Counties (cities, districts) Construction Bureau, municipal water supply and drainage company and all units directly under the Bureau:

The "Implementation Plan for the Construction of" Smart Site "in Lishui City" is hereby printed and distributed to you, please conscientiously implement it according to the actual work.

Lishui housing and urban construction bureau

December 9, 2019

(This piece is publicly released)

Issued by the Office of Lishui Housing and Urban-Rural Development Bureau on December 9, 2019 　

Implementation Plan of "Smart Site" Construction in Lishui City

In order to implement the Opinions of the General Office of the State Council on Promoting the Sustainable and Healthy Development of the Construction Industry (Guo Ban Fa [2017] No.19), the Notice of the Ministry of Housing and Urban-Rural Development on Printing and Distributing the Outline of the Informatization Development of the Construction Industry from 2016 to 2020 (Jian Zhi Han [2016] No.183) and the Notice of the Housing and Urban-Rural Development Department of Zhejiang Province on Accelerating the Construction of "Smart Sites" in the Province (Zhejiang Jian Zhi An Fa Effectively improve the efficiency of industry supervision and service, and improve the fine management level of the construction site in our city. Our bureau decided to immediately carry out the construction of smart sites, and formulated this implementation plan.

I. General requirements

Fully implement the requirements of high-quality development of the construction industry, take improving the engineering quality and safety level and building a harmonious and civilized industry environment as the main line, adhere to the problem-oriented and goal-oriented principles, and use the modern management concept of "wisdom+interconnection+collaboration" to build the subsystems of "smart site" according to local conditions in about two years, gradually realize the full coverage of the city’s "smart site" management system and connect with the province’s "smart site" management system.

Second, the basic situation

(1) Platform functions. Lishui Smart Work Site Platform includes video monitoring management, real-name registration system attendance management, environmental monitoring management, quality supervision and safety supervision, etc. Combined with the requirements of industry supervision functions, it gradually realizes functions such as quality, safety, dust prevention, project progress, personnel management, data statistical analysis and government supervision.

(2) Information collection. Smart site platform mainly collects basic information of enterprises and projects, video monitoring information, attendance information of real-name registration system, environmental monitoring information, quality and safety supervision information, etc., and realizes real-time early warning, task release and disposal based on the same platform, and later provides decision support through big data analysis services.

(3) management authority. Lishui Smart Site Platform is built and managed by the Municipal Construction Bureau in a unified way, and it is opened and applied to the relevant offices (stations) of the Municipal Construction Bureau, the housing construction departments of all districts (cities) and counties, and relevant enterprises and project departments according to the responsibilities and authorities, so as to realize the smart management of the city’s construction projects and improve the quality, safety and civilized construction control level of the city’s construction projects.

(4) Responsibilities of service providers. The network service provider is responsible for assisting the competent business department in daily maintenance of the system platform, network access, system training and site equipment compliance acceptance service. The construction unit and equipment service provider are responsible for the installation and daily maintenance of site equipment, that is, who installs, manages and is responsible.

Third, the construction content

(A) video surveillance

1. Scope of implementation

Since December 10, 2019, the following construction projects must be equipped with an online video surveillance system and connected to the platform:

(1) Projects with a newly started construction area of 5,000 square meters or more after December 10, 2019, including new construction, renovation and expansion of houses; Municipal infrastructure projects with a project cost of 20 million yuan or more.

(2) Construction projects under construction with a construction area of 5,000 square meters or more that have not been accepted by the main branch project before December 10, 2019; Municipal infrastructure projects under construction with a project cost of 20 million yuan or more and a remaining construction period of 6 months or more.

(3) The construction projects listed in Lishui City’s standardized construction site creation plan for building safety and civilized construction, including those newly built or whose main branch projects have not been accepted before December 1.

Meet the above conditions, it is a special project or other special circumstances, the project is located in the construction department for examination and approval, you can not install online video monitoring system.

2. Installation requirements

(1) The number of video monitoring points installed. Housing construction project construction area of less than 20 thousand square meters, not less than 1 ball machine and 3 bolt machines; Housing construction project construction area of 20 thousand square meters and less than 50 thousand square meters, not less than 1 ball machine and 4 bolt machines; For every 50,000 square meters increase in construction area, it is necessary to add another ball machine monitoring point; For projects with complex surrounding environment or large scale, the number of video monitoring points should be increased according to the actual needs of the project, and the specific requirements should be determined by the construction administrative department where the project is located.

(2) Installation position of video monitoring point. The arrangement and installation of video monitoring points should be determined according to the actual situation of the construction site. The main installation positions are as follows: the highest point of the construction site (the installation position of the ball machine), the entrance and exit of the construction site, the vehicle washing pool, the processing area, major hazard sources and other parts. If there is a living area, at least one gun must be installed in the living area, and each entrance with multiple entrances and exits in the construction site should be equipped with a gun monitoring point. The installation position should be the most reasonable and favorable position that can reflect the construction situation of the project. Ensure that the construction status of personnel, major hazard sources and engineering subjects at the entrance and exit of the whole project can be displayed. The installation height should be considered to meet the needs of the whole construction process and reflect the construction status of the main places as much as possible. The monitoring points should be installed at locations that do not need to be moved during construction as far as possible to avoid repeated demolition and reinstallation.

(3) Technical standards and access requirements of video monitoring system. See Annex 1 for the technical standards of video surveillance system. Only qualified equipment can access the platform. See Annex 2 for the interface protocol of video monitoring platform. Monitoring equipment meeting the requirements of technical standards should be adopted in each construction site, and the Municipal Construction Bureau should be contacted for testing and access. Units that have completed the construction in advance should upgrade all kinds of equipment that do not meet this standard to ensure that they can be integrated with the platform.

(2) real-name registration system attendance

1. Scope of implementation

All newly started projects after December 10, 2019 will be connected, and the projects that have started, special projects or other special circumstances are the same as video surveillance requirements.

2. Attendance object

Main management personnel and construction workers of construction and supervision units.

3. real-name registration system attendance equipment installation requirements

(1) Installation quantity and location. The quantity of equipment shall be purchased according to the actual demand of the construction site, and the actual attendance needs shall be met. The equipment shall be installed at the main entrance and exit positions. In order to ensure the equipment identification effect, the installation position shall avoid east-west orientation as far as possible.

(2) real-name registration system attendance equipment technical standards and access requirements. See Annex 3 for the technical standard of attendance equipment in real-name registration system. Only qualified equipment can access the platform. See Annex 4 for the interface agreement of real-name registration system attendance equipment platform. real-name registration system attendance equipment meeting the requirements of technical standards should be adopted in each construction site, and contact the Municipal Construction Bureau for testing and access. Units that have completed the construction in advance should upgrade all kinds of equipment that do not meet this standard to ensure that they can be integrated with the platform.

(3) Environmental monitoring

1. Scope of implementation

(1) Newly started projects covering an area of 5,000 square meters or more after December 10, 2019, including new construction, renovation and expansion of housing construction projects; Municipal infrastructure projects with a project cost of 20 million yuan or more.

(2) Construction projects under construction with a building area of 5,000 square meters or more that have not been accepted by the main branch project before December 10, 2019; Municipal infrastructure projects under construction with a project cost of 20 million yuan or more and a remaining construction period of 6 months or more.

(3) The construction projects listed in Lishui City’s standardized construction site creation plan for building safety and civilized construction, including those newly built or whose main branch projects have not been accepted before December 10th.

Meet the above conditions, it is a special project or other special circumstances, the project is located in the construction (construction) department in charge of examination and approval, you can not install online environmental monitoring system.

2. Collecting parameters

PM10, PM2.5, noise, temperature, humidity, wind power, wind direction and wind speed.

3. Installation requirements of environmental monitoring equipment

(1) Installation quantity requirements. The quantity of equipment shall be purchased according to the actual demand of the construction site, and if the area is within 50,000 square meters, at least one inspection point shall be installed; For every 50,000 square meters of floor space, one more monitoring point will be added. Meet the requirements of municipal infrastructure projects each bid set at least 1 monitoring point. Installed at the main entrance or exit or around the foundation pit.

(2) Installation position requirements. The monitoring equipment shall be installed within the enclosure of the construction site and can directly monitor the main construction area on the site. The on-site spraying system should avoid the on-line monitoring facilities for dust, and should not interfere with the normal monitoring of the monitoring facilities. If one monitoring point is set, it should be set at the main entrance and exit of construction vehicles; If two or more monitoring points are set, at least one of them should be set at the main entrance and exit, and the rest should be set at the field boundary closest to the surrounding sensitive points. When it is adjacent to other construction projects, monitoring points should be avoided at the adjacent boundary.

(3) Technical standards and access requirements of environmental monitoring equipment. See Annex 5 for the technical standards of environmental monitoring equipment. Only the equipment that meets the requirements can access the platform. Refer to Annex 6 for the interface agreement of environmental monitoring platform. Monitoring equipment meeting the requirements of technical standards should be adopted in each construction site, and contact the Municipal Construction Bureau for testing and access. Units that have completed the construction in advance should upgrade all kinds of equipment that do not meet this standard to ensure that they can be integrated with the platform.

IV. Procedures

The installation, use and removal of smart site equipment shall be handled according to the following procedures:

(1) Determine the installation scheme. Network operation service providers go to the construction site for survey, and jointly determine the number of equipment points, installation locations, installation plans, etc. with construction, supervision and construction units; The construction unit shall complete the production of the equipment installation scheme and point layout of the smart construction site in the construction site, fill in the Notice Form for Equipment Installation of Smart Construction Site in Lishui City (Annex 7), and report it to the construction engineering quality and safety supervision institution where the project is located for the record. 　

(2) Installation and use. With the cooperation of the construction unit, the supervision unit and the construction unit, the network operation service provider installed the special network for the smart site. After the construction unit passed the acceptance, the smart site system was officially put into use. Within one month after the official start of the project, at least two video monitoring points (vehicle washing pool and real-name registration system attendance machine), environmental monitoring equipment and real-name registration system attendance equipment must be installed, and other smart site equipment should be installed in time according to the construction progress.

(3) Modification of the system scheme. No unit or individual is allowed to modify the reviewed smart site plan and smart site equipment layout plan without authorization. If it is really necessary to modify, the construction unit shall apply, and the modification can only be made after the network operation service provider, supervision unit and construction unit audit and report to the construction administrative department where the project is located for approval.

(4) Demolition and relocation. Without the consent of the construction administrative department where the project is located, the construction unit shall not dismantle or move the smart site equipment. If it is necessary to dismantle or move the equipment, the construction unit shall go through the formalities at the construction administrative department where the project is located three working days in advance, and fill in the Notice Form for Equipment Demolition (Relocation) of Lishui Building Engineering Smart Site (Annex 8). With the Notice Form of Equipment Removal (Relocation) of Lishui Smart Construction Site, the network operation service provider will remove or move the dedicated network of smart construction site, and the construction unit shall not remove or move the smart construction site equipment without authorization.

V. Supervision and management

(1) Local construction authorities should regard smart sites as an important starting point for quality and safety supervision, strictly implement them in accordance with the provisions of the implementation measures, and urge those sites that fail to install the smart site system on time, refuse to install the smart site system, and fail to ensure that the smart site system is in good working condition to be rectified in place, so as to promote the smooth implementation of smart sites. Local construction authorities shall supervise the construction sites under construction in real time through the smart site system, and keep account records.

(2) For the construction projects that have started before the implementation of this notice and need to install smart site systems, the equipment installation and system access of all smart site systems should be completed before December 31, 2019.

(III) The construction of smart site is included in the "one-vote veto" of creating a standardized construction site for building safety and civilized construction in Lishui City. In accordance with the requirements of this notice, a site that fails to install or refuses to install the smart site system on time and cannot guarantee that the smart site system is in good working condition may not participate in the standardized construction site for building safety and civilized construction in Lishui City in principle.

(four) local construction authorities shall, within 3 working days after receiving the application for modification or removal of the smart site system, review and reply to the applicant.

(five) local construction departments should complete the construction of local smart site sub-centers before June 30, 2020, and can formulate implementation rules according to this notice.

VI. Maintenance Management

(1) Network operation service providers and equipment service providers that provide smart site system services must ensure the normal operation of smart site systems, diagnose equipment failures in real time and immediately deal with them, and regularly send people to the construction site for maintenance. 　

(2) The construction unit shall assign a special person to be responsible for the management of smart site systems and equipment, and complete the work of scheme formulation, contract signing and equipment acceptance, and check and make records every day. If abnormal conditions are found, it is necessary to find out the reasons and notify network operation service providers and equipment service providers in time, take effective measures to ensure the safety of facilities and lines in smart construction sites, and actively do a good job in maintaining facilities and lines. If it is found that the monitoring equipment of the smart site is intentionally damaged, the competent construction department where the project is located shall immediately order it to be repaired immediately.

(3) If the smart site system fails, all relevant units should carry out maintenance as soon as possible according to the contract, and in principle, the repair should be completed within 24 hours after receiving the report.

(4) In order to ensure the effective implementation of the smart site, the expenses of online video monitoring system such as leasing, installation, debugging, maintenance and network leasing are included in the expenses of safety protection and civilized construction measures of construction projects, and the funds are special.

(5) Local construction (construction industry) authorities, construction engineering quality and safety supervision institutions, construction units, construction units and supervision units should use the smart site system to realize remote dynamic supervision and management of the construction site. The login website, user account number, password and usage of the smart site system are provided by Lishui Housing and Urban-Rural Construction Planning Bureau and network service providers.

Li Jianfa [2019] No.225 Annex. doc

All relevant units:

　　According to the requirements of the China National Intellectual Property Administration Office’s Notice on Initiating the Recommendation of the Establishment of the Second Batch of Technology and Innovation Support Centers (TISC), and in order to thoroughly implement the spirit of the important instructions of the Supreme Leader General Secretary on forming an intellectual property public service system that will benefit the people and the people, the Beijing Intellectual Property Office is now organizing the application for the establishment of the second batch of technology and innovation support centers (TISC). The relevant matters are hereby notified as follows:

　　First, the reporting conditions

　　The subject of application is intellectual property information service institutions engaged in the fields of patents, trademarks, geographical indications and designs, including social information service institutions such as universities, scientific research institutions, public libraries, scientific and technological intelligence agencies, industry organizations, productivity promotion institutions in industrial parks, and various legal entities such as public service institutions of intellectual property systems at all levels. An institution that meets the basic conditions stipulated in Article 6 of the Implementation Measures for the Construction of Technology and Innovation Support Center (TISC) (Guo Zhi Ban Fa Fu Zi [2019] No.27), and can carry out relevant work or play a supporting role in promoting the transformation and application of innovation achievements, promoting intellectual property pledge financing, promoting strong chain efficiency in key industries, cultivating and popularizing patent-intensive products, supporting national strategic scientific and technological research, guiding enterprises to defend their rights overseas and early warning of infringement, etc.

　　According to the public welfare orientation and nature of TISC, market-oriented information service institutions that only provide commercial services are not recommended; Do not repeatedly recommend institutions that have been approved to become national intellectual property information service centers in colleges and universities. Institutions that have filed national public service outlets for intellectual property information are given priority under the same conditions.

　　Second, the declaration and audit procedures

　　All reporting units fill in the application materials and submit them to the Beijing Intellectual Property Office. The Beijing Intellectual Property Office will carefully examine the submitted materials, and in principle, recommend no more than five local units with good basic conditions and strong service capabilities as the second batch of TISC recommendation candidate institutions in the second phase and submit them to China National Intellectual Property Administration.

　　China National Intellectual Property Administration will review the application materials in accordance with the established procedures, organize expert review, and conduct field research as needed. Finally, China National Intellectual Property Administration and WIPO will jointly determine the list of the second batch of TISC preparation organizations in the second phase and publish it on the official website.

　　Third, the reporting requirements

　　Please fill in the Recommendation Form for the Establishment of Technology and Innovation Support Center (TISC) (see attachment) carefully, and ensure that the contents are true, accurate and complete, and submit it to the mailbox of International Exchange and Cooperation Office of Beijing Intellectual Property Office (guojichu@zscqj.beijing.gov.cn) before closing on March 22nd. If it is recommended after examination, the Municipal Intellectual Property Office shall notify the recommended unit to enter all information items in the recommendation form through the public service management system of the National Intellectual Property Public Service Network (https://ggfw.cnipa.gov.cn/gl/), and submit the sealed PDF version and the electronic WORD version of the recommendation form.

　　I hereby inform you.

Beijing Intellectual Property Office　　　　

March 18th, 2024　　

　　(Contact: Yang Qi; Tel: 55536355)

With the recent official statements on optimizing and adjusting the real estate policy, a new round of stabilizing the property market has revived. The analysis generally believes that the signal that the current "policy bottom" is once again solid is obvious.

However, in the process of great changes in the relationship between supply and demand, it is particularly important to judge the boundaries and trends of policy easing. In the attempt to adjust and explore, many cities first gave a relatively safe way of encouragement-housing subsidies.

Data map: There are many high-rise buildings in the city. China News Service reporter Wang Dongming photo

Two provincial capitals increased subsidies.

On August 4th, according to the official micro-signal "Nanjing Real Estate Micro-government" of Nanjing Housing Security and Real Estate Bureau, Nanjing issued the notice of "Further Optimizing Policy Measures to Promote the Stable and Healthy Development of Nanjing Real Estate Market". The first of the eight policies is the implementation subsidy for purchasing new commercial housing.

Specifically, the new six districts are encouraged to continue to give a certain proportion of housing subsidies to those who buy new commercial housing within the specified period according to the actual regional market, and Qixia District and Yuhuatai District will give subsidies to the purchase of new commercial housing after evaluation based on the actual market within their respective jurisdictions, so as to effectively reduce the burden of rigid and improved housing purchase.

Zhao Qian, a senior analyst at the Central Finger Research Institute, pointed out that as early as 2022, several suburban areas in Nanjing, such as Liuhe, Lishui and Gaochun, had already implemented a series of subsidy policies. This official document, in addition to re-emphasizing that the new six districts can continue to implement housing subsidies, mentioned the new regulations for Qixia and Yuhuatai for the first time.

"This is also a policy put forward by Nanjing after comprehensively studying the buyers in various regional markets. Later, each district will introduce specific implementation details, and the implementation effect remains to be seen." Zhao Wei said.

Nanjing has also become the second provincial capital city to join in this round of property market adjustment. Just the day before the introduction of the New Deal, Zhengzhou issued 15 policies to regulate the property market, which also put the content of housing subsidies at the forefront, including subsidies for young talents to buy houses, families with many children to buy houses, and deed tax on housing purchases.

"Zhengzhou has a total of 15 policies, and 3 of them all mention various subsidies, which fully shows that in this round of property market boosting work, financial subsidies and other tools will be actively used, reflecting the new orientation of the current housing purchase policy." Yan Yuejin, research director of Yiju Research Institute, said.

　　Data Map: Painting boats swim on Qinhuai River in Nanjing, Jiangsu. China News Service reporter Li Bo photo

What is the thrust of the "icing on the cake" policy?

Following Politburo meeting of the Chinese Communist Party’s "timely adjustment and optimization of real estate policy" on July 24th, and the Ministry of Housing and Urban-Rural Development followed closely to clarify the direction of policy support, many places quickly launched actions to release policies related to stabilizing the property market, and the content related to housing subsidies also became hot.

On August 4th, Ganzhou, Jiangxi Province issued 18 real estate measures, which mentioned supporting the implementation of house purchase subsidies and continuing to implement phased house purchase deed tax subsidies. On August 1st, Jiangsu Jurong introduced a new policy to stabilize the property market, including deed tax subsidies for families with many children to buy new houses and deed tax subsidies for new commercial housing. On the same day, Sichuan Ya ‘an Economic and Technological Development Zone issued a new policy to stabilize the property market, and proposed to buy new houses to subsidize the purchase of houses, including subsidies for talents and families with many children.

"The biggest feeling is that although I spent a lot of money to buy a house before, I still feel like I am getting a subsidy." Citizen Xiao Miao (pseudonym) bought a new house in July this year, and after paying the deed tax, she applied for a subsidy for talents to buy a house. She received a short message one week after the application, and the money arrived less than half an hour later.

On social platforms, more and more people share their experience of applying for housing subsidies like Xiao Miao. At present, granting housing subsidies is one of the important means for cities to support housing consumption, and the frequency and proportion of policies remain high.

According to the statistics of the Central Finger Research Institute, in the first half of 2023, more than 50 cities have implemented the housing subsidy policy. The subsidy methods mainly include one-time subsidies according to sets or areas, one-time or phased payment of deed tax subsidies, payment of consumer vouchers subsidies, talent housing subsidies, and a certain proportion of housing price subsidies.

"In the short term, it is expected that the demand-side policy will still focus on reducing the threshold and cost of buying a house. The’ one district, one policy’ and the combination of the birth policy are important directions, and the credit policy for improving housing demand is also expected to increase." Chen Wenjing, director of market research at the Central Finger Research Institute, said.

However, there are also voices that housing subsidies tend to be short-term encouragement and assistance, and cannot really become a decisive factor affecting property buyers. The White Paper on House Purchase Intention in 2023 published by Leju. com shows that tax adjustment and house purchase subsidy have little influence on decision-making. In the choice of "which of the following changes will affect your decision to buy a house", "tax/interest rate will continue to decrease" and "large house purchase subsidy" can only affect 4.81% and 11.12% of buyers.

"Judging from the current relaxed environment of the property market as a whole, most of the housing subsidies in various places are part of the’ combination boxing’ of local regulation and relaxation." Zhang Bo, president of 58 Anjuke Research Institute, previously commented on the housing subsidy policy, saying that the effectiveness of a single policy on market release is relatively limited, and it needs to form a joint force with other regulatory relaxation policies, which will have a certain influence on the market.

　　CCTV News:Precision manufacturing is the main pillar of Japanese manufacturing, and it is regarded as Japan’s "national business card". However, last year, after Kobe Steel Works was exposed to fraud scandals and continued to ferment, more and more leading Japanese manufacturing enterprises encountered the "quality gate", and Japanese manufacturing was falling from the "altar" to the "quagmire".

　　"The problem of making Japanese manufacturers lose their sense of trust has developed into a criminal case." Kyodo News reported on the 5th that the Special Search Department and the Metropolitan Police Department of the Tokyo District Prosecutor’s Office of Japan conducted a home invasion search on five locations in Tokyo and Kobe office buildings of Kobe Steel Works and three factories on the grounds of suspected violation of the Anti-Unfair Competition Law that day. The report stressed that although the company voluntarily submitted some information, considering its decades-long data fraud, it decided to "carry out compulsory search".

　　Established in 1905, Kobe Steel Works is the third largest steel producer in Japan, the top supplier of aluminum products and copper products in Japan and one of the top 500 enterprises in the world. Japanese Prime Minister Shinzo Abe worked in Kobe Steel Works before he entered the political arena. He also revisited his hometown twice as prime minister and wrote an inscription praising his technology and quality.

　　However, in October 2017, many factories in Kobe Steel Works were exposed to long-term tampering with the factory inspection data such as the strength and size of aluminum and copper products, and then it was exposed that the parameters of iron powder products were falsified, which led to the questioning of its entire line of products.

　　The Chinese official website of Kobe Steel Works shows that "the wire rod for automobile valve springs is used by one in every two cars in the world", "the aluminum sheet for automobiles accounts for 50% of the Japanese market" and "the aluminum profile for railway vehicles accounts for the highest share of the Japanese market".　

　 　 　 　 　Therefore, the "suspected fraud" of Kobe Steel Works can be described as "pulling the whole body", and about 200 Japanese companies have been affected. Toyota, Nissan, Honda, Mitsubishi, Subaru, Mazda, Suzuki and other Japanese car companies have confirmed the use of the problem parts, and the affected parts are mainly engine covers and doors. The Shinkansen train of Donghai Railway Company and the first Japanese-made jet regional aircraft MRJ under development were all found to have used aluminum products that did not meet Japanese industrial specifications.

　

The original digging number is included in the topic # 44 migrant workers.

In recent weeks, I have a toothache. According to past experience, either my gums are severely atrophied or my teeth are cracked and need to be filled. So I hung up the number of a famous dental hospital in Guangzhou with my mobile phone, which was particularly difficult to hang up. It was full in recent days and I could only hang up the number four days later.

At 7 o’clock this morning, it was drizzling in the sky. I set off for the hospital, filled out a form to take a temperature measurement, and wanted to know whether the dental insurance could be reported at the registration office. I saw a buddy in front of me paying money, the first one was more than 6,700, and the second one was more than 1,900. I was so scared that I almost wanted to go home, but I wanted to come all over again. The dentistry was so profitable that I had to dig it.

At 8: 30, there were a lot of people sitting at the door. The hospital was not big, but there were departments in the elevator. I was looking at the dental pulp department.

On a whim, I want to see the flow distribution of people in various departments at this time, and I ran a circle on the upper and lower floors:

6F Children’s Stomatology: 1 person

5F Orthodontics Department: 8 people, Dental Pulp Department: 8 people.

4F Implant and Prosthetic Department: 8 people, Oral and Maxillofacial Surgery: 6 people.

1F Radiology Department: 5 people, Periodontology Department: 9 people.

(Not included in the treatment)

It’s my turn. After checking, it was concluded that a tooth needs to be filled. After paying the total fee of 305, I paid 200 medical insurance for reimbursement of 105. I just saw the expenses of various projects on the screen of the hall, and took a photo.

How to estimate the annual income of this hospital? It is known that the maximum number of doctors registered in a day is 30. From the registration applet, we can see that the number here is full almost every day, and we can see how many doctors there are in each department every day.

The number of patients per day can be calculated as follows:

Pediatric stomatology: 6 doctors *30 numbers =180 people.

Oral and Maxillofacial Surgery: 5 doctors *30 numbers =150 people

Orthodontics: 7*30=210 people

Dental and endodontic department: 9*30=270 people

Periodontal disease department: 5*30=150 people

Implant Restoration Section: 5*30=150 people

According to this number of people, the registration fee alone can earn 10 yuan *1110 people =11100 yuan per day, which is really cool!

The total income can be estimated if there is another per capita cost. My idea is to take the cost of the most common treatment items in each department instead of the per capita cost. For example, periodontal disease is tooth cleaning, and dental pulp is tooth filling. Combined with the cost photographed in the hall and online data, some common treatments, such as tooth cleaning, pulling out a wisdom tooth, applying fluoride to the whole mouth, filling a tooth, etc., cost about 500. Roughly speaking, if 500 yuan is taken as the per capita cost, then the hospital’s annual income.

500 yuan *1110 people/day *365 days = about 200 million.

This hospital is only a small branch. If it is the General Hospital, it is estimated that its income will double. According to the hospital’s WeChat WeChat official account, there are 50 doctors here, which means that each doctor brings 200 million /50=4 million in revenue every year.

With such a high per capita income, it can be inferred that the income of dentists should be high. Digging through the financial report of a dental A-share listed company, which has 21 dental hospitals in Zhejiang, there are several interesting data in the financial report:

For example, the annual revenues of the above four stomatological hospitals are 620 million, 390 million, 140 million and 40 million respectively, and the net profit margins are 40%, 28%, 28% and 16% respectively.

For example, 54.99% of the cost of stomatological hospital is labor cost, which proves the high income of dentists.

So how high is the income of dentists? I searched a lot of answers in Zhihu. The monthly salary of dentists in public hospitals in first-and second-tier cities is between 10,000 and 20,000, and 30,000 to 40,000 if they are deputy directors or above.

Data reference from: https://www.zhihu.com/question/364101818/answer/958783096

Dentists in private hospitals earn more. Here is an authoritative data, which comes from the dictation of the founder of a dentist online platform:

At present, private dental hospitals basically adopt the salary method of basic salary plus commission. The monthly income of dentists with lower income is about 20,000 to 30,000 yuan, and the monthly income of dentists with higher income can reach 60,000 to 70,000 yuan. Some top dentists will have a higher commission, and may even break 500,000 yuan a month.

As we are now, we basically recruit doctors from some good public hospitals such as Huaxi Stomatology, and the success rate is still relatively high, because in private clinics, especially brand-operated private clinics, the treatment is also better, and the recognition of doctors in the industry is not worse than that in public hospitals.

He also mentioned that there is a great demand for dentists in China:

The ratio of dentists to population is only 1: 28,000, compared with 1: 1,000 in developed countries such as the United States, 1: 2,000 in Japan and 1: 4,000 in Western Europe, which fully shows that there is a great gap in the demand for dentists in China.

Source: https://www.iyiou.com/analysis/2018052373041.

I really envy, envy and hate. The key dentist is still a profession that gets more and more popular as he gets older. He will not retire at the age of 35 like the siege lion, and he has a high sense of security!

Original title: "How much can a dental clinic earn a year? 》

Read the original text

　　Recently, China’s economic indicators from January to July were released one after another, which aroused a lot of concern.

　　As the largest trading partner of more than 120 countries and regions in the world, the next trend of China’s economy affects the pulse of the global economy.

　　In the past ten years, the air routes of 11 international hub ports along the coast of China have increased by 60%. The maritime service network connects the major ports of more than 100 countries and regions, making it the country with the highest maritime connectivity in the world.

　　At present, the century-old changes and the century-old epidemic are intertwined, and countries around the world are deeply impacted. How should we understand the challenges that China’s economy is experiencing and the expectations of future growth?

　　And how to find the right coordinates to evaluate China’s economy?

　　Master Tan worked out an account with the authority.

01

Which epidemic prevention and control mode has the lowest cost?

A research team of the National Bureau of Statistics has made a model calculation on the relationship between epidemic prevention and control policies, macroeconomic policies and economic loss rate in various countries since the outbreak of the COVID-19 epidemic. The results show that:

　　From 2020 to the first half of 2022, the total economic loss rate of China was only 2.3% under strict prevention and control.

　　However, the economic loss rate under tight prevention and control (such as Japan and South Korea), passive prevention and control (such as Germany and France) and passive prevention and control (such as the United States and Britain) reached 3.9%, 5.5% and 5.9% respectively.

　　At the same time, after excluding the impact of macroeconomic policies, China’s economic loss rate dropped to.floor level.

　　The international media pointed out in an article entitled "China’s policy of" dynamic clearing "of COVID-19 infection contains lessons for other countries" that China’s anti-epidemic policy of "dynamic clearing" has achieved the goal that every country sought two years ago: low mortality and as little economic chaos as possible.

　　China’s epidemic prevention model has been achieved.Give consideration to anti-epidemic and production developmentThe effect.

　　A typical example is that in the first half of this year, China’s export data became the bright spot of growth, while the economic growth expectations of major countries in the world were declining.

　　02 　

　　Why has China become a global lifeline?

　　This is one of the perspectives of epidemic prevention cost accounting. China insists on "dynamic zero clearing", which reduces the manpower, material resources and economic and social costs as much as possible, in exchange for overall economic and social stability.

　　Behind China’s low economic loss rate is the stability and toughness of China’s supply chain and industrial chain under the policy of "dynamic clearing".

　　In the past two years, repeated outbreaks have made this more prominent.

　　Recently, Tan Zhu chatted with Yan Ci, the chief representative of China, the global container shipping logistics giant Maersk Group.

　　The year when Maersk invested in the first fully automated storage project in China was 2020, when the epidemic had just begun.

　　Maersk has a reason to dare to cast this project against the wind.

　　At the China International Fair for Trade in Services in 2020, Yanci praised the company for maintaining normal operation and uninterrupted supply chain with the help of China government.

　　During the epidemic, China fully guaranteed the production of enterprises with a stable soft and hard environment. The goods manufactured in China are continuously transported to the world through logistics companies like Maersk.

　　According to the statistics of the United Nations Conference on Trade and Development,During the epidemic, China’s share of global merchandise exports increased from 13% in 2019 to 15% by the end of 2021..

　　Among them, China’s share in global electronic products exports increased from 38% in 2019 to 42% in 2021, and its share in textile exports increased from 32% to 34%.

　　China’s increased export share has become the "lifeline" for countries such as the United States and Britain to maintain their operations.

　　In 2020, when the epidemic just broke out, 83% of the imported masks in the United States were made in China, two-thirds of the protective clothing came from China, and 90% of the imported box refrigerators specially used for storing vaccines came from China, showing an explosive growth.

　　The epidemic prevention and control in China has stabilized the industrial chain and supply chain, making China a ballast stone to meet the needs of global epidemic prevention, production and life.

　　Stability in the face of wind and rain comes from the accumulation of a sword in ten years.The "Decoding Decade" broadcast by the main station is the best example.

Despite the epidemic, the number of China-Europe trains that are still running smoothly in the Eurasian continent has exploded in this decade, reaching nearly 900 times that of the opening year. Now, there are an average of 42 trains running between China and more than 190 European cities every day.

In the complicated global epidemic situation, stable policies and environment are more attractive, and the keen international capital flow is very convincing.

A few days ago, the Ministry of Commerce announced that from January to July this year, the actual amount of foreign capital used nationwide was 798.33 billion yuan, an increase of 17.3% on a comparable basis.

Investment is confidence.

　　03　　

　　Who has more confidence in China?

　　You can look at the four sources of investment in China highlighted by the Ministry of Commerce:

　　The United States, which has failed to prevent and control the epidemic, has increased its investment in China by 36.3%, and the rest of the countries are also allies that the United States is trying to win over.

　　You know, for a long time in the past, a focus of American diplomacy was to build small courtyards and high walls on the industrial chain with these countries as the axis.

　　But what is it?as the trend of the times indicatesMultinational enterprises have given their choices by voting with their feet.

　　According to the 2022 White Paper on American Enterprises in China released by the American Chamber of Commerce in China this year, more than two-thirds of the member companies continue to list China as the primary market.

　　Starbucks, a Seattle-based coffee chain, is committed to opening 6,000 stores in China before the end of the year.

　　Germany, in the first half of this year, set a record high for its investment in China in the first half of this year since 2000. Among the industries in which Germany increased its investment in China, there was its manufacturing "crown jewel" — — Automobile industry.

　　This year, German Volkswagen, which has been producing and operating in China for nearly 40 years, set the first subsidiary of its software company CARIAD in China — — This is also CARIAD’s first overseas subsidiary.

　　Nearly 40 years ago, the presence of Volkswagen once planted the seeds of growth for China automobile industry.

　　Today, in the eyes of the public, the establishment of a new factory in China, which ranks first in the world in the new energy automobile industry, represents the hope of the public.

　　Bringing the "leader" of China’s top industries to China means more precious confidence besides economic considerations.

　　From a global perspective, the United States, Japan, South Korea and Germany are the economic leaders in America, Asia-Pacific and Europe respectively, and they are also the weathervanes in their regions. Their choices are very convincing.

　　In fact, the Americans themselves have long forgotten: China is one of the countries with the highest total rate of return on foreign direct investment in the United States.

　　According to the U.S. Department of Economic Analysis, from 2000 to 2020, the average rate of return on American direct investment in China is14.7%, much higher than the US overseas direct investment.9.7%Yield.

　　On the contrary, if American companies reduce their investment in China by half, it will cause very direct damage to the American economy, and the one-time loss of gross domestic product (GDP) will be as high as 500 billion US dollars.

　　Even during the COVID-19 epidemic, the overall rate of return of foreign investment in China is still rising. In 2021, foreign investors can still get a rate of return of over 6% when they invest in China.

　　From a longer time dimension, the rate of return on investment in China in 2020 and 2021 remains at a stable level compared with before.

　　Under the epidemic, it remains stable, which is very telling.

　　Pan Yuanyuan, an international investment expert at China Academy of Social Sciences, told Tan Zhu:

　　The first characteristic of foreign direct investment is the long time period; Second, foreign-funded enterprises will also participate in management, bringing their own technology, experience and channels to China, and combining them with China’s resources for transformation. Therefore, unlike short-term speculative investment in the securities market, direct investment pays more attention to the fundamentals of the economy and is also more alert to risks and uncertainties.

　　In other words, the most important thing for foreign direct investment is the stability of a country’s economic expectations.

　　04

　　Where does the stability of China’s economic expectations come from?

　　Recently, the International Monetary Fund also increased the RMB weight in the Special Drawing Rights (SDR) from 10.92% in 2016 to 12.28%.

　　This figure is the confidence of the international community in the stability of China’s economy and financial market, and also the recognition of effective epidemic prevention and control in China.

　　In 2020, under the epidemic crisis, countries’ economic policies to deal with the impact are completely different.

　　Countries represented by the United States, passive prevention and control, but in order to get quick results in the short term, have adopted unlimited quantitative easing policies.

　　From the second quarter of 2020 to the first quarter of 2021, the year-on-year growth rate of M2 in the United States remained above 20%, and the average growth rate of M2 after the epidemic was about 10 percentage points faster than that before the epidemic.

　　Moreover, the United States has repeatedly introduced large-scale economic rescue bills. In 2021, the fiscal deficit ratio reached 12.4%, even higher than the historical high of 9.8% during the financial crisis in 2009.

　　The "strong medicine" seems to be effective quickly, but it has led to bad consequences.

　　During the epidemic, the United States not only ranked among the countries involved in the survey with an economic loss rate of 6.5% (excluding the impact of macroeconomic policies). The more direct performance is that the inflation level in the United States has reached a 41-year high.

Inflation in the United States not only makes American enterprises and consumers bear high production and living costs, but also transfers the crisis to the whole world.

　　According to the assessment of the Bank for International Settlements, the annual inflation rate of nearly 60% developed economies exceeds 5%, the highest level since the late 1980s. The inflation rate of more than 50% developing countries has also exceeded 7%.

　　The rapid interest rate hike by the Federal Reserve in response to inflation has expanded the debt scale of emerging market countries. According to the International Monetary Fund, there are currently 38 developing countries facing debt risks.

　　Under the impact of global inflation and the Federal Reserve’s interest rate hike, Sri Lanka was forced to declare bankruptcy due to "insolvency" and became the first new market country to default on its sovereign debt in 2022.

　　Compared with the strong stimulus measures of the United States, during the epidemic, China’s macroeconomic policies were always guided at a steady pace. In the first half of this year, the national consumer price index (CPI) rose by 1.7% year-on-year, far below the level of European and American countries.

　　Because of this, the US dollar index has risen by more than 11% this year, and the depreciation of the euro, pound and yen against the US dollar is between 10% and 17%. Compared with these major global currencies, the performance of RMB is relatively stable — — It depreciated by about 5.8% against the US dollar.

　　As Lu Jinyong, director of the university of international business and economics Foreign Direct Investment Research Center, said, China still gives people an expectation and hope — — A growth expectation, profit expectation and better and better hope.

　　One of the articles in the international media commenting on China’s economy was titled "China’s economy has hidden power".

　　What are the hidden forces of China’s economy?

　　It is to plan development and safety as a whole, and it is a prominent problem to deal with economic development with systematic concept.

　　It is the wind and waves that are high, but it is as tough as a rock, and it is slow and steady, and it has its own sky.

　　This report is compiled in accordance with Article 50 of the Regulations of People’s Republic of China (PRC) Municipality on the Openness of Government Information (hereinafter referred to as the Regulations on the Openness of Government Information).

　　I. General situation

　　In 2021, the Changping District Government earnestly implemented the Regulations on the Openness of Government Information, continuously expanded the open content, innovated the open forms, improved the open system, strengthened the open supervision, and promoted the open work of government information and government affairs in an orderly manner.

　　(A) the implementation of open process specification

　　The first is to compile the "Changping District Government Information and Government Affairs Disclosure Work System Manual", refine nine system rules, and standardize the government affairs disclosure work process in the whole region. The second is to strengthen the voluntary disclosure of government information, standardize the setting of government information disclosure columns, and timely release the statutory voluntary disclosure content. Special topics such as "the construction of two districts" were established, and information in key areas such as the approval and implementation of major construction projects, the allocation of public resources, people’s livelihood, law enforcement supervision, and urban and rural construction was actively disclosed, and 3,401 pieces of information were released throughout the year. The third is to optimize the mechanism of disclosure according to the application, and actively respond to the needs of enterprises for government information disclosure. The whole region has handled 923 applications for government information disclosure. The fourth is to strengthen the business guidance for the open work of all units, combine the online business training of the universality of government affairs disclosure with the offline analysis and discussion according to the application difficulties, and promote the continuous improvement of the standardization level of government information and government affairs disclosure in the whole region.

　　(2) Strengthen the management of open platforms.

　　First, strengthen the construction of the website platform of the district government and improve the application efficiency of data classification management of government websites. Strengthen the construction of information content on government websites to ensure timely information release and update. The second is to complete the development and testing of the "Pingping" function module of the government service intelligent robot and the development of WeChat applet, expand the knowledge base data by more than 14,000 pieces, realize the voice interaction function, and provide instant question and answer service for the enterprise masses. The third is to strengthen the application of cutting-edge monitoring and inspection technologies such as big data and cloud monitoring, refine the assessment rules for new government media, and implement the monthly notification system for government websites and new government media work.

　　(3) Improve the interaction mechanism between the government and the people

　　The first is to expand public participation in policy formulation. For policy documents concerning people’s interests and people’s livelihood, the function of "I want to make suggestions" is set to collect people’s opinions and give play to the role of public participation in the process of policy formulation. The second is to intensify the policy interpretation, and interpret 17 district-level policy documents in an easy-to-understand way, such as illustrated cases, policy questions and answers, videos, etc., so that enterprises can understand and understand them well. Third, we will actively carry out a series of activities of "I do practical things for the masses", hold four "policy public lectures" and 11 "government open days" around optimizing the business environment, improving people’s livelihood and safe production, strengthen the interactive communication between the government and the people, and guide the public to participate in social governance in an orderly manner.

　　(D) to strengthen the assessment and supervision.

　　Incorporate government information and government affairs disclosure into the performance appraisal scope of the district government, and further optimize the appraisal rules. Carry out third-party evaluation of government information and government affairs disclosure on a quarterly basis, and report the evaluation results. There was no accountability in the whole year.

　　Second, the initiative to disclose government information

　　Iii. Receiving and handling applications for government information disclosure

　　Four, the government information disclosure of administrative reconsideration and administrative litigation.

　　V. Main Problems and Improvements

　　The main problems are as follows: First, the disclosure of government information by various units lacks depth and breadth, and the disclosure ratio of government information concerned by enterprises and the masses is not high. Second, the underlying content management platform system of government websites cannot fully meet the requirements of intelligent and digital applications of government websites. The operation and maintenance management of new government media is not standardized. Third, the staff’s professional ability needs to be improved, and the work norms and standards need to be further strengthened.

　　Improvement: First, we will promote the integrated development of government information, government affairs disclosure and government affairs service, combine the disclosure of statutory contents of government information with the disclosure of information needed for handling affairs, and promote the whole process of handling services to fully meet the personalized service needs of handlers. The second is to continuously upgrade and explore the in-depth application of new technologies in the government information disclosure platform, and promote the integrated development of government websites and government new media knowledge bases. The third is to establish a normalization mechanism for government information and government affairs publicity training, form good measures into typical cases, adopt video, offline meetings and other forms of experience exchange, earnestly do a good job in business guidance, and improve the business ability of government information and government affairs publicity staff in all units in the region.

　　Vi. Other matters that need to be reported

　　This unit collects information processing fees according to the Measures for the Administration of Information Processing Fees for Government Information Disclosure. In 2021, there were 0 pieces of charge notices, with a total amount of 0 yuan. The total amount actually collected is 0 yuan.

The third week of May is National Nutrition Week.

This year’s theme is "How to cook, how to choose and how to read labels"

Learn to read nutrition labels

Do on-demand meal preparation and nutrition catering.

Koppjun believes that

This is a compulsory course for everyone.

So, how do we read food labels?

Make a reasonable meal plan?

The higher the ranking of ingredients, the more content.

It is stipulated in our country that all prepackaged foods must be printed with nutrition labels on the outer packaging, including ingredient list, nutrition ingredient list, nutrition claim, etc. Otherwise, it is an illegal product.

Just know one key point about the ingredient list: the higher the content, the higher the ranking.

Therefore, no matter how extravagant the advertisement is, you can understand it at first glance.

For example, if you buy dried fruit, if white sugar is at the top of the ingredient list, or if there is edible salt and oil, it is not recommended to give it to children, which will easily lead to excessive sugar and sodium in one day.

In addition, we need to pay attention to the food additives in the ingredient list.

The purpose of food additives is to meet the needs of color, fragrance, seasoning, preservation, preservation and processing technology.

The following ham sausage and instant noodles cover almost all additives.

Image source: Weibo

Slide up and down

↓ View food additives for various purposes ↓

● Color matching-colorant, color fixative and bleach.

● Flavoring-edible essence

● Seasoning-salt, flavor enhancer, sweetener, sour agent, salty agent and umami agent.

● Anticorrosion-preservatives and antioxidants

● Preservation-antioxidant

● Processing technology needs-thickener, emulsifier, etc.

● Nutritional fortification-nutritional fortifier

To sum up, the conclusion can be drawn from the ingredient list is that materials are the best for food, and the shorter the ingredient list, the better.

Understand the nutrient composition table

There are usually three main contents in the nutrient composition table. From left to right, the names of the nutrients, the contents of the nutrients and the nutrient reference values (NRV%) are listed.

The contents that must be marked in the nutrient composition table are:

01

Nutrients that need to be listed:

China adopts the "1+4" model, that is, energy+four core nutrients (protein, fat, carbohydrate and sodium). Except for some exempted foods, all nutritional ingredients must have these five ingredients on the list.

In addition, when there are raw materials (hydrogenated and/or partially hydrogenated vegetable oil, non-dairy creamer, etc.) that may contain trans fatty acids in the ingredient list, it must be marked.

Merchants can also selectively add some nutrients. For example, dairy products usually add "calcium" and coarse grain products often add "cellulose".

Examples of nutritional components of basic models in GB 28050-2011

02

Specific values corresponding to five items:

Generally speaking, how much is contained in "every 100g", drinks are used in "every 100ml", and many snacks with high energy will be used in "each serving" or "each package".

03

Nutrient reference values percentage (NRV%):

The country has a recommended daily intake value for ordinary adults for each nutrient, and the latter percentage value represents how much share you used today when you ate 100g/ml of this food.

After learning the above "basic knowledge"

It helps to know yourself.

How many calories have you eaten?

How do you know what you eat?

How much heat is there?

According to the national standard, the content in the table of nutrients is per 100ml, or per 100g, or in a serving of food.

net content

If it is 100g or 100ml, it needs to be combined with the "net content".

For example, the net content of a bottle of beverage is 500ml, and the energy value in the nutrition table is 190 kilojoules per 100ml, so the energy of the whole bottle of beverage is 190×5=950 kilojoules.

a part; a portion; a share

According to the "one copy", the specific amount of "one copy" will be written.

For example, if a packet of instant coffee powder is 15g, its nutrient content table may be "one serving (15g)", so you can look at it directly without counting.

convert

In addition, the energy unit of food labels is kilojoules (KJ), which is an internationally used unit for labeling calories, but the calories we normally say are kilocalories (Kcal), which are also called calories and calories. The conversion relationship between them is as follows:

1kcal=4.184kJ

Calculate daily requirements according to NRV

As we said earlier, NRV% is the content that must be marked in the nutrient composition table. NRV is short for Nutrition Reference Values, which is translated into Chinese as Nutrient Reference Values.

Nutrient reference values refers to the amount of certain nutrients that ordinary people should eat every day under normal circumstances.

The NRV value of each nutrient is given in the national standard General Rules for Nutrition Labeling in prepackaged foods (GB 28050-2011):

Understand what NRV is, add a percent sign and write it as "NRV%" or "nutrient reference values%", which means that the actual content of a nutrient in this food accounts for the proportion of its NRV.

It is difficult for ordinary consumers to see the level of a certain nutrient in food from the digital surface. For example, the fat content in a nut nutrient composition table below is 53.2g/100g, and consumers can’t know whether the "53.2 g" here is high or low, but it is easy to understand if it is expressed by NRV%. Eating 100 grams of this food can probably meet 89% of the fat I need in a day, and other foods with more fat should be eaten less!

NRV%= content ÷NRV×100%

The above picture shows the nutritional composition table of a dairy product. We can see that every 100ml of dairy product contains 110mg of calcium, and nutritionists suggest that adults consume 800mg of calcium every day, and 110÷800×100%=13.75% (about 14% in the composition table), which is the meaning of our NRV%.

If the whole box of milk has 250 ml, when you finish it, you have completed 34.4% of today’s calcium intake task.

Friends who have special needs for food, such as gaining muscle, losing weight and controlling salt, need to pay special attention to NRV%. Through these values, calculate your daily intake.

How’s it going?

Want to achieve "can cook and choose, can read the label"

Isn’t it that difficult?

Congratulations!

Understand ingredient list, nutrient composition list, NRV%

Next time I go shopping in the supermarket

You can compare and choose ~

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Not only will the figure not look good.

It will become loose!

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Popular reading

(Click on the picture to read)

Original title: "I heard that you buy food without looking at the nutrient list? It is necessary to popularize science! 》

Read the original text

　　In the summer night, maybe you are craving barbecue, draft beer and food stalls, or maybe you are keen on reducing fat, shaping and living a healthy life. But you know what? Whether you are drinking with a glass in the night wind, or you are sweating on the treadmill to keep fit and self-disciplined, you may be targeted by a disease called gout. The latest data shows that the number of gout patients in China has exceeded 80 million, and it continues to rise, and at the same time it is getting younger and younger. Hyperuricemia has become the "fourth highest" after hypertension, hyperglycemia and hyperlipidemia.

　　Do you know anything about gout? Who does gout "favor" most? How will the talons of gout affect our lives? Can food supplement "drive away" gout? How can we prevent it? How to treat it? How to exercise?

　　Are you a gouty person?

　　□ Dong Lingling, Professor of Rheumatology and Immunology, tongji hospital, Tongji Medical College, Huazhong University of Science and Technology

　　According to the white paper on gout status report in China in 2017, there are more than 80 million gout patients in China, and gout has become the second largest metabolic disease in China after diabetes.

　　What kind of disease is gout?

　　As the saying goes, gout is the arthritis of the rich and rheumatism is the arthritis of the poor. So how was gout discovered?

　　In 1776, carl scheele, a Swedish chemist, discovered an organic acid in urine stones, which was named litholic acid. More than 20 years later, French chemists found that there was not only lithoid acid in stones, but also in urine, so they changed their names to uric acid. At the same time, British doctors found that the composition of gout patients’ nodules was uric acid. Finally, the doctors finally determined that gout was related to uric acid.

　　So what is gout? It is a crystal-related arthropathy caused by monosodium urate deposition, which is directly related to hyperuricemia caused by purine metabolic disorder and/or decreased uric acid excretion, and belongs to the category of metabolic rheumatism. Patients often show acute paroxysmal arthritis, tophus formation, tophus chronic arthritis, urate nephropathy and uric acid urinary calculi. Every gout patient must have a period of hyperuricemia before the attack, which is undetected or ignored.

　　Gout can be complicated with joint disability and renal disease, and in severe cases, joint destruction and renal function damage can occur, often accompanied by other manifestations of metabolic syndrome, such as hyperlipidemia, hypertension, diabetes, arteriosclerosis and cardiovascular diseases.

　　In which parts of the body does gout occur frequently?

　　Gout patients often have sudden joint pain at night, and the onset is sudden. Patients will wake up in pain in the middle of the night, and the affected joints may have severe redness and heat pain, showing a local burning sensation. Then the patient’s pain will gradually reduce until it disappears, lasting for several days or weeks.

　　The most common joint is the big toe, and it is also common in the joints of the hand, knee joint cover, elbow joint and so on. The affected joints will eventually become red, swollen and inflamed, and the tissues will become soft and their activities will be limited after edema, thus affecting daily life.

　　When does gout usually occur?

　　Many gout patients have had this experience. In the middle of the night, especially in the middle of the night, when they were sleeping soundly, they were awakened by sudden joint pain. They often felt heartbroken and sweaty, which could not be alleviated for a long time.

　　Why is gout more common at night? First of all, the glucocorticoid level is low at night, and the ability of anti-inflammatory, analgesic and uric acid excretion is reduced. Secondly, the human body is in a state of relative water shortage at night, and uric acid is easier to deposit. Third, the body temperature is low at night. Fourth, lack of oxygen.

　　What kind of people does gout prefer?

　　Men’s data show that the ratio of male to female patients with gout is about 15: 1, so why are men more likely to get gout than women? Women have a congenital advantage because estrogen can promote uric acid excretion and help inhibit the onset of arthritis. Men, on the other hand, have more androgens in the body, and androgens especially love uric acid, which will inhibit the excretion of uric acid by the kidneys, lead to the increase of uric acid content in the body, accelerate the formation and deposition of uric acid crystals, and finally attract gout.

　　People who love to drink alcohol will produce a lot of lactic acid in our bodies, and these lactic acids will compete with uric acid. When both are excreted, overbearing lactic acid is more easily excreted, and less uric acid is excreted. Over time, it will cause gout.

　　People who love meat and seafood have high purine content in crustacean seafood such as viscera, shellfish, oysters and lobster, and they are prone to gout if they eat too much. For example, the youngest gout patient in Qingdao is only 13 years old, and he just ate it.

　　In the impression of most people, gout is a patent for middle-aged and elderly people, which is scientifically based. Postmenopausal women are prone to gout with decreased estrogen and increased androgen. After 60 years old, people are old, joints are aging, coupled with calcium loss, cartilage tissue is also reduced a lot, and in this way, gout began to bully the elderly.

　　People with a family history of gout will inherit gout.

　　A former athlete or a fitness expert. Athletes or fitness experts have more activities than ordinary people, and the intensity is greater, which leads to the burning and decomposition of adenosine triphosphate in their bodies and the faster metabolism of cells than ordinary people, thus producing more purines in their bodies. In addition, many athletes have been injured and are more likely to attract gout.

　　Obese people, especially those who lose weight, may also attract gout, which is similar to drinking. If you lose weight too fast, you will produce a lot of ketone bodies after burning fat, and ketone bodies and uric acid will also have a competitive mechanism. If ketone bodies are overbearing, they will be discharged more, and uric acid will be discharged less. Most obese people love high-calorie foods such as fried chicken and cola, and they eat too much fat. The above drama is repeated again.

　　Skillful exercise, uric acid control and gout prevention

　　□ Professor of Orthopaedics, tongji hospital, Tongji Medical College, Huazhong University of Science and Technology Guo Fengjin Li Feng Deputy Chief Physician Hu Weihua

　　Like a needle! Like a tiger bite! Like a devil’s bite, I can’t wait to cut it off A gust of wind hurts … … This is the description of acute attack by gout patients. Gout is considered as "the first pain in the world", but at present, most patients are "forgetting the pain after getting rid of the scar" and only pay attention to the treatment of acute attack. When the pain was relieved, most people returned to normal life without effective prevention and treatment.

　　As everyone knows, with the development of time, sodium urate will be deposited on the joints and around them, which will form crystals, that is, tophi. These tophi can cause painful nodules covering the skin. After tophus gradually increases, it may affect joint function, compress nerves and affect organ function, and its external skin may become thinner and ulcerated, forming fistula and discharging white chalk-like urate crystals, which will not heal for a long time. At this point, it can only be treated by surgery.

　　Can gout patients exercise?

　　Many small things in life can easily lead to gout if you don’t pay attention to them. You must pay attention to the care of gout patients and cooperate with the doctor’s treatment. Does that mean that gout patients can’t exercise? The answer is no. Life lies in exercise, which is also applicable to gout patients. However, they should pay more attention to some exercise methods. Studies have shown that proper exercise can enhance physical fitness, promote systemic blood circulation, and the utilization of sugar, fat and protein by muscles and tissues, thus reducing blood uric acid and blood sugar concentration, reducing the production of uric acid, and also preventing diabetes and arteriosclerosis, improving heart function, stabilizing blood pressure and reducing cardiovascular complications.

　　Which exercises are suitable for gout patients?

　　Tread on the stone barefoot. Treading on stones barefoot refers to walking on cobblestone roads without wearing shoes and socks. Pebbles can stimulate acupuncture points and nerve endings on the soles of feet, cause excitement, activate the functions of autonomic nervous system and endocrine system, accelerate blood circulation, promote metabolism, nourish yin and tonify yang, maintain kidney meridian and adjust blood pressure, improve sleep, relieve fatigue, improve immunity and adaptability to external environmental changes, and have certain preventive and therapeutic effects on gouty arthritis and other diseases.

　　Swimming. Moderate swimming can rotate all joints, keep them flexible, reduce the friction and extrusion between bones, improve local blood circulation and promote the dissolution and excretion of urate. It should be noted that it is best to control swimming within one hour. Do not increase lactic acid in the body due to excessive exercise and inhibit uric acid excretion by the kidneys.

　　Jogging. Running is a common and easy sport. For people under pressure, strenuous running is more inclined to vent, but it is not as good as jogging. Before exercise, you can do some warm-up exercises and adjust your breathing. It is recommended to jog for half an hour to an hour every day, and the best time is from 5 pm to 7 pm.

　　Although physical exercise alone can’t effectively reduce serum uric acid, it can significantly reduce serum uric acid concentration when combined with diet health care, thus playing a role in preventing gout attack and delaying the progress of the disease.

　　It hurts enough to doubt the rational use of drugs to relieve life.

　　□ Department of Pharmacy, tongji hospital, Tongji Medical College, Huazhong University of Science and Technology Tang Liying Peng Jingning Fang Jianguo

　　Gout, pain in the bone, pain in the heart, its ferocity, people doubt life.

　　The treatment of gout attack should be as urgent as fire fighting. Although there are many strategies to deal with gout, non-drug treatment should be the first choice, pay attention to adjusting the diet structure, and follow the doctor’s advice, take medicine according to the doctor’s advice and review regularly.

　　The main drugs for gout are colchicine, non-steroidal anti-inflammatory drugs, drugs that promote uric acid excretion (such as probenecid and benbromarone) and drugs that inhibit uric acid synthesis (allopurinol and febuxostat).

　　"Treat its target first" — — Control acute inflammation. Colchicine and non-steroidal anti-inflammatory drugs are mainly used in the acute onset of gout, and the principle of taking medicine in full at an early stage and gradually stopping after taking effect is generally very obvious. If the pain does not improve obviously after taking the medicine for one week, you should seek medical advice in time. Non-steroidal anti-inflammatory drugs commonly used in clinic include cyclooxygenase -1(COX-1) inhibitors and COX-2 inhibitors, such as indomethacin, ibuprofen, celecoxib, etc. As the first-line drugs for gout, these drugs are effective and relatively safe. However, these two drugs have side effects, mainly gastrointestinal toxicity, which should be paid close attention to in clinical application. The toxic side effects of colchicine tablets in acute phase are great, so it is necessary to monitor blood routine and liver and kidney function regularly during taking the drug. Some patients will have vomiting, diarrhea and other reactions after taking the medicine. At this time, the medicine should be stopped or reduced.

　　"Slow down and cure its roots" — — Medication in remission should be avoided in acute attack. Patients in remission can start the treatment of allopurinol, an acid inhibitor, 1-2 weeks after joint inflammation is controlled. During the remission period, you should pay attention to drink more water, more than 3000ml per day, supplement sodium bicarbonate when necessary, and alkalize urine to prevent uric acid crystals from depositing in the process of excretion.

　　In the chronic phase, drugs that inhibit uric acid synthesis and drugs that promote uric acid excretion should be used. Excessive uric acid needs treatment even if it does not cause pain symptoms, and patients can’t ignore it. In addition, patients should pay attention to the interaction between drugs, such as hypoglycemic drugs (biguanides) and antihypertensive drugs (ACEI), which will reduce the excretion of uric acid, and gout patients should be cautious in using such drugs.

　　As the first choice for reducing uric acid, febuxostat has a strong effect on reducing uric acid. The effect of one tablet of febuxostat is similar to that of three tablets of allopurinol, and patients with impaired renal function do not need to adjust their drug use through liver metabolism. The recommended initial dose of febuxostat tablets is 40mg once a day. If the serum uric acid level is not lower than 6mg/dL after 2 weeks, it is recommended to increase the dosage to 80mg once a day.

　　At present, febuxostat is the only gout drug whose therapeutic effect is not affected by high-fat diet. However, at the initial stage of taking this product, it may cause gout attack, because the uric acid deposited in tissues is mobilized due to the change of blood uric acid level. It is recommended to take non-steroidal anti-inflammatory drugs or colchicine at the same time.

　　In short, the treatment of gout is a lifelong process of reducing uric acid, unless intolerance or adverse reactions occur. Patients should pay attention to a low purine diet, maintain a reasonable weight, abstain from drinking, drink more water, avoid overeating, drinking too much, getting cold and getting wet, fatigue and mental stress, wear comfortable shoes to prevent joint injury, and use drugs that affect uric acid excretion with caution, such as some diuretics and low-dose aspirin. In addition, we should pay attention to the prevention and treatment of concomitant diseases, such as hypertension, diabetes and coronary heart disease.

　　Did you get caught in the eight misunderstandings of gout diet?

　　□ Ye Ting, Deputy Chief Physician, Department of Clinical Nutrition, tongji hospital, Tongji Medical College, Huazhong University of Science and Technology, Dong Lingling, Professor of Rheumatology and Immunology.

　　Diet adjustment is an important part of gout treatment. By actively adjusting diet structure and living habits, we can choose different diet methods according to our own condition, which can not only meet the body’s demand for nutrition, but also prevent gout attacks. However, in life, gout patients are often caught in a diet misunderstanding.

　　First, eat less high-purity foods such as meat, eggs and milk?

　　Half right and half wrong!

　　Animal offal, seafood, all kinds of meat including livestock, poultry, most fish and thick broth contain a lot of purine, so it is really necessary to eat less. Purine is soluble in water. When cooking meat, it can be eaten by boiling and stewing.

　　Milk and eggs, however, are low-purine foods, and are rich in high-quality protein with essential amino acids, which can be eaten by gout patients. Many epidemiological studies show that higher intake of low-fat dairy products is beneficial to prevent gout. For patients with acute gout, milk and eggs can be used as the main sources of high-quality protein in diet. How to eat? We suggest that the daily intake of meat should not exceed 150g, and encourage the intake of low-fat or skim dairy products, 300ml per day.

　　Second, spinach, cauliflower, mushrooms, asparagus and other vegetables are rich in purine, and gout patients can’t eat them?

　　Wrong!

　　Although dark green tender stem and leaf vegetables (such as spinach and asparagus); Flower vegetables (such as cauliflower); Tender bean vegetables (such as edamame and tender peas); Dried fungi (all kinds of fresh mushrooms) are not low-purine foods, but studies show that vegetables rich in purine have no obvious correlation with high uric acid and gout attacks. Eating a lot of vegetables can also play a role in alkalizing urine, which is beneficial to the excretion of uric acid. The recommended daily intake of vegetables for ordinary residents is 300~500 grams, which can be increased to 700~1000 grams if the gastrointestinal function of gout patients can be tolerated.

　　Third, gout patients can’t eat coarse grains?

　　Wrong!

　　Like vegetable selection, although the purine content of some whole grains is higher than that of polished rice flour, it is not accurate to evaluate whether a food is suitable for gout patients only by considering the purine content. At present, no research has found that whole grains increase the risk of gout, and the purine content of millet, corn and other grains is equivalent to that of rice and white flour, or even lower. Moreover, miscellaneous grains are also a good food source of B vitamins, potassium and dietary fiber, which is beneficial to uric acid excretion, inflammatory reaction and weight control in patients with gout and hyperuricemia.

　　Fourth, soy products can’t be eaten?

　　Wrong!

　　Although soybean is a high purine food, the latest research shows that beans, especially bean products, can not only reduce the level of serum uric acid, but also reduce it. The mechanism is mainly because beans can increase blood uric acid and promote uric acid excretion at the same time, and the latter is more significant.

　　The cooking method of food has a great influence on the purine content of bean products. After soaking and grinding, the purine content is diluted. When tofu is made, part of the slurry water is squeezed out, and the purine content is further reduced due to the loss of water. The purine content of soybean products is greatly reduced, and it is rich in high-quality protein, which can make up for the reduction of protein intake caused by the restriction of red meat intake and reduce the risk of coronary heart disease. Therefore, gout patients can eat soy products in moderation.

　　Five, fruit contains fructose, gout patients can’t eat?

　　Wrong!

　　Although many fruits contain a lot of fructose, they are also rich in dietary fiber, potassium and vitamin C, which is beneficial to the excretion of uric acid and the reduction of blood uric acid level. At the same time, polyphenols in fruits are beneficial to reduce the level of inflammatory reaction, which are beneficial to gout patients. Studies have shown that fruits can reduce the risk of gout attacks.

　　But after all, fruit contains a lot of sugar, so it is not recommended for all gout patients to eat a lot of fruit. Fruits with less fructose can be eaten, such as cherries, strawberries, pineapples, watermelons, peaches, etc. It is no problem to eat 200~300 grams according to the normal quantity of healthy people.

　　Sixth, fat has no effect on uric acid?

　　Wrong!

　　Although fat itself does not contain purine, it will not increase uric acid production, but it will reduce uric acid excretion. At the same time, the high energy density of fat is not conducive to weight control. Therefore, we should try to reduce fat intake, such as fat meat and poultry with skin; Avoid frying high-fat foods.

　　Drinking beer, tea, coffee and fruit juice can increase the amount of drinking water and help to excrete uric acid?

　　Not quite right!

　　For the prevention and control of hyperuricemia and gout, what you eat is important, and what you drink is also important. Purine is easily soluble in water. Drinking more water for gout patients is beneficial to uric acid excretion, and it can also prevent kidney calculi of uric acid and delay the damage of kidney caused by the disease. Drinking plenty of water can shorten the duration of gout attack and relieve symptoms. People with normal heart and kidney function can drink more water and maintain a daily urine volume of 2000~3000ml.

　　However, it is not good to drink more beer, because alcohol metabolism can increase the concentration of lactic acid in the blood, and lactic acid can inhibit the secretion of uric acid by renal tubules and reduce the ability of kidney to excrete uric acid; Fruit juice drinks are rich in fructose, which can promote the production of endogenous uric acid. Excessive sugar intake accompanied by excessive fruit juice intake will promote obesity and metabolic disorders, which are themselves factors that promote gout. The relationship between coffee and high urea and gout is still inconclusive. Some studies show that coffee does not increase the risk of high uric acid, and may reduce the risk of gout. We believe that the best drink for gout patients is boiled water, which should be more than 2 liters per day.

　　Eight, gout patients only need to pay attention to the purine content of food?

　　Wrong!

　　Gout patients often pay too much attention to the purine content of food, and are entangled in whether this food can be eaten or not. There are two sources of uric acid in human body. The one decomposed from purine-rich foods (exogenous) accounts for about 20% of the total uric acid in the body, while the one synthesized in the body or metabolized by nucleic acids (endogenous) accounts for about 80% of the total uric acid in the body. In addition to reducing the intake of purine in diet, we should also control weight, reasonable diet and improve the metabolic disorder of the body. Obesity increases the risk of gout in patients with high uric acid, and weight loss can effectively reduce the level of serum uric acid. It is suggested that patients with hyperuricemia should control their weight in the normal range. However, you should avoid dieting and losing weight too fast, and ketone body production will interfere with uric acid excretion.

Fuzhou Meteorological Observatory changed the release of high-temperature red warning signal at 13: 46 on August 21st: It is estimated that the highest temperature in some towns (streets) in Fuzhou city and high-tech zone will reach 38 ~ 40℃ this afternoon, with some exceeding 40℃.

The meteorological department reminds relevant units and personnel to pay attention to heatstroke prevention and cooling, especially those working outdoors or under high temperature conditions should take necessary protective measures! (General Station reporter Wu Yanmin)