which has also spawned a variety of dating apps and websites. These social platforms for marriage and love mostly use interests, hobbies, personalities and dietary preferences as labels to make a detailed classification of single men and women for young people as a shortcut to find the other half of their lives. Can seemingly highly intelligent technical means really solve the pain point of "empty nesters"? . In the movie, everyone’s hobbies and life trajectories are controlled by a data company, and Xiaojia, a marriage guidance robot, is developed based on big data.

As a love wingman, Xiao Jia, a robot, always accompanies Xu Yunfei, the male host, and makes suggestions for him. In the daily life of "love each other and kill each other", I gradually integrated into the life of the man. With Xiao Jia’s help, many women with different personalities, such as coldness, cuteness and frankness, also came into the man’s life, so many funny scenes were born. For example, according to the instructions of the robot, the man came to the place where "the right girl" was about to appear with plush toys, and he was greeted by a camouflage suit courting man holding flowers. Under the guidance of Xiao Jia, a vicious tongue, the man has repeatedly changed from the excitement of love to the loss of love, constantly accepting the ridicule of fate. At the same time, the film adopts a double-clue narrative structure to show the emotional lines of the man and the woman. After going around, their life trajectories are finally perfectly intertwined.

Can the fate of "lonely life" really be solved by modern technology? The answer may be pessimistic. Big data seems to never grasp the accuracy of love. Perhaps, the code of love depends more on feelings. Fast food, express, express &hellip; &hellip; In today’s era when everything is fast, can love match quickly? The director tried to make an in-depth discussion through the film. Of course, everyone wants to have a sweet love, and also wants to have a love wingman like Xiao Jia to accompany them and guide their love direction. Then you might as well walk into the cinema to appreciate the many possibilities of life. Perhaps, the person who often passes by you, like the hostess Li Qiuyue, is waiting for you in the near future.

The film "Love Call Waiting" re-examines the views on the subject of "love" in the era of big data from the perspective of contemporary urban men and women.