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Original: Shi Juan returns to the park

As double 11 approaches, many people have already filled their shopping carts with health care products in advance, just waiting for the zero discount time to start shooting. Among them, one of the hottest and most publicized commodities is probably imported joint health care products. However, the latest research proves that the key ingredients in joint health care products may not be as useful as placebos. At the same time, because its formula changes at will, its medicinal properties and toxicity are also difficult to monitor. Friends who want to buy such health care products at special prices need to think twice before you do.

Today’s two articles bring together some kinds of goods that should be bought carefully or even not. Among them, the e-cigarettes that we strongly warned about were completely removed from Taobao and Tmall on November 6. So far, the online sales platform has completely banned the sale of e-cigarettes.

Writing | Shi Juan

Maybe you exercise a lot, maybe you need to sit still for a long time because of your work, or maybe you are old. In either case, the concept of protecting your joints must be familiar.

Known as a health care product that is good for joints, the most popular brand at present is Move Free, which is a brand of Schiff, a famous American health care company. Common models are as follows:

Image from Schiff official website

Costco, a famous American supermarket, also has several kinds that people often buy.

Image from CVS official website

The main components of these drugs are glucosamine and chondroitin sulfate. Some of them are added with vitamin D or an organic sulfur compound: dimethyl sulfone (MSM, an essential substance for human collagen synthesis).

Glucosamine claims to "strengthen, protect and rebuild joints", while chondroitin sulfate "can help lubricate and cushion joints", thus finally relieving joint pain, joint stiffness and arthritis.

I believe everyone has read many online articles recommending this health care product (the screenshot is omitted here).

However, are glucosamine and chondroitin sulfate really good for joints?

One study after another published in authoritative magazines shows that glucosamine and chondroitin sulfate health care products have no effect on joints. Even in the United States, there are several class actions, accusing the manufacturers of these health care products of making false advertisements, misleading and deceiving ordinary consumers [1, 2].

Photo: In June 2019, consumers collectively sued Schiff Move Free for false advertising and formally filed a case. [2]

A series of studies, the answer is getting clearer and clearer.

The most famous research is called Gait (Glucosamine/Chondroitin Arthritis Intervention Trial), which took four years and cost $12.5 million. It was funded by two departments under the National Institutes of Health (NIH), namely National Center for Complementary and Alternative Medicine (NCCAM) and National Institute of Arthritis/Musculoskeletal/Dermatology (NIAMS).

The purpose of this study is to determine whether glucosamine and chondroitin sulfate are effective in the treatment of osteoarthritis.

Let’s take out these studies and analyze them for everyone.

one

This study was published in the authoritative medical journal New England Medicine in 2006 [3].

A total of 1583 patients with osteoarthritis were recruited and randomly assigned to take:

Placebo (the same shape as medicine, but without the ingredients of medicine, it can be simply understood as sugar ball)

1,500 milligrams of glucosamine per day

1200 mg chondroitin sulfate per day

1500 mg glucosamine +1200 mg chondroitin sulfate per day

200 mg of prescription drug celebrex (an analgesic used to relieve pain for arthritis and other diseases) every day.

It is worth noting that this dose is the dose of glucosamine and chondroitin sulfate in popular health care products at that time. It is emphasized here that there was a reason for the dose in health care products at that time, which will be further explained later.

If the patient feels that the joint pain is still uncontrollable, he can take up to 4000 mg of acetaminophen (the main component of Tylenol) every day.

The main purpose of the study is to see if the pain in the knee joint is reduced by 20% after taking the medicine for 24 weeks.

The result is as follows:

It can be seen that there is no significant difference between the group taking glucosamine and chondroitin sulfate and the placebo group.

However, it is worth noting that at 24 weeks, 60.1% (more than half) people who took placebos also felt that their symptoms had improved. This extraordinary placebo effect is often seen in clinical trials of arthritis. Without knowing what they are eating, patients think they are taking useful drugs, and strong psychological hints will make the pain less intense.

Source: The-Science-Site.com.

This trial is a good example to explain why clinical trials are rigorous only if they are randomized and double-blind. Randomized double-blind trials should make sure that there is basically no difference in appearance between the pills in the placebo group and the real pills. The people who eat them can’t guess what they are eating at all, and the people who collect data don’t know what each patient is eating, so as to ensure that there will be no bias in the data collection process.

After taking celebrex for 24 weeks, those who felt that their pain was reduced by 20% were about 10% higher than those in the placebo group, achieving a statistically significant effect. Once again, it proves that this prescription drug is effective.

Finally, the author of this study divided the patients into groups according to the severity of symptoms, and found that the combined therapy of 1500 mg glucosamine and 1200 mg chondroitin sulfate/day seems to have certain effect on patients with severe symptoms. However, it is worth noting that the number of volunteers with severe symptoms in this study is relatively small, and the sample size is too small to be conclusive, which needs further research to confirm.

2

So, these authors continued to study. The new results were published in the journal Arthritis and Rheumatism in 2008 [4]. We call it study 2 (the last one was called study 1).

The time of the second study was extended from 24 weeks to 24 months (two years), and the patients with severe symptoms were studied emphatically, because the last short-term trial found that the combination therapy of glucosamine and chondroitin sulfate might be useful for these patients.

572 patients with moderate or severe knee osteoarthritis were recruited and randomly divided into five groups:

placebo

Glucosamine (500 mg each time, 3 times a day: 1500 mg/day)

Chondroitin sulfate (400 mg each time, 3 times a day: 1200 mg/day)

Glucosamine (500 mg each time, 3 times a day)+chondroitin sulfate (400 mg each time, 3 times a day)

Celebrex (200 mg once a day)

The final effective index of this experiment is not the subjective pain feeling in the first experiment (this kind of patient’s feeling is the most prone to error), but the change of joint space width is determined by X-ray at 24 months. The more severe osteoarthritis is, the more cartilage loss is, and the smaller joint space is. If a drug can stop or even reverse the shortening of joint space, it can improve the joint structure and relieve symptoms.

Finally, in the second study, the average joint spacing of patients with osteoarthritis in the placebo group decreased by 0.166 mm after two years, which meant that osteoarthritis was aggravated.

Compared with placebo, glucosamine, chondroitin sulfate or their combination therapy did not significantly reduce the loss of joint space width (arthritis did not relieve).

The researchers even observed that the joint space shortening (arthritis aggravation) of combined therapy was more serious than that of other groups, probably because taking two drugs at the same time affected the absorption of each drug-and most health care products on the market mixed these two ingredients together.

three

The final result of the GAIT study was published in Rheumatology Annual Report in 2010 [5]. We call it study three.

The third study was similar to the first study, except that the experiment was extended from 24 weeks to 24 months.

This time, the researcher recruited 662 volunteers with moderate to severe osteoarthritis and randomly divided them into five groups as in the second paper. The main index is, as in the first study, to see whether the pain of knee joint is reduced by 20% compared with that before taking medicine.

The results of this long-term experiment are similar to those of study 1. All groups had significant pain and functional improvement within 2 years. However, no treatment is significantly better than placebo. There was no statistically significant difference between the treatment groups, which once again proved the powerful placebo effect.

The good news is that no serious side effects were observed in all the treatment groups-it seems that these drugs are safe to take for at least two years in this experiment.

GAIT research tells us:

1. The curative effect of glucosamine and chondroitin sulfate comes from strong psychological suggestion to a great extent. Even if you eat "sugar balls", if you think you are eating drugs that are useful for joints, more than half of people will feel that joint pain is reduced.

2. Taking glucosamine and chondroitin sulfate at the same time may affect the absorption of any single component.

3. Glucosamine and chondroitin sulfate can not improve the shortening of joint space after illness.

four

The latest study on glucosamine and chondroitin sulfate was completed in 2016 [6]. This experiment recruited 164 patients with knee pain caused by osteoarthritis, and half of them took glucosamine (1500 mg/day) and chondroitin sulfate (1200 mg/day). The other half took a placebo.

However, the study was terminated early for an unusual reason: compared with the placebo group, the symptoms of patients who took glucosamine and chondroitin sulfate worsened.

Further than the previous three experimental results, this result suggests a terrible possibility: taking glucosamine and chondroitin sulfate may make the joint condition worse than doing nothing.

Move Free, hepatotoxicity?

I often hear friends around me say that most people eat health care products without any side effects. What if they eat them? If you don’t eat, don’t you miss that "one thousand" opportunity?

However, have you overlooked the "one thousand" harmful situation?

In fact, there are no published prospective studies on the efficacy, tolerance and safety of most health care products.

Remarks:

Prospective study usually involves observing a group of subjects for a long time, and studying whether some observed results (such as illness) are related to other factors (such as suspicious risks or protective factors) during the trial. The prospective study related to the safety of health products mentioned here is to observe whether a group of people who eat health products will have some adverse reactions related to eating health products.

This is because the ingredients of health care products are not strictly monitored by FDA, and the formula can be changed frequently. This not only makes it difficult to study its security, but also means that its security is even more insecure. Who knows which batch of formula will go wrong?

Take the current Schiff Move Free series products as an example.

If you look closely at the website of Schiff Nutrition International, the manufacturer of Move Free, you will find that there is a small line below:

“Our packaging and/or formulas change from time to time. Please refer to the actual packaging for current product information.”

Our packaging and/or formula will change from time to time. Please refer to the actual packaging for current product information. "

Figure: Composition description of a Move Free product on Schiff Nutrition International website.

At present, many cases have been reported, saying that patients taking Move Free have obvious liver damage in clinic.

In 2010, the first case report on liver injury caused by taking Move Free was published in the United States [7]. Subsequently, new cases were reported in August 2012 and September 2013. In these published cases, patients developed acute hepatocyte injury within 1-3 weeks after taking a Move Free product. The degree of injury is moderate and can be relieved within 1 to 2 months after stopping taking it; There is no immune allergy and autoimmune reaction, and it can finally recover completely in all cases. However, one patient resumed using the product when he was half well, and immediately developed acute liver injury with similar symptoms. In addition, although no more cases have been published, there are three prospective studies on drug-induced hepatotoxicity in the United States, all of which mentioned acute liver injury cases related to Move Free, all of which occurred in 2012-2013 [October 12].

The specific Move Free products mentioned in these cases at that time, in addition to the main glucosamine and chondroitin sulfate, also contained a patented herbal mixture, including China Scutellaria baicalensis and Acacia catechu.

These reports attributed the liver injury caused by Move Free to Scutellaria baicalensis Georgi in China [13], and only one case was attributed to glucosamine [11]. However, China Scutellaria baicalensis Georgi protects the liver in animal models, but not damages it [14-16]. Why can it cause human liver injury? The report did not reasonably explain its mechanism of liver injury. There is also a kind of explanation that the China Scutellaria baicalensis Georgi in Move Free contains pollutants, or maybe it is not China Scutellaria baicalensis Georgi at all (the manufacturer made a mistake and added a similar plant as China Scutellaria baicalensis Georgi).

Therefore, it is still uncertain what specific components may cause liver injury. Manufacturers often change the composition and concentration of health care products, so it is not certain whether the products currently on the market still contain these harmful ingredients. At present, Move Free series products no longer list "including China Scutellaria baicalensis Georgi and other herbal ingredients", but give a patented ingredient with a new name on some products, which is called "uniflex (fruitex-b calcium fruitoborate)", claiming to be a mineral extracted from vegetables and fruits.

What’s more noteworthy is that the content of chondroitin sulfate in the Move Free series products listed on the official website in the United States has been greatly reduced (see the figure below), and the dosage has been reduced from 1200mg per day to 200mg per day. There is no glucosamine and chondroitin sulfate in the Move Free Ultra series products, one of which only contains calcium and calcium borate, and the other contains a patented cartilage mixture. However, most of them are produced by different manufacturers, such as similar products of Kirkland brand sold by Costco, and the dosage is still 1500 mg of glucosamine and 1200 mg of chondroitin sulfate every day.

Figure: The ingredients of four existing Move Free series products (from official website, USA) are chondroitin sulfate content in the red box. Click to see a bigger picture.

Figure: Components of four existing Move Free Ultra series products (from official website, USA).

In addition, a small study in 2013 found that taking glucosamine may increase the risk of glaucoma, which will threaten vision if it is not treated in time [17]. Chondroitin sulfate can play the role of blood anticoagulant, so it may cause internal bleeding.

Another problem that is often overlooked is drug interaction: any combination of compounds may produce bad interactions. If you are taking other drugs, you must decide carefully whether to take health care products. Because they may not contain the amount indicated on the label, or they may contain pollutants-this will make it more difficult for you to accurately judge whether there will be drug interactions.

Other side effects of glucosamine and chondroitin sulfate include:

Heartburn, heartburn

feel tired and sleepy

headache

Allergic reaction (especially if you are allergic to shellfish)

What drugs/treatments are there for arthritis?

So far, there is no therapy or medicine that can cure arthritis.

There are many drugs that can be used to improve symptoms (mainly to relieve pain) and slow down the deterioration of the disease, but they cannot completely reverse the structural damage.

Because there are more than 100 different kinds of arthritis, each specific type of treatment is not exactly the same. We should prescribe the right medicine after diagnosis.

After the doctor looked around and guessed the type of arthritis he might have, there were two main methods for further diagnosis:

1. Body fluid analysis. Analyzing blood, urine and joint fluid can help determine what type of arthritis you may have. In order to obtain a sample of joint fluid, doctors usually need to put a needle into the joint space to suck some fluid.

2. Imaging analysis. Commonly used imaging methods include X-ray, CT, magnetic resonance imaging (MRI) and ultrasound.

After confirming the type of arthritis, you may need to try several different treatments or combinations of treatments to find the one that suits you best.

There are usually three types of therapies: drugs, physical therapy and surgery.

01

medicine

Different types of arthritis, should use different drugs. Commonly used arthritis drugs include:

Analgesics These drugs help to relieve pain, but they can’t diminish inflammation. For example, acetaminophen (the main component of Tylenol), Ultram (Ultracet), and some strictly regulated painkillers (such as oxycodone).

Non-steroidal anti-inflammatory drugs (NSAIDs). These drugs can relieve pain and diminish inflammation at the same time. Over-the-counter NSAID include ibuprofen (Motrin) and naproxen sodium (Aleve). Some types of NSAID must be obtained by prescription. Oral NSAID may cause stomach upset, and some may increase the risk of heart attack or stroke. Some NSAID can also be rubbed on joints as creams or gels. I have talked about the points for attention in the use of Tylenol and Ibuprofen before. If you are interested, you can go and see it (→ How to use Tylenol and Ibuprofen correctly? | 117 threesome).

Anti-irritant Some kinds of ointment contain menthol or capsaicin. Rubbing these ointments on the skin of painful joints may interfere with the transmission of pain signals, thus achieving the effect of relieving pain.

Antirheumatic drugs. Usually used to treat rheumatoid arthritis, it can slow down or prevent the immune system from attacking joints. Such as methotrexate (Trexall) and hydroxychloroquine.

Specific immune response modulators. It is usually used with anti-rheumatic drugs, which target certain protein molecules involved in immune response. Such as etanercept (Enbrel) and infliximab (Remicade).

Corticosteroids. These drugs, including prednisone and cortisone, can reduce inflammation and suppress the immune system. Corticosteroids can be administered orally or directly into joints.

02

physiotherapy

Physical therapy is helpful for some types of arthritis. Moderate exercise can improve and strengthen the muscles around the joints.

03

operation

If nothing works, it will be operated. Include joint repair or joint replacement.

04

Acupuncture, yoga, Tai Ji Chuan and massage.

There is little data to support these unconventional treatments, but there is no conclusive evidence that they are ineffective. You can look at your own reaction to see if you try.

Total knot

Although there is no convincing data to prove that health products containing glucosamine and chondroitin sulfate are beneficial to joints, many people will buy and take them. Some people think that even if there is no effect from the overall data of the population, it may be useful for individuals because of some factors; Others believe that even if most of the effects come from the placebo effect, the benefits of the placebo effect are real and hard to give up.

However, the latest clinical results and several cases of side effects show that these health care products may also be harmful to health. Manufacturers often change the formula, and the actual ingredients and dosage may be far from what you expected.

Most types of arthritis are chronic and will affect life-long diseases. Knowing all kinds of risk factors (including obesity, sedentary lifestyle, eating habits, joint injuries, smoking, etc.), changing lifestyle and reducing the chance of getting sick are the best preventive measures. It is absolutely unacceptable to put all your hopes on health care products without fundamentally changing your living habits.

references

[1] https://topclassactions.com/lawsuit-settlements/consumer-products/supplements/900914-move-free-supplement-buyers-get-class-cert-false-ad-lawsuit/

[2] https://topclassactions.com/lawsuit-settlements/lawsuit-news/791647-schiff-move-free-class-action-says-joint-health-supplements-dont-work/

[3] D. O. Clegg et al., Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med 354, 795-808 (2006).

[4] A. D. Sawitzke et al., The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/ chondroitin arthritis intervention trial. Arthritis Rheum 58, 3183-3191 (2008).

[5] A. D. Sawitzke et al., Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT. Ann Rheum Dis 69, 1459-1464 (2010).

[6] J. A. Roman-Blas et al., Combined Treatment With Chondroitin Sulfate and Glucosamine Sulfate Shows No Superiority Over Placebo for Reduction of Joint Pain and Functional Impai rment in Patients With Knee Osteoarthritis: A Six-Month Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Arthritis & Rheumatology 69, 77-85 (2017).

[7] S. A. Linnebur, O. C. Rapacchietta, M. Vejar, Hepatotoxicity associated with chinese skullcap contained in Move Free Advanced dietary supplement: two case reports and review of the literature. Pharmacotherapy 30, 750, 258e-262e (2010).

[8] L. Yang, A. Aronsohn, J. Hart, D. Jensen, Herbal hepatoxicity from Chinese skullcap: A case report. World J Hepatol 4, 231-233 (2012).

9. R. Dhanasekaran, V. Owens, W. Sanchez, Chinese skullcap in move free arthritis supplement causes drug induced liver injury and pulmonary infiltrates. Case Reports Hepatol 2013, 965092-965092 (2013).

[10] V. J. Navarro et al., Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network. Hepatology (Baltimore, Md.) 60, 1399-1408 (2014).

[11] S. Rossi, V. J. Navarro, Herbs and Liver Injury: A Clinical Perspective. Clinical Gastroenterology and Hepatology 12, 1069-1076 (2014).

[12] N. Chalasani et al., Features and Outcomes of 899 Patients With Drug-Induced Liver Injury: The DILIN Prospective Study. Gastroenterology 148, 1340-1352.e1347 (2015).

[13] V. J. Navarro, L. B. Seeff, Liver Injury Induced by Herbal Complementary and Alternative Medicine. Clinics in Liver Disease 17, 715-735 (2013).

[14] Q. Dong et al., Scutellaria baicalensis Georgi extract protects against alcohol?induced acute liver injury in mice and affects the mechanism of ER stress. Mol Med Rep 13, 3052-3062 (2016).

[15] J. Boer et al., Protection against aflatoxin-B-1-induced liver mutagenesis by Scutellaria baicalensis. Mutation research 578, 15-22 (2005).

[16] H. N. Thanh et al., Ethanol extracts of Scutellaria baicalensis protect against lipopolysaccharide-induced acute liver injury in mice. Asian Pacific Journal of Tropical Biomedicine 5, 761-767 (2015).

[17] R. K. Murphy et al., Oral Glucosamine Supplements as a Possible Ocular Hypertensive Agent. JAMA Ophthalmology 131, 955-957 (2013).

The pen name is "Cats at My Will" and now lives in Boston, USA. I graduated from the Department of Biological Sciences and Technology in Tsinghua University with a bachelor’s degree, and joined a multinational well-known pharmaceutical company to engage in drug research and development after obtaining a doctorate in the United States. For more than ten years, he led the team to fight diabetes and muscular dystrophy. In recent years, he focused on the research and development of anti-aging drugs. Personal WeChat WeChat official account "Feel Free" to talk to you about medical care.

Shi Juan

END

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Original title: "double 11 carefully buys joint health products: the formula is changed at will, and the effect is not as good as placebo | 117 threesome"

Read the original text

Recently, fraud cases caused by AI face-changing technology have attracted people’s attention. With the development of AI model, the application scope of "face changing" technology is getting wider and wider, and the breakthrough of technology also makes the facial expressions and action details of the characters after face changing more realistic, which may bring serious harm once it is used by criminals. The reporter’s investigation found that it is very easy to obtain AI face-changing software on the Internet. Where is the legal boundary of using AI face-changing software? How to supervise beforehand?

Paid AI face-changing software appears on the network.

Package prices range from 499 yuan to 2888 yuan.

At present, relying on the breakthrough of large models and algorithms, AI face-changing is realizing a wider range of applications, causing more concerns. On the internet, there are many tutorials demonstrating the use and effect of face-changing software. Different from a large number of free software that gives ordinary people "early adopters", the reporter found that there are many high-priced paid AI face-changing software on the Internet. What is the difference between these paid software and free software?

The reporter contacted a developer after searching for "AI face-changing software", and he provided the reporter with a demonstration video of using his software to realize face-changing. On the left side of the dual-window page is the original video before face-changing, and on the right side is the video after face-changing. To the naked eye, the mouth shape, expression and tiny movements of the "digital man" after face-changing are almost flawless.

△ The face changing effect of the amateur shown by the seller (S is the original video, D is after the replacement)

On its sales website, the software developer also showed how to stitch the eyes and mouths of two famous actresses together to generate a new "digital man" video.

△ Local facial features replacement displayed by the seller

This paid software offers different versions from basic (LV1) to super (LV4) to full set (LV5). For the primary package, 499 yuan provides software interface, video guidance, face changing model, etc. If 2888 yuan is spent, you can get a full set of (LV5) video face changing models.

△ There are many different levels of face-changing software products available on the network.

"You can change your face if you want."

AI big model can integrate multiple functions to create a "digital person"

Open the website, there is no text at the bottom showing that it has been filed. The seller is also very cautious, and only uses words to communicate throughout. He said that compared with the basic (LV1) to super (LV4) packages, the full (LV5) version has more iterations and stronger capabilities, which can also be understood as a more realistic face-changing effect. At the same time, it can not only realize video face-changing, but also support live face-changing.

The reporter further asked, can you change your face according to your own needs? Software developers said: "What kind of face you want to change can be trained with material."

△ Software developers are chatting with reporters.

A technician engaged in AI development said that this means that there may be more uncontrollable risks. "AI face-changing technology like deepfake is open source. Recently, the AI ? ? big model has become popular, and its algorithm has been updated. It is possible to integrate the functions of Wensheng map, Wensheng text, Wensheng audio, Wensheng video and face-changing. By combining these functions, a completely new’ digital person’ or’ AI person’ can be created, and the cost and difficulty of supervision are several orders of magnitude higher."

△ User feedback displayed by the seller

Expert: An Effective Supervision System for Labeling

Can clarify the fuzzy boundary brought by AI face change in advance.

Zhao Zhanling, a lawyer and IT legal expert of Beijing Jiawei Law Firm, said that from the perspective of post-strike, there are provisions on fraud in the criminal law; It is clear in the Civil Code that citizens have the right to portrait, name, reputation and other corresponding civil rights. In other words, if there is a related case of fraud by using someone else’s portrait, the criminals can be bound and sanctioned by law afterwards. However, with the rapid development of artificial intelligence technology, we should also explore how to effectively prevent beforehand.

For example, in the Regulations on the Management of Deep Integration of Internet Information Services, it is required that if the deep integration service may lead to confusion or misidentification by the public, the deep integration service provider shall prominently mark the reasonable position and area of the generated or edited information content.

The Measures for the Administration of Generative Artificial Intelligence Services (Draft for Comment) requires that before using generative artificial intelligence products to provide services to the public, a safety assessment should be reported to the national network information department in accordance with relevant regulations; Respect the legitimate interests of others; Product providers should be responsible for the legality of pre-training data and optimizing the source of training data for generative artificial intelligence products.

△ Source: vision china

Pan Helin, co-director of the Digital Economy and Financial Innovation Research Center of the International Joint Business School of Zhejiang University, believes that at present, if the requirements of the logo can be effectively implemented and an effective supervision system can be formed, the fuzzy boundary brought by the AI ? ? face change can be clarified in advance to a great extent.

Pan Helin: At present, the supervision system of AI face-changing logo has not yet been formed. It is necessary to identify the unlabeled content through technical means, and there must be specific punishment measures, standards and systems for unlabeled individuals or units.

Zhao Zhanling believes that in the long run, the supervision and punishment measures need to be "iterated" with the development of technology to form a three-dimensional and effective governance plan.

Life photo

Commendation photo

Free clinic consultation

Chu Liyun, female, born in July 1966, enlisted in the army in July 1981, with a level 5 professional skill. She is currently the chief nurse and head nurse of the Third Division of the Cadre Ward of the 401st Hospital of the People’s Liberation Army, and is the mother of Comrade Zhang Xuejiao at Qingdao Frontier Inspection Station. Since graduating from the military academy in 1984, this comrade has been rooted in the clinical front line for 33 years, showing the value of life by caring for patients, improving the quality of work by continuous exploration and enterprising, interpreting angel’s love with scientific human management, and silently doing nursing work in ordinary posts to the extreme, practicing the Nightingale spirit with practical actions of respecting every patient and being kind to every life. Because of outstanding work achievements, He has been rated as "Top Ten Nurses", "Excellent Nurses", "Excellent Head Nurse" and "Excellent Communist party member" in the hospital for many times, and has been awarded many honorary medals such as "Advanced Woman" and "Ideal Shines in the Post" by the Navy North Sea Fleet. For three years in a row, it has been rated as "excellent service star" in Qingdao health system, "civilized worker" in Qingdao health system, "good nurse satisfied by the people" in Qingdao, the fourth "Li Guimei’s good nurse" nursing outstanding contribution award in Qingdao, and Qingdao "Adhere to the clinical good nurse for 30 years and the "most beautiful head nurse" in Qingdao; He was awarded the title of "Excellent Nurse" and "Excellent Nursing Worker" in the Ninth Branch of jinan military area command for many times, and won the third-class merit three times.

Filial piety to parents-in-law, caring for husband and teaching daughter are the "wife’s help" in the neighborhood.

Shortly after Chu Liyun got married, his father-in-law was diagnosed with advanced esophageal cancer, and he could not eat through his mouth, so he could only maintain his life by intravenous infusion. Because her family agreed to hide her illness from her father-in-law and refused to send her father-in-law to the hospital, Chu Liyun took the initiative to assume the responsibility of home care. No matter whether she worked at night shift in the unit or worked at night shift, no matter whether it was windy or snowy, she took a trip every day and rode her bike to and from more than 20 kilometers. More than half a year after her father-in-law died, she never stopped. When my father-in-law died, he left a last wish that "her lover must apply for graduate school." To this end, she has undertaken almost all the housework and tried her best to support her lover to concentrate on studying for master’s and doctoral students. In six years, she spent a lot of time together. While working, she took care of her ailing mother-in-law, while taking care of her daughter’s preschool education, and cultivated her daughter’s interests in dance, calligraphy and painting. Her paintings and calligraphy won the first and second prizes in the National Children’s Painting and Calligraphy Competition. After enlisting in the army, Zhang Xuejiao gave full play to his literary and artistic expertise, and directed more than 10 special cultural programs such as dance and allegro, which were performed in the cultural performances of provincial offices, corps and Qingdao Cooperation Zone successively, and won unanimous praise from officers and men.

Benevolence and kindness nursing are recognized as "service stars" by doctors and patients.

As the head nurse in the cadre ward above the military level, I can’t remember how many different roles she played — Granddaughter, daughter, sister, comrade-in-arms … … In 2015, a 97-year-old veteran cadre was unconscious due to a sudden cerebral hemorrhage. She took meticulous care of her like a baby. She lived in the department for several days and guarded her bed. After the veteran cadre woke up, she heard about this and pointed to her wife. Emotionally said: "This is our own daughter!" . When she was discharged from the hospital, she was specially presented with a banner, which read "To Head Nurse Chu Liyun: She is extremely enthusiastic about her comrades and is active and responsible for her work". In addition, she insisted on visiting newly admitted patients within 12 hours, patrolling the ward at least twice a day on weekdays and at least once a day on holidays, keeping abreast of patients’ needs and doing her best to solve problems for patients; She insisted on taking the initiative to leave her mobile phone number for every hospitalized patient, and turned it on 24 hours a day, so as to be responsive, answer questions and be on call.

In 2002, as one of the first nurses sent abroad to study in the hospital, she went to Japan to study clinical nursing and nursing education. After returning home, she eagerly updated her knowledge, assiduously studied related rehabilitation skills, and applied the early rehabilitation concept of cerebrovascular disease to clinical work, which was highly recognized by her peers. In 2006, she was selected by the hospital and sent to the special training center of Run Run Run Shaw Hospital affiliated to Zhejiang University for venous catheterization technology. After strict examination, she successfully obtained PICC technical qualification certification, and now she has successfully placed catheters for more than 1,000 patients, improving the level of venous treatment in the hospital. A patient from Taiwan Province was in hemorrhagic shock due to sudden upper gastrointestinal bleeding, and her blood pressure could not be measured. She quickly and skillfully performed central venous catheterization for him through femoral vein, established a safe venous passage, and transfused 3000ML for 2 hours, saving the patient’s life. A patient with esophageal cancer survived for nine months after PICC intubation, and his family regarded PICC intubation as a life channel. The diligent pursuit of her career has yielded fruitful results. She once participated in the "First Naval Nursing Technology Competition" on behalf of the hospital and won many awards such as individual event, pentathlon and group. Also won the first prize in Qingdao vein indwelling needle competition. In addition, she has served as the coach and evaluation of nursing technology competitions organized by hospitals, logistics department of Qingdao base, Qingdao base, North Sea Fleet Air Force, North Sea Fleet and Qingdao for many times, and trained many nursing technical backbones for grass-roots health units of the army.He has published 20 professional papers and 5 monographs by the first author, and successively won one third prize for military medical achievements, four third prizes for military scientific and technological progress, one second prize for Qingdao scientific and technological progress, one third prize for Shandong scientific and technological progress, two national utility model patents and one national invention patent.

Chu Liyun’s selfless, selfless and conscientious professionalism has brought her a personal influence. Zhang Xuejiao worked hard in her post and worked hard for many years. In 2015, she was commended as an "advanced individual in law enforcement" by the Border Defense Bureau of the Ministry of Public Security.

Perseverance, courage and responsibility are the "loving elder sister" respected by officers and men.

During his 36-year military career, Chu Liyun has participated in military medical support tasks many times. In December 2015, she was nearly 50 years old. With the strong support of her family, she actively requested to participate in the 22nd escort mission of the Navy and served as the party branch secretary of the medical team. During the seven-month mission, he not only withstood the severe physical and mental tests of various complex sea conditions, but also took the lead, actively participated in various exercises, and always served every officer and soldier patiently and meticulously with full work enthusiasm. Take the initiative, carry out health knowledge teaching, and organize self-help and mutual rescue training and competitions for officers and men in war injuries. Actively participate in the rescue and care of the fishermen of the "Zhangyuan" in the Gulf of Aden. In every medical emergency, she always takes the lead and rushes to the front, showing the good image of female soldiers in China. Many media, such as People’s Navy Daily and Zhongxin. com, have given special reports, and the escorted officers and men are affectionately known as "loving big sisters". Mother and daughter always encourage each other tacitly, whether they are concerned about their daughters during the voyage across the equator or worried about their mothers in the Gulf of Aden mission area. They are both close friends and like-minded comrades-in-arms. Zhang Xuejiao proudly said: "Mom is escorted by one person, and our whole family is glorious. My mother has set a good example for me as a revolutionary soldier, and I will work harder like my mother. " Engaged in information legal work, often have to work overtime,Sometimes she works continuously until late at night. Zhang Xuejiao never complains that she is tired and full of energy.

Enthusiastic public welfare and selfless dedication are the "most beautiful head nurses" praised by the masses.

Years of work practice have made Chu Liyun feel that as a head nurse, it is far from enough to rely on one’s love, patience and compassion. Only by bringing out an excellent nursing team, cultivating a group of excellent nursing talents and creating a series of advanced nursing cultures with a responsible attitude, scientific management and innovative spirit can we be truly responsible for the nursing cause. And she is willing to devote her life to this great and beloved cause. The nursing group led by her has been rated as "advanced clinical teaching department", "excellent training department" and "advanced nursing unit" for many times. "Standardized nursing unit with high quality service", the "excellent nursing unit" of the ninth branch of the Joint Logistics Department, was jointly commended by the Ministry of Health of the People’s Liberation Army General Logistics Department and the Ministry of Health in 2010 as "demonstration ward with high quality nursing service". In 2014, it was named "Top Ten Outstanding Nursing Teams" in Qingdao. The "Rose in the Army" initiated by her — The Nightingale Nursing Volunteer Service Team of 401 Hospital often uses holidays to go deep into street communities to carry out free clinic activities for the people, carry out health education and rehabilitation guidance, and is welcomed by the masses. She has lived for decades,Leading nurses to regularly and voluntarily replace catheters, fistulas, nasal feeding tubes, PICC catheter maintenance, skin and wound care for patients with mobility difficulties after discharge. Many patients said in thank-you letters: "The head nurse thought of the front of the patient and did it in the patient’s heart!" Other patients’ families embroidered "meticulous care and consideration" on the banner. She also often uses her rest time to go to nursing homes for nursing business guidance, persistent dedication, and convey the warmth of angels with true love. In May this year, Comrade Chu Liyun won the title of "the most beautiful head nurse" in the activity of "Looking for the most beautiful head nurse" carried out by Qingdao News Network.

A few days ago, we learned from Tengshi official that Tengshi’s medium and large MPV——2025 will be listed on December 26. It is reported that the appearance of the new car is basically the same as the cash, but there will be no small upgrade in configuration.

In terms of details, a laser radar is installed above the roof of the 2025 Tengshi D9, which is expected to be greatly improved in terms of intelligent driving; In addition, the "DM-I AWD" logo is added to the rear logo. In terms of size, the length, width and height of the new car are 5250×1960×1900mm and the wheelbase is 3110mm respectively.

The interior of the new car is a highlight of the 2025 Tengshi D9 upgrade. Although it still continues the overall layout of cash, the new car will be replaced with a new one. It is expected that there will be no small changes in the central island area. In addition, whether the co-pilot is equipped with an entertainment screen is also a hot spot for netizens to pay attention to this upgrade, and more information is still to be announced by the official.

In terms of power, the 2025 Tengshi D9 will be upgraded to the fifth-generation DM technology, equipped with a 1.5T engine+plug-in hybrid system, with a maximum engine power of 115kW and a maximum speed of 190km/h; On the power battery level, the new car will be equipped with a set of 39.938kWh lithium iron phosphate batteries, with pure battery life of 145km and 155km. We will continue to pay attention to the latest news about the 2025 Tengshi D9.

Takeaway riders’ war escalated: riders laugh and users worry, when will the price war stop?

With the development of science and technology, internet giants have set foot in the take-away industry, and the war of take-away riders has escalated. In this highly competitive market, riders laugh, but users are worried. When will the price war stop? This paper will analyze the current competitive situation of the take-away market from a professional perspective and put forward some possible solutions.

First of all, we need to know the advantages of Internet giants such as JD.COM and Meituan in policy, technology and capital, as well as the protection of the rights and interests of take-away riders. In terms of policies, major platforms have introduced policies such as paying five insurances and one gold for riders and canceling the overtime penalty for delivery, aiming at improving the welfare of riders and protecting their rights and interests. In terms of technology, major platforms improve distribution efficiency and reduce costs through artificial intelligence, big data and other technical means. In terms of funds, the major platforms have strong financial strength and can invest more resources to increase market share.

However, the competition in the take-away market is fierce, and the price war has become an important means for major platforms to compete for market share. The price war caused the take-away platform to reduce the profit margin in order to reduce the cost, and then passed the cost on to the settled merchants and users. In order to attract more orders, merchants reduce prices, which leads to further compression of profit margins. At the same time, users have to accept higher prices in order to get more coupons. This vicious circle not only harms the interests of merchants and users, but also brings greater work pressure and safety risks to takeaway riders.

In order to solve this problem, we need to put forward some possible solutions from multiple angles. First of all, the government should strengthen supervision, standardize market competition behavior, and prevent vicious competition from causing market chaos. Secondly, the take-away platform should strengthen its own management, improve distribution efficiency, and reduce the work pressure and safety risks of riders. In addition, the take-away platform can also increase revenue sources and profit margins by increasing delivery rates and introducing third-party payment. Finally, the take-away platform can introduce some preferential policies to attract merchants to settle in and improve their profit margins.

For users, they should look at the competitive situation in the take-away market more rationally, and don’t blindly pursue low prices and ignore quality and service. At the same time, they should also pay attention to their own health and safety issues and choose businesses with high credibility and good service for consumption. For riders, they should strengthen their awareness of self-protection, improve their safety awareness, obey traffic rules and ensure their own safety. In addition, they can improve their welfare and career development prospects by joining trade unions and improving their skills.

To sum up, the take-away market is fiercely competitive, and the price war has become an important means for major platforms to compete for market share. In this highly competitive market, we need to put forward some possible solutions from multiple angles. Measures such as strengthening supervision by the government, strengthening self-management of take-away platforms and introducing preferential policies to attract merchants to settle in will help solve the current predicament of the take-away market. At the same time, users and riders should also strengthen their awareness of self-protection and jointly safeguard market order and consumer rights. Only in this way can we realize the sustainable development of the take-away market.

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　　Reporter Sun Wei

　　On March 18th, the National Bureau of Statistics announced the basic situation of the national real estate market. From January to February, the housing construction area of real estate development enterprises was 6,669.02 million square meters, down 11.0% year-on-year; The newly started housing area was 94.29 million square meters, down by 29.7%; The completed housing area was 103.95 million square meters, down by 20.2%. From January to February, the national investment in real estate development was 1,184.2 billion yuan, down 9.0% year-on-year, of which residential investment was 882.3 billion yuan, down 9.7%. Liu Aihua, chief economist of the National Bureau of Statistics, said that the real estate market is still in the process of adjustment and transformation, and the next step is to implement the clear deployment of the real estate industry made by the National People’s Congress and the National People’s Congress, so as to further promote the stable, healthy and high-quality development of the real estate market.

　　New home sales fell year-on-year

　　Specifically, from January to February, the sales area of newly-built commercial housing was 113.69 million square meters, down 20.5% year-on-year, of which the sales area of residential housing decreased by 24.8%. The sales volume of newly-built commercial housing was 1,056.6 billion yuan, down by 29.3%, of which residential sales decreased by 32.7%. At the end of February, the area of commercial housing for sale was 759.69 million square meters, a year-on-year increase of 15.9%. Among them, the residential area for sale increased by 23.8%.

　　Chen Wenjing, director of market research of China Central Finger Research Institute, said in an interview that the decline in new house sales compared with the same period of last year was mainly due to two reasons. First, driven by the centralized release of the backlog of demand for house purchase during the epidemic, new house sales continued to maintain a high scale at the beginning of last year, and the sales area of new houses was at a historical high in January and February last year. Second, during the Spring Festival this year, the holiday is long, and residents have a high enthusiasm for traveling, which has affected the pace of housing demand entering the market to some extent.

　　According to the data of the middle finger, from January to February, the transaction area of second-hand residential buildings in key 25 cities decreased by 13.1% year-on-year, which was significantly lower than that of new houses. Chen Wenjing believes that this shows that the second-hand housing market has maintained a certain degree of activity, which shows that the demand for buying houses is still steadily released, and the second-hand housing transactions are active, which is expected to provide more replacement and improvement demand for the new housing market in the future.

　　According to Wang Xiaoyu, chief analyst of Zhuge Data Research Center, the performance of the new housing market has been sluggish since the beginning of the year. On the one hand, the supply scale of new houses in January and February this year remained at a historical low; On the other hand, second-hand houses continue to divert the demand for new houses. The second-hand housing market has sufficient housing, and the surrounding facilities of second-hand housing are generally more mature, so it still maintains the trend that the transaction performance of second-hand housing is better than that of new housing. With the arrival of the "Golden Three Silver Four" sales season, the market turnover will usher in an upward trend, but it is estimated that it is difficult to surpass last year’s turnover level.

　　The decline in development investment narrowed.

　　Judging from the investment in real estate development, there have been some positive changes in the first two months. From January to February, the investment in real estate development decreased by 9.0% year-on-year, which was 0.6 percentage points narrower than that of the previous year.

　　Wang Xiaoying said that the decline in investment in real estate development has improved, mainly due to land acquisition. In the beginning of the year, many cities launched high-quality land plots, such as Hangzhou and Beijing, where the market heat is heating up. With the recent reduction of LPR by the central bank and the support of the two sessions for the real estate market, the new model of real estate development will enter a new stage. In March, the market will enter the peak season of Xiaoyangchun, and the decline in real estate development investment will continue to improve.

　　Yan Yuejin, research director of Yiju Research Institute, believes that the real estate development investment index has shown a low opening trend, but the overall risk is controllable. There are two positive signals that need attention: First, the year-on-year decline in development investment has narrowed, which means that the shrinking state of development investment last year has been contained, which is a positive signal for the supply side to stabilize; Second, the competitive structure of housing enterprises has been continuously adjusted. At present, enterprises that have the ability to invest in development are healthier and have stronger financial capabilities.

　　Good policies help development.

　　In 2024, the Central Economic Work Conference and the National People’s Congress put forward clear requirements for optimizing the real estate policy and promoting the stable and healthy development of the real estate market, demanding to adapt to the development trend of new urbanization and the changes in the relationship between supply and demand in the real estate market, accelerate the construction of a new real estate development model, increase the construction and supply of affordable housing, improve the basic system related to commercial housing, and meet the residents’ demand for rigid housing and diversified and improved housing. Liu Aihua said that the implementation of these policies and measures will contribute to the stable, healthy and high-quality development of the real estate market.

　　Chen Wenjing thinks. At present, the coordination mechanism of real estate financing in various places has been accelerated, and funds for many projects are in place, which is expected to further repair the market expectations of enterprises and residents. Since March, the effect of the core city policy has continued to appear. The second-hand housing transactions in several cities have reached a high level since the second half of last year, and the sales scale of the new housing market has also rebounded moderately. For example, the recent cancellation of the second-hand housing purchase restriction policy in Hangzhou has further boosted market confidence. In the short term, local demand-side policies are expected to continue to be optimized and adjusted. It is expected that the real estate market activity in core cities will be further enhanced, and the "Xiaoyangchun" market in some cities is still expected.

　　Yan Yuejin, research director of Yiju Research Institute, believes that from the actual feedback, the housing transaction market has begun to show signs of stabilization. All localities have a better understanding of housing prices and are willing to further exchange prices for quantity to boost sales data. At the same time, various favorable policies continue to be released, which has begun to be reflected in the volume of house viewing and transaction volume. Judging from the actual transaction situation, the market transactions of some large-sized units are better, indicating that the demand for improved housing is also being actively released.

　　BEIJING, April 17 (Xinhua) According to the website of the National Bureau of Statistics, the National Bureau of Statistics announced today the investment and sales of real estate development in China from January to March 2019.

　　Completion of investment in real estate development

　　From January to March 2019, the national investment in real estate development was 2,380.3 billion yuan, up 11.8% year-on-year, and the growth rate was 0.2 percentage points higher than that in January and February. Among them, residential investment was 1,725.6 billion yuan, an increase of 17.3%, and the growth rate dropped by 0.7 percentage points. The proportion of residential investment in real estate development investment is 72.5%.

　　From January to March, the investment in real estate development in the eastern region was 1,354 billion yuan, up 10.3% year-on-year, and the growth rate dropped by 0.6 percentage points compared with that in January and February. The investment in the central region was 481.6 billion yuan, an increase of 8.4%, and the growth rate dropped by 0.4 percentage points; The investment in the western region was 490.1 billion yuan, an increase of 18.9%, and the growth rate increased by 2.1 percentage points; The investment in Northeast China was 54.7 billion yuan, an increase of 21.8%, and the growth rate increased by 10.9 percentage points.

　　From January to March, the housing construction area of real estate development enterprises was 6,994.44 million square meters, up 8.2% year-on-year, and the growth rate was 1.4 percentage points higher than that in January and February. Among them, the residential construction area was 4,845.6 million square meters, an increase of 9.7%. The newly started housing area was 387.28 million square meters, an increase of 11.9%, and the growth rate increased by 5.9 percentage points. Among them, the newly started residential area was 284.67 million square meters, an increase of 11.5%. The completed housing area was 184.74 million square meters, down by 10.8%, and the decline rate narrowed by 1.1 percentage points. Among them, the completed residential area was 130.43 million square meters, down by 8.1%.

　　From January to March, the land acquisition area of real estate development enterprises was 25.43 million square meters, down 33.1% year-on-year, and the decline rate was 1 percentage point narrower than that in January and February; The land transaction price was 119.4 billion yuan, down by 27.0%, and the decline rate increased by 13.9 percentage points.

　　Sales and sale of commercial housing

　　From January to March, the sales area of commercial housing was 298.29 million square meters, down 0.9% year-on-year, and the decline rate was 2.7 percentage points narrower than that in January and February. Among them, residential sales area decreased by 0.6%, office sales area decreased by 11.1%, and commercial sales area decreased by 6.9%. The sales volume of commercial housing was 2,703.9 billion yuan, up by 5.6%, and the growth rate increased by 2.8 percentage points. Among them, residential sales increased by 7.5%, office sales decreased by 13.0%, and business sales decreased by 2.6%.

　　From January to March, the sales area of commercial housing in the eastern region was 116.36 million square meters, down 6.8% year-on-year, and the decline rate was 2.9 percentage points narrower than that in January and February. Sales reached 1,428 billion yuan, up by 1.1%, and decreased by 1.2% in January and February. The sales area of commercial housing in the central region was 84.96 million square meters, up by 2.8%, and decreased by 0.6% in January and February. Sales reached 589.7 billion yuan, up by 10.9%, and the growth rate increased by 4.3 percentage points. The sales area of commercial housing in the western region was 87.36 million square meters, an increase of 4.3%, and the growth rate increased by 2.1 percentage points; Sales reached 609.3 billion yuan, up by 12.2%, and the growth rate increased by 2 percentage points. The sales area of commercial housing in Northeast China was 9.6 million square meters, up by 0.3%, and decreased by 4.8 percentage points in January and February. Sales reached 76.8 billion yuan, up by 6.3%, and decreased by 2.4% in January and February.

　　At the end of March, the area of commercial housing for sale was 516.46 million square meters, a decrease of 6.05 million square meters compared with the end of February. Among them, the area for sale of residential buildings decreased by 5.31 million square meters, the area for sale of office buildings decreased by 470,000 square meters, and the area for sale of commercial buildings increased by 210,000 square meters.

　　Real estate development enterprises in place funds.

　　From January to March, the funds put in place by real estate development enterprises were 3,894.8 billion yuan, up 5.9% year-on-year, and the growth rate was 3.8 percentage points higher than that in January and February. Among them, domestic loans were 713.4 billion yuan, an increase of 2.5%; The utilization of foreign capital was 3.3 billion yuan, an increase of 1.1 times; Self-raised funds were 1,179.5 billion yuan, an increase of 3.0%; Deposits and advance receipts were 1,230.3 billion yuan, up by 10.5%; Personal mortgage loans reached 564.5 billion yuan, an increase of 9.4%.

　　In March, the real estate development boom index (referred to as "national housing boom index") was 100.78, 0.21 points higher than that in February.