A few days ago, Tesla Motors (Beijing) Co., Ltd. and Tesla (Shanghai) Co., Ltd. filed a recall plan with the General Administration of Market Supervision according to the relevant requirements for the recall management of defective automobile products. Since May 29, 2023, some imported Model S, Model X, Model 3 and domestic Model 3 and Model Y vehicles with production dates from January 12, 2019 to April 24, 2023 have been recalled, totaling 1,104,622 vehicles.

　　The vehicles within the scope of this recall are not allowed to choose the energy recovery braking strategy, which may not provide enough reminders for the driver to step on the accelerator pedal for a long time. The superposition of these factors may increase the probability of mistakenly stepping on the accelerator pedal for a long time, which may increase the risk of collision and pose a safety hazard.

　　This recall was carried out when the General Administration of Market Supervision initiated a defect investigation. Affected by the investigation, Tesla Motors (Beijing) Co., Ltd. and Tesla (Shanghai) Co., Ltd. plan to push newly developed functions for vehicles within the recall range through OTA technology, so as to reduce the collision risk caused by excessive speed caused by long-term deep stepping on the accelerator pedal. The specific functions include: providing options to allow drivers to choose energy recovery braking intensity for vehicles that do not have the option of energy recovery braking intensity; Adjust the factory default state of vehicle energy recovery braking strategy; Give a reminder when the driver deeply depresses the accelerator pedal for a long time.

　　Tesla Motors (Beijing) Co., Ltd. and Tesla (Shanghai) Co., Ltd. will notify the relevant car owners by registered mail, SMS, etc., and arrange the recall and maintenance. Users can call Tesla customer service hotline through mobile phones and fixed telephones, or log on to the website or follow WeChat WeChat official account for more information and reflect the defect clues. (Reporter Zhao Wenjun)

? ? ? ? ? ? Many car owners are buying Xpeng Motors for the first time, some are pure novice users, and they are not familiar with all kinds of buttons on the car. In addition, the minimalist design of Tucki similar to Tesla, many users say that they can’t use it, so it’s hard to remember, and their heads are so big! ! !

? ? ? ? ? ?Today’s most detailed graphic tutorial, here he comes! Hand in hand to teach you the usage of MONA M03 buttons. It is recommended to save them and look at them often to ensure that you can use them quickly without making mistakes! ! !

? ? ? ? ? 1. The first scene, the buttons on the steering wheel, the intelligent adjustment and the use of lighting, are used the most and must be mastered!

? ? ? ? 2. Second, double flashing lights and reading lights, put down in the back row, in case of emergency, such as high-speed breakdown, be sure to know where it is and turn it on at the first time! ! !

? ? ? ? ?3. Adjust the seat button and the glass lifting switch!

? ? ? ?4. Air conditioning adjustment in the back row, as well as charging port and small storage box under the trunk!

? ? ? ?5. It is our biggest feature, how to open and close the electric hatchback door, and how to set your own default opening height to avoid rubbing on it!

? ? ? ? That’s all for today’s sharing. Have you all learned? Novices must remember the meaning and usage of each key to travel safely on the road! ! !

? ? ? Finally, I wish all new friends a happy Mid-Autumn Festival! ! !

CCTV News:This year, in Spring Festival travel rush, in order to reduce the risk of epidemic, some returning tourists chose to drive home for the New Year, avoiding too much contact with public places in a peer-to-peer way. Local transportation departments should strictly and carefully do a good job in epidemic prevention and control and safety supervision, and create a safe and smooth traffic environment for returning home by car.

Traffic departments in Jiangsu and Shanxi have instructed expressway service areas to formulate Measures for Prevention and Treatment of Pneumonia Infected in novel coronavirus. Additional staff have been assigned at the entrance of the service area, and administrators for daily inspection of epidemic prevention and control have been added. In strict accordance with the requirements of prevention and control, the requirements and knowledge of prevention and control have been broadcast circularly by using rolling large screens and speakers, and the service area has been sterilized at high frequency, and the trip code has been checked for 24 hours, and the temperature has been measured. On-site supervision and guidance company has been urged to scan and show the trip code to eliminate the hidden danger of epidemic prevention and control.

According to the regional characteristics of road sections and the distribution of law enforcement forces, Sichuan Transportation Department has rationally arranged 189 emergency material storage points in the 8608 km expressway network in Sichuan, and all of them have been moved forward to accident-prone areas such as service areas, tunnel entrances and interchange ramps to ensure that rescuers and equipment are in place in time. The expressway service area (toll station) has set up 294 warm-hearted convenience service points in Spring Festival travel rush as a whole, which not only has basic epidemic prevention and disinfection items, but also upgrades the hot water provided 24 hours a day to ginger soup, and provides car maintenance tools and umbrellas to solve the practical difficulties of traveling; 79 pairs of charging piles in expressway service area basically meet the charging needs of new energy vehicles.

The Ministry of Transport reminds drivers to master the car condition, road conditions and weather conditions in advance and plan the travel route reasonably; When traveling by car, be sure to fasten your seat belt and don’t be distracted by driving; In case of bad weather, drive slowly and steadily to prevent the adverse effects of snowfall, snow freezing and low visibility on traffic, and avoid blindly taking risks.

　　Pushing forward the new great project of Party building in an all-round way is the key to Socialism with Chinese characteristics’s great cause. Since the 18th National Congress of the Communist Party of China, the CPC Central Committee with the Supreme Leader as the core has firmly promoted the strict administration of the Party in an all-round way, and the new great project of Party building has comprehensively advanced to a new stage. Significant progress has been made in Party building because the CPC Central Committee with the Supreme Leader as the core insists on promoting Party building with the spirit of reform and innovation, putting forward a series of new ideas, making a series of new arrangements and implementing a series of new measures, thus continuously improving the scientific level of Party building.

　　Theoretical innovation provides scientific guidance for party building.

　　Innovation is an inexhaustible motive force to promote the development of party building. Since the 18th National Congress of the Communist Party of China, it has been one of the most active periods for the Party to put forward scientific new ideas, new ideas and new viewpoints. This kind of innovation has both macro-level innovation and meso-and micro-level innovation. Multi-level theoretical innovation is the primary prerequisite for outstanding achievements in party building.

　　Put forward the strategy of strictly administering the party in an all-round way — — A major innovation in party building. Since the 18th National Congress of the Communist Party of China, the CPC Central Committee with the Supreme Leader as the core has regarded the comprehensive and strict administration of the Party as an important historical mission. Just after the 18th National Congress of the Communist Party of China closed, the Supreme Leader pointed out: The development of the situation, the development of the cause and the expectations of the people all require us to comprehensively push forward the new great project of party building with the spirit of reform and innovation. "Under the new situation, strengthening and improving Party building faces ‘ Four major tests ’ 、‘ Four kinds of dangers ’ The task of implementing the party’s management of the party and strictly administering the party is more arduous and urgent than ever. " After proposing to build a well-off society in an all-round way, deepen reform in an all-round way and govern the country according to law, in mid-December 2014, the supreme leader comrade pointed out in his investigation in Jiangsu that it is necessary to "coordinate and promote the building of a well-off society in an all-round way, deepen reform in an all-round way, comprehensively promote the rule of law, comprehensively and strictly manage the party, and push reform, opening up and socialist modernization to a new level". From then on, strictly administering the party in an all-round way has become an important strategy to promote the new great project of party building. Strictly administering the party in an all-round way is not just as simple as adding the word "comprehensive" before "strictly administering the party", but an important theoretical innovation. Comrade Supreme Leader pointed out: It is not only a literal change,It is also the development of practice and the deepening of understanding. " To strictly manage the party in an all-round way, the core is to strengthen the party’s leadership, the foundation is comprehensive, the key is strict, and the key is governance. "Comprehensive" means managing and governing the whole party, covering all fields, aspects and departments of party building, with the focus on grasping the "key minority"; "Strictness" means being really strict, daring to be strict, and being long and strict; "Governance" means that from the CPC Central Committee to the grass-roots party branch, we should shoulder the main responsibility, and the party secretary should take party building as a necessary responsibility. Judging from the practice since the 18th National Congress of the Communist Party of China, it is precisely because of putting forward and promoting the strategy of strictly administering the Party in an all-round way that the Party’s construction has continuously opened up a new situation.

　　Put forward "the close combination of ideological party building and institutional party building" — — Great development of Marxist theory of party building. Ideological Party Building is a great creation of Comrade Mao Zedong. He first put forward the idea of focusing on building the party ideologically in the resolution of Gutian conference. After the Third Plenary Session of the Eleventh Central Committee of the Communist Party of China, Comrade Deng Xiaoping put forward the reform of the leadership system of the party and the state through profound reflection on the "Cultural Revolution", and thought that the system problem was fundamental, overall, stable and long-term, which was related to whether the party and the state changed their colors. This system is a new development of ideological party building. In the process of promoting the "four comprehensive" strategic layout, the CPC Central Committee with the Supreme Leader as the core put forward the idea of "closely combining ideological party building with institutional party management" according to the new problems that need to be solved in party building. Comrade Supreme Leader pointed out: "Strictly administering the Party depends on education as well as system. Both are flexible and rigid, and they should exert their strength in the same direction and at the same time." "We should make the process of strengthening the system to govern the party a process of strengthening the ideological party building, and also make the process of strengthening the ideological party building a process of strengthening the system to govern the party." This thought enriches and develops the Marxist theory of party building and provides scientific theoretical guidance for the comprehensive and strict administration of the party.

　　Put forward that "governing the party according to regulations is closely integrated with governing the party by virtue" — — Deepening the thought of "the close combination of ideological party building and institutional party management" This is a logical extension of the idea of combining the rule of law with the rule of virtue, and it is also the foothold of the close combination of ideological party building and institutional party management. Governing the party according to regulations, as a concrete embodiment of the system of governing the party, requires strict party discipline, especially political discipline and rules, so that the vast number of party member and cadres maintain a high degree of consistency with the CPC Central Committee in ideological and political actions; It is required to be strict with the law and discipline before the law, and to control the majority with discipline and rules, so that the vast number of party member and cadres can strictly implement party rules and discipline and set an example in observing national laws and regulations. Putting forward the idea of ruling the party by virtue aims at fulfilling the requirements of ideological party building. Comrade Supreme Leader stressed: Do a good job in ideological and theoretical construction, strengthen the education of ideals and beliefs, regard ideals and beliefs as the spiritual "calcium" of communist party people, and use firm ideals and beliefs to cultivate a "indestructible body"; Do a good job in ideological and moral construction, strengthen party spirit cultivation education, constantly consolidate the ideological and moral foundation of party member and cadres’ clean and honest administration, and build an ideological and moral defense line against corruption and change; Do a good job in the construction of work style, which is not only strict with self-cultivation, strict with the use of power, strict with self-discipline, but also practical in seeking things, starting a business and being a real person. Governing the party by virtue and governing the party by rules are interrelated. The revision of the Code of Integrity and Self-discipline in the Communist Party of China (CPC) and the Regulations on Disciplinary Actions in the Communist Party of China (CPC),It runs through the spirit of closely combining the rule of law with the rule of virtue.

　　Put forward to strengthen the "four consciousnesses" — — The latest achievements of theoretical innovation in party building. Comrade Supreme Leader stressed: "All Party comrades should enhance their political awareness, overall awareness, core awareness and conformity awareness, and earnestly be loyal to the party, share their worries, take responsibility for the party and do their duty for the party." "Four consciousnesses" is not a simple combination of four concepts, but an organic whole with internal logic, close connection and mutual support. Political awareness is fundamental, ensuring correct and firm direction and position; The overall situation consciousness is the foundation to ensure the coordination between the local and the whole; Core consciousness is the key to ensure the centralization and unity of the whole party; The sense of conformity is the guarantee to ensure that the team is neat and powerful. The Sixth Plenary Session of the 18th CPC Central Committee established the core position of the Supreme Leader Comrade in the CPC Central Committee and the whole party, and the core consciousness is highlighted by resolutely safeguarding the authority of the CPC Central Committee with the Supreme Leader as the core and the core position of the Supreme Leader Comrade. The two are organically unified and mutually external.

　　Practical innovation makes the party’s construction take a firm step.

　　Theoretical innovation brings practical innovation, and practical innovation implements theoretical innovation. Since the 18th National Congress of the Communist Party of China, the CPC Central Committee, with the Supreme Leader as the core, has put forward many new requirements, formulated many new regulations and carried out many new practices in practice in order to implement the theoretical innovation achievements of party building in practical work and solve the outstanding problems in party building, which has brought new changes, new atmosphere and new features to party building.

　　Realize the normalization of learning and education. The implementation of ideological party building and the rule of the party by virtue cannot be separated from regular study and education. The CPC Central Committee with the Supreme Leader as the core first carried out the Party’s mass line education and practice activities throughout the Party, then carried out the special education of "three strictness and three realities" among leading cadres at or above the county level, and then carried out the study and education of "two studies and one doing" in all party member. In March this year, the central government issued a notice to promote the normalization and institutionalization of "two studies and one work" study and education. The "newness" of these learning and education lies in: first, to carry out criticism and self-criticism seriously rather than perfunctorily, earnestly rather than ostentatiously. Second, all links should be practical and detailed, and good things should be done from the beginning to the end. Third, leading cadres at all levels take the lead in setting an example, studying deeply, taking a close look, and sticking to it, forming a good atmosphere of learning and education. These learning and education have achieved innovation from content to form, which has played an important role in comprehensively and strictly administering the party.

　　The institutional governance of the party has achieved remarkable results. The Sixth Plenary Session of the 18th CPC Central Committee deliberated and adopted "Several Guidelines on Political Life within the Party under the New Situation" and "Regulations on Inner-Party Supervision in the Communist Party of China (CPC)", which systematized, standardized and institutionalized the Party Central Committee’s ideological theory and practical experience of strictly administering the Party in an all-round way with the Supreme Leader as the core, are the landmark achievements of institutional governance of the Party and have a benchmark role in promoting the party’s system construction. These two documents can be called the party’s "protector of the law", which is not only an important starting point for continuing to comprehensively promote the new great project of party building, but also an important guarantee for comprehensively administering the party strictly. At the same time, the successive issuance of the Regulations on Patrol Work in the Communist Party of China (CPC), the Code of Integrity and Self-discipline in the Communist Party of China (CPC), and the Regulations on Disciplinary Actions in the Communist Party of China (CPC) reflect the spirit of reform and innovation of our party in managing the party, and also make the management of the party more standardized, procedural and institutionalized, effectively promoting the new great project of party building.

　　Severely punish corruption with zero tolerance. For a period of time, the high incidence of corruption has been worrying, seriously damaging the advanced nature and purity of the party and seriously affecting the flesh-and-blood ties between the party and the people. Since the 18th National Congress of the Communist Party of China, the CPC Central Committee with the Supreme Leader as the core has taken innovative measures to fight corruption with an iron fist. Comrade Supreme Leader clearly pointed out: "If you don’t offend corrupt elements, you will inevitably disappoint the party and offend the people." "If you don’t offend hundreds of corrupt elements, you will offend 1.3 billion people. This is a political account that is clear enough, and the account of the people is back. " Since the 18th National Congress of the Communist Party of China, the Central Committee of the Communist Party of China has taken drastic measures to eliminate malnutrition and severely punish chaos, and "tigers" and "flies" have fought together, which has effectively curbed the frequent and high-incidence of corruption that has been unstoppable for years.

　　Strengthening the sword function of patrol supervision. The innovations of the CPC Central Committee with the Supreme Leader as the core in patrol supervision are mainly as follows: First, the important role of patrol supervision has been enhanced. Comrade Supreme Leader pointed out: "Patrol is a strategic institutional arrangement for inner-party supervision" and "a weapon of the country and the party". The second is to clarify the patrol work policy. The key point is "four efforts", that is, to find out whether leading cadres have problems of violation of law and discipline such as trading power and money, abusing power for personal gain, corruption and bribery, corruption and degeneration; Focus on discovering whether there are problems such as formalism, bureaucracy, hedonism and extravagance; Focus on finding out whether there is a violation of the party’s political discipline; Focus on finding out whether there are unhealthy practices and corruption in selecting and employing people. More than half of the middle-ranking cadres who were put on file for review by the Central Commission for Discipline Inspection were investigated and dealt with according to the clues of patrol handover. The third is to comprehensively carry out special inspections. Comrade Supreme Leader pointed out: the special patrol "moves at the wind, takes it by surprise, and runs wherever there is a reflection." The regions and departments that have visited can always kill a comeback and have a ‘ Looking back ’ 。” This is the "light cavalry" for patrol work.

　　The new achievements in party building have brought profound enlightenment.

　　Since the 18th National Congress of the Communist Party of China, the CPC Central Committee with the Supreme Leader as the core has firmly promoted the comprehensive and strict administration of the Party, adhered to the close combination of ideological party building and institutional party management, concentrated put in order’s party style, severely punished corruption, and purified the political ecology within the Party, showing a new atmosphere in the political life within the Party, winning the hearts and minds of the Party and providing an important guarantee for creating a new situation in the cause of the Party and the state. The practice of developing Party building through innovation has brought us many profound inspirations.

　　To promote party building in the spirit of reform and innovation, we must be firm in political determination and full of responsibility. The innovation of party building is different from other innovations, which is closely linked with politics and must adhere to the principle of party spirit. Therefore, to promote innovation in party building, we must first stand firm in politics and be loyal to the cause of the party and the people. Only in this way can we solve the complex problems in party building with innovative thinking and keep the innovation of party building in the correct political direction. To promote party building in the spirit of reform and innovation, we must solve the outstanding problems in the party, some of which are still very complicated and difficult, which requires a sense of responsibility. Comrade Supreme Leader pointed out: When the people hand over power to us, we must promise the party and the country by ourselves and report it to the party and the country. He stressed: we must "promote the building of a clean and honest party style and the struggle against corruption with a strong sense of historical responsibility, a deep sense of mission anxiety and tenacious will." With political determination and responsibility, the innovation of party building has a solid political foundation and a strong driving force.

　　Scientific thinking and correct methods are needed to promote Party building in the spirit of reform and innovation. Party building is a complex systematic project, involving all aspects of the development of the cause of the party and the state, and it must have scientific thinking and correct methods. Comrade Supreme Leader has repeatedly stressed the need to improve the ability of dialectical thinking, systematic thinking, strategic thinking and bottom line thinking, enhance the eyesight of seeing problems, the brainpower of seeking things, the listening ability of observing people’s feelings, and the foot strength of walking at the grassroots level, and combine subjective understanding with objective reality to make ideas, plans and plans conform to objective laws. Since the 18th National Congress of the Communist Party of China, the key reason why the CPC Central Committee with the Supreme Leader as the core can promote the innovative development of party building lies in insisting on analyzing, studying and planning party building with scientific thinking. To promote party building in the spirit of reform and innovation, we must also adhere to the problem orientation. Comrade Supreme Leader pointed out: Problems are the starting point and the power source of innovation. Only by listening to the voice of the times, responding to the call of the times and seriously studying and solving major and urgent problems can we grasp the historical context, find the law of development and promote theoretical innovation. It is precisely by grasping the outstanding problems existing in the party that the party’s construction will continue to show a new look and create a new situation.

　　To promote party building in the spirit of reform and innovation, we should be strict and meticulous, advocate long-term and practical work. Comrades of the Supreme Leader have repeatedly stressed that "empty talk is wrong with the country, and hard work is good for the country". Over the years, the CPC Central Committee has persisted in doing practical work, not only courageously taking responsibility, being resolute and vigorous, but also being serious and meticulous. The supreme leader comrade pointed out: "in the world, doing things in detail is strict." Strictness is an important guarantee for us to do all the work well. We in communist party are the most serious. To be serious is to be strict, to do things that we can’t cope with, and to be a man that we can’t cope with. Instead, we must conscientiously implement our words in all work, such as the construction of work style, the construction of the party, and all the work of the party and the state. " He also pointed out: it seems trivial for us to implement the eight central regulations, but it reflects a spirit. If we can’t grasp the eight central regulations well and can’t stick to them, what are the 18 regulations and 28 regulations? To grasp the "four winds", we must first grasp the eight central regulations, and grasp the party building from the "four winds". Do one thing well and then do the second thing, so that everyone feels that we can do things, and we are serious. Only in this way can we win the trust of the people and the whole party. This reflects the work style of the CPC Central Committee with the Supreme Leader as the core. It is this serious and meticulous style of work that has promoted the party’s construction to achieve tangible results and won the hearts and minds of the party.

　　(The author is Shi Zhongquan, former deputy director of the Central Party History Research Office)

On March 12th, Xiaomi launched Xiaomi 14 Ultra mobile phone on February 22nd, and the titanium special edition in this mobile phone will be on sale at 10:00 today.

According to reports, this mobile phone uses a technology nano-leather back cover and a "higher-grade titanium metal" middle frame.

In terms of performance, Xiaomi 14 Ultra is equipped with the third-generation Snapdragon 8 platform, equipped with LPDDR5X memory and UFS 4.0 flash memory, adopting a brand-new 4000m㎡ dual-channel annular cold pump cooling system, adding a main camera independent cooling loop, and the vapor-liquid separation design has three times the performance of traditional VC.

In terms of communication, Xiaomi 14 Ultra is equipped with two self-developed T1 signal enhancement chips, and adopts the strongest high-performance antenna group in Xiaomi’s history. The performance of medium and high-frequency cellular communication is improved by 37%, and the performance of Wi-Fi and Bluetooth is improved by 16%. It supports roaming in 160+countries and regions around the world, covering 430+carrier networks.

According to the previous report of IT House, Xiaomi 14 Ultra supports the direct connection of mobile phones to Tiantong satellites, and supports real-time voice and two-way short messages. One of the two T1 chips on Xiaomi 14 Ultra is a chip specially used for satellite communication, and the transceiver performance of satellite antenna is improved by 21%. It supports electronic fence and super power-saving mode, and will automatically remind to open satellite service before entering no man’s land.

"6999/8799 Yuan, Xiaomi 14 Pro/Ultra Satellite Communication Titanium Mobile Phone Release"

　　Location introduction:

　　In your microsoft account: Log in to your microsoft account on another device to find your recovery key. If other users have accounts on the device, you can ask them to log in to their Microsoft account to see if they have a key.

　　In the saved printout: Your recovery key may be in the printout saved when BitLocker was activated. Look for important files related to your computer.

　　On the USB flash drive: Insert the USB flash drive into the locked PC and follow the instructions. If you have saved the key as a text file on the USB drive, use another computer to read the text file.

　　In an Azure Active Directory account: If your device used a work or school email account to log in to an organization, your recovery key may be stored in the AZURE AD account of the organization associated with your device. You may have direct access to it, or you may need to contact the system administrator to access the recovery key.

　　Owned by your system administrator: If your device is connected to a domain (usually a work or school device), please ask the system administrator for the recovery key.

　　View method:

　　Method 1:

　　Open this pc. At this time, we can see that disk F is encrypted. Double-click it to pop up a dialog box for entering the password. After entering the password, click Unlock in the lower right corner, then right-click the unlocked disk and select Manage BitLocker】； in the pop-up dialog box.

　　After entering the encryption page of BitLocker drive, select 【 Backup Recovery Key 】, and then you can choose the way to save the password, such as 【 Save to File 】, set the save path and click 【 Save 】, then open the corresponding save path in the computer to find the file of BitLocker recovery key.

　　Method 2:

　　1. You don’t need to remember the key itself to save the key in Microsoft account, but you can get the recovery key by logging in to Microsoft account (htt://account.microsoft.com/devices/recoverykey). The recovery key consists of 8 6-digit strings with 48 bits in total, and each key has a corresponding key ID corresponding to the corresponding device name and drive name. If you forget your Microsoft account, you can’t recover it.

　　2. Save the recovery key as a text file, which can be flexibly backed up to any location with multiple backups. Open it with notepad of another computer to verify whether the recovery key is correct. First, compare the identifier with the identifier value displayed on the computer, and if it matches, use the key to unlock the encrypted drive.

Original Wuyuan Li Na and other SIFIC infection horizons　

Author: Wu Yuan Li Na Jin Wenting Ma Yuyan

Review: Hu Bijie and Pan Jue

First, a brief introduction to medical history

Male, 63 years old, from Shanghai, was admitted to the Infectious Diseases Department of Zhongshan Hospital for the second time on November 23, 2022.

Chief complaint: indwelling catheterization with repeated urine color turbidity for 2 months and then 8 days.

Current medical history:

On September 19, 2022, I went to a hospital in Shanghai for fatigue, anorexia and dysuria. WBC 10.12×10 9/L, N 87.6%, Hb 53g/L, hsCRP 135.22mg/L, ESR 62mm/H, albumin 30.1g/L, Scr 589μmol/L, K 2 were examined. Urine routine: WBC 3892/ul, occult blood 3+/RBC 5579/ul, protein 2+; Chest CT: bilateral pleural effusion, partial atelectasis of lower lobe of both lungs; Abdominal pelvic CT: Bilateral middle and upper ureteral dilatation and renal pelvis and calyceal dilatation, the patch in the right part of calyceal is slightly high density, the bladder wall is thickened, there is a little flocculent blur around the left renal fat sac and ileocecal part, and there is a little effusion in the pelvic cavity. A large amount of turbid urine was drained by indwelling catheter. Urine culture showed that Klebsiella pneumoniae was positive. Considering urinary tract infection, acute kidney injury, hypokalemia and severe anemia, patients were given symptomatic support treatment such as anti-infection, bladder irrigation, antioxidation, potassium supplementation and blood transfusion. The symptoms of patients improved and the urine was slightly clarified. 10-18 Review urine routine: WBC3+, RBC3+, protein 1+, SCR 263 μ mol/L.

I was admitted to our department on October 19, 2022. Blood routine: WBC 5.08X10 9/L, N 66.1%, inflammatory markers: ESR 19mm/H, hsCRP 52.3mg/L, PCT 0.52ng/ml, Scr 257μmol/L, and urine routine: WBC 28493/μ. Urinary color Doppler ultrasound: hydronephrosis, bilateral ureteral dilatation, bladder wall thickening significantly; Abdominal pelvic CT: hydronephrosis of both renal pelvis and ureter, thickening of ureter wall (inflammatory change), inflammatory change of bladder and ureter may be large, the volume of both kidneys increases and the substance is thin. Meropenem 1g q12h is given for empirical anti-infection. Urology consultation considers the acute stage of infection, so it is not suitable to put double J tubes. If necessary, pyelostomy can be done, but it does not improve renal function much. Bladder irrigation is recommended. 10-20 middle-stage urine culture (sampling on October 19): Klebsiella pneumoniae was positive; 10-22 urine culture drug sensitivity: Carbapenem-resistant Klebsiella pneumoniae (CRKP), adjusted to ceftazidime and abamectin 2.5g q12h for anti-infection, and daily bladder irrigation. After treatment, the urine color of the patients gradually became clear, and the urine white blood cell and bacterial count gradually decreased during follow-up. The urine bacterial culture was negative on November 1 and November 4. Check the urine routine on November 09: WBC 28/uL, RBC 4/uL, urine protein+,bacterial count 29/UL;Blood WBC 7.64×10 9/L, N 76.5%, hs-CRP 0.4mg/L, ESR 25mm/H, PCT 0.18ng/mL, Scr 175μmol/L, which were significantly improved compared with those at admission. Stop ceftazidime and abamectin on November 11 and be discharged.

On November 15, 2022, the patient appeared turbid urine again, and there was no fever and other discomfort. On November 23, he was admitted to the hospital for a second diagnosis and treatment.

Past history: In September, 1991, T12-L1 comminuted fracture was treated with internal fixation. After operation, the catheter was retained for half a year due to urinary incontinence, and then the catheter was removed after urination. There was no urinary tract infection during this period. Diabetes for 16 years, insulin therapy, blood sugar control can be; Hypertension for 5 years, oral amlodipine to reduce blood pressure, blood pressure control can be.

Second, the admission examination (admitted on November 23, 2022)

[physical examination]

T: 36.2℃ P: 90 times/min R: 20 times/min BP: 176/105 mmHg.

Stay in bed, feel refreshed and calm, lose weight, and muscle atrophy of lower limbs; Breathing sounds in both lungs are thick, and dry and wet rales are not heard; The rhythm of the heart is regular, the abdomen is soft, without tenderness and rebound pain, without mass, without percussion pain in both kidneys, without tenderness at ureter point and rib and waist point, and the lower abdomen does not touch the enlarged bladder. During indwelling catheterization, the urine in the urine collection bag is turbid and more white flocs are deposited. Limbs are not swollen.

[Laboratory examination]

Blood routine: WBC 7.85×10 9/L, N 81.3%, HB 121g/L, PLT 170×10 9/L.

Urine routine: WBC 2775/μ l; RBC 2/μl, bacterial count: 39879/μl, nitrite positive, leukocyte esterase+++.

Inflammation markers: hs-CRP 17.9mg/L, ESR 68mm/H, PCT 0.12ng/mL.

Biochemistry: ALT/AST 23/21U/L, Alb 47g/L, Scr 199μmol/L, eGFR 30ml/min/1.73m2, na/k 140/5.5mmol/l.

Third, clinical analysis

Characteristics of medical history: middle-aged and elderly male, indwelling catheter, with repeated urinary turbidity and abnormal urine routine. Urine culture showed CRKP one month ago, and it improved after ceftazidime-ababactam treatment, but urine turbidity reappeared three days after drug withdrawal, blood inflammatory index increased, urinary leukocyte and bacterial count increased significantly, and the diagnosis of urinary tract infection was clear. The reasons for short-term recurrence after antibacterial drug treatment improved were considered:

Recurrence of CRKP infection: The patient has been indwelling catheter for 2 months, and there may be biofilm formation of catheter and abnormal urinary tract structure, which makes it difficult to completely eliminate the infection and relapse after stopping taking the drug. Therefore, urine culture and drug sensitivity test can be improved.

New infection: the patient has high risk factors of recurrent urinary tract infection, and the pathogen may be different each time. The patient’s previous CRKP infection treatment was effective, and the possibility of new pathogen infection should be considered in the short term, until the urine culture is perfect and clear.

Multiple infections: patients with abnormal urinary tract structure, indwelling catheter and other risk factors can not be removed, so it is necessary to be alert to the possibility of multiple pathogens including fungi combined with infection, repeat the cultivation of urine bacteria, mycoplasma, fungi and mycobacteria, and improve urine mNGS to help clarify the infected pathogens.

Four, further examination, diagnosis and treatment process and treatment response

On November 23, 2022, the middle urine smear was used to find bacteria: moderate amount of G- bacilli, and continued ceftazidime and abamectin 2.5g q12h ivgtt for anti-infection and bladder irrigation.

On November 26, 2022, the bacterial drug sensitivity of the middle-stage urine culture (sampling on November 23) was CRKP, ≥ 100,000 /ml, and urine mNGS: a large number of Klebsiella pneumoniae (species strict sequence number: 406,866) was detected.

On November 29, 2022, the abdominal and pelvic CT was reexamined: bilateral dilated hydronephrosis accompanied with inflammatory changes of ureter, and the parenchyma of both kidneys was thin, and the inflammatory changes of cystitis might be larger, similar to that of 22-10-20 slices.

November 30, 2022 (sampling on November 29): Enterococcus faecalis was positive. On December 2, according to the drug sensitivity, fosfomycin 3g qod was added orally, and ceftazidime and abamectin were suspended.

Repeated urine cultures on March, April and June, December, 2022: Enterococcus faecalis was positive and CRKP was negative.

On December 8, 2022, the urine WBC was 38738/μ L, and the bacterial count was 43285/μ L; Urine culture: CRKP positive, Enterococcus faecalis negative.

Phage therapy was carried out from the afternoon of December August, 2022: Phage cocktail (composed of 5 strains of Klebsiella pneumoniae phages A103KP172, A106KP176, A121KP192, A49KP106 and A58KP118, 5mL each), injected with 225mL physiological saline (according to the estimated bladder volume), and the total volume was 250mL, and then the catheter was clamped.

Urine routine on the third day of phage treatment on December 11, 2022: white blood cell count: 235/uL, bacterial count: 722/uL；; Urine bacterial culture was negative.

Urine routine on the 5th day of phage therapy on December 13th, 2022: white blood cell count: 279/uL, bacterial count: 92/ul; Urine bacterial culture was negative; Blood WBC 6.35X109/L, N 70%, hs-CRP 0.9mg/L, ESR 26mm/H, and inflammatory index decreased compared with before; Re-examination of urinary color ultrasound showed that bilateral renal pelvis separation and upper ureteral dilatation were better than before (10-20), and the thickness of bladder wall was reduced (12-25mm→13mm).

He was discharged from hospital on December 14, 2022 for follow-up.

V. Final diagnosis and diagnosis basis

Final diagnosis:

Complex urinary tract infection (CRKP, Enterococcus faecalis)

Neurogenic bladder, hydronephrosis and hydroureter (indwelling catheter)

Renal insufficiency

Diagnostic basis:

The patient is a middle-aged and elderly male with neurogenic bladder caused by paraplegia, indwelling catheter, turbid urine with flocs, increased CRP and PCT, significantly increased WBC and bacterial count in urine, repeated CRKP positive in urine culture, positive in enterococcus faecalis, abdominal basin CT: hydronephrosis of renal pelvis and ureter, anti-infection, normal inflammatory markers and urine routine after phage treatment, clear urine and negative urine culture, so complicated urinary tract infection.

The patient suffered from anorexia and dysuria, and the serum creatinine increased obviously. Abdominal CT showed that both kidneys were enlarged, the cortex was thin, and bilateral urinary tract was hydronephrosis. After active treatment such as controlling infection and improving renal function, the serum creatinine decreased, so the diagnosis of renal insufficiency was clear.

Six, experience and experience

Phage is a targeted sterilization virus in nature and a sterilization star in the "pre-antibiotic era". Phage therapy has a history of more than 100 years, but the discovery and application of broad-spectrum antibiotics have gradually marginalized it. With the increasingly serious problem of bacterial drug resistance, phages have once again received attention and become the most promising supplement and alternative therapy for treating superbugs. The clinical application of phage in China is relatively late, but it has developed rapidly in recent years. In 2017, the Shanghai Institute of Phage and Drug Resistance was established, with Professor Hu Bijie as an academic member. Since 2018, the institute has carried out the first clinical trial of phage therapy in China. At present, it has treated nearly 100 patients with drug-resistant bacterial infections from all over the country and accumulated rich clinical experience in phage therapy, which is a leading position in the field of clinical phage therapy in China.

Phage has many advantages, such as host bacteria dependence, targeted specific sterilization, no infection to eukaryotic cells (little influence on normal flora), no influence on bacterial drug resistance, synergy with antibacterial drugs, penetration of biofilm and so on. The cure rate of acute bacterial infection is high, and the therapeutic effect of chronic bacterial infection is no less than that of antibacterial drugs, and the safety of phage treatment is also extremely high. A systematic retrospective study showed that the vast majority of patients who received phage therapy had no or only slight adverse reactions, 86.7% patients’ clinical symptoms improved, and 78.8% patients achieved the eradication of pathogenic bacteria. Our clinical trials also show that more than 70% of patients have achieved good therapeutic effects, and there are no obvious cases of adverse reactions. This patient was repeatedly infected with Klebsiella pneumoniae due to long-term paraplegia, abnormal urinary tract structure, indwelling catheter and other factors. The diagnosis of complicated urinary tract infection was unquestionable, and the choice of antibacterial drugs was limited due to multi-drug resistance and renal insufficiency. Phage therapy is very suitable.

The disadvantages of phage therapy include narrow host spectrum, individualized plan (it is difficult to treat empirically), no unified standard for the best treatment decision, and rapid tolerance. Phage cocktails, combined antibacterial drugs and multiple treatments are usually used in clinic to improve the curative effect. At present, the targeted pathogens of phage therapy in our team mainly include: multi-drug resistant Gram-negative bacteria (Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli) and Gram-positive bacteria (Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecalis); Covering respiratory system, urinary system, abdominal cavity, bones and joints, skin and soft tissue and other infected sites; Treatment depends on the site of infection, and intravenous application of phage is still being explored. In this case, the patient didn’t have percutaneous nephrostomy because of the little clinical benefit, so he was treated by transurethral bladder perfusion, and the phage could not cover the whole urinary tract evenly. Although the pathogen turned negative in a short period of time and was well tolerated, its long-term curative effect may not be good, and it needs repeated phage treatment.

Phage therapy has huge clinical demand and broad market. In recent years, our team has focused on the clinical application (treatment and prevention and control of nosocomial infection) and basic research of phage therapy, with a view to becoming a powerful weapon to curb drug-resistant bacteria in the future.

references

[1] Uyttebroek S, Chen B, Onsea J, Ruythooren F, Debaveye Y, Devolder D, Spriet I, Depypere M, Wagemans J, Lavigne R, Pirnay JP, Merabishvili M, De Munter P, Peetermans WE, Dupont L, Van Gerven L, Metsemakers WJ. Safety and efficacy of phage therapy in difficult-to-treat infections: a systematic review. Lancet Infect Dis. 2022 Aug; 22(8):e208-e220.

[2] Chegini Z, Khoshbayan A, Taati Moghadam M, Farahani I, Jazireian P, Shariati A. Bacteriophage therapy against Pseudomonas aeruginosa biofilms: a review. Ann Clin Microbiol Antimicrob. 2020 Sep 30; 19(1):45.

[3] Lusiak-Szelachowska M, Weber-Dabrowska B, Gorski A. Bacteriophages and Lysins in Biofilm Control[J]. Virol Sin, 2020,35(2):125-133.

Every Monday night

The Department of Infectious Diseases of Zhongshan Hospital affiliated to Fudan University in Shanghai will be with you!

Photo: Xiaoxiao

Original title: "Detective Case: The Nemesis of Super Bacteria is Coming"

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Xinhua Silk Road, Beijing, September 2 (Reporter Dong Daoyong) "How to enjoy preferential tax agreements? How to prevent overseas tax risks? How to deal with issues such as the collection and management of overseas tax authorities is a huge test for’ going out’ enterprises. " Linlin Chen, finance minister of Ningbo Xinmingda Knitting Co., Ltd. said.

Rules and standards are the bridge and link to promote interconnection. Since the "One Belt, One Road" initiative was put forward, China has taken "soft connectivity" as an important support, steadily expanded institutional opening, and continued to promote cooperation with the co-construction countries in the fields of standards and norms, tax collection and management, intellectual property rights, digital information, etc., and promoted the co-construction of the "Belt and Road" along the direction of high-quality development.

"One Belt, One Road" cooperation in tax collection and management has gone deep and solid.

Taxation plays an important role in the national governance system, playing a fundamental, pillar and supportive role. Because there are many differences in the level of economic development, tax design and the ability of tax collection and management, strengthening coordination and cooperation in the field of taxation plays an increasingly important role in promoting the high-quality construction of the Belt and Road.

In April 2019, the first multilateral tax cooperation platform initiated by China-the "Belt and Road" tax collection and management cooperation mechanism was formally established, which played an important role in strengthening the capacity building of tax collection and management and promoting the construction of a growth-friendly tax environment. At present, the number of members of the Council of the cooperation mechanism has increased to 36, and the number of observers has increased to 30. The "circle of friends" and its influence have continued to expand.

"There are many uncertainties in setting up companies abroad and opening up overseas markets. The difference in tax policies between different countries is a problem we often encounter." Jiang Jingyuan, chief financial officer of China Yituo Group Co., Ltd. said that on the way of "going out", the tax authorities took the initiative to sort out the tax-related guidelines for overseas investment in advance, and provided accurate guidance on the preferential treatment of tax treaties and tax risks involved during the establishment of the company, which solved the worries of enterprise development.

The picture shows the tax bureau of Runzhou District, Zhenjiang City, State Taxation Administration of The People’s Republic of China, going to the "going out" enterprises to publicize the latest preferential tax policies for international taxation.

In terms of "going global", China has signed agreements to avoid double taxation with 112 countries (regions) around the world, which basically covers the main destinations of China’s foreign investment and most of the "Belt and Road" partners, providing a strong tax legal guarantee for "going global" enterprises to eliminate double taxation and resolve cross-border tax-related disputes.

In terms of "bringing in", the electronic tax bureaus of various provinces, autonomous regions and municipalities in China have recently launched the scene of "non-resident cross-border taxation", and non-resident enterprises around the world can apply for tax-related matters online to realize "one place registration and coding, national mutual recognition".

Meng Yuying, director of the International Taxation Department of State Taxation Administration of The People’s Republic of China, said that at a new starting point, the tax authorities will give full play to their tax functions, take the initiative to serve the overall situation of the country, and make greater efforts to help build the "Belt and Road".

The "Belt and Road" standard cooperation is getting closer and closer.

Research by the Organization for Economic Cooperation and Development (OECD) shows that standards and product conformity assessment affect 80% of global investment and trade, and technical standards can promote economic globalization and investment facilitation. Since the "One Belt, One Road" initiative was put forward, the pace of China’s participation in international standards has accelerated.

Bi Shunjie, managing partner of Ernst & Young’s Greater China business, said that the "soft connectivity" of rules and standards is an important support for building the "Belt and Road Initiative" with high quality. Constantly strengthening the construction of international cooperation mechanism is the key to jointly build the "Belt and Road Initiative" and "Soft Unicom".

The picture shows the construction site of the Sino-Thai railway photographed by Nakhon Ratchasima, Thailand. The Sino-Thai Railway is designed and built according to China standards. It is the flagship project of "One Belt, One Road" jointly built by China and Thailand and the first standard gauge high-speed railway in Thailand. (photo of drone, taken on February 23, 2023)

The reporter learned that in order to support the "Belt and Road" high-quality co-construction, the State Administration of Markets took the lead in building the "Belt and Road" national standard information platform, conformity assessment service trade facilitation information platform and technical trade measures public service platform, and promoted the "Belt and Road" to build national standards connectivity.

Since 2014, China has signed 43 standardized cooperation agreements with 36 countries and international (regional) organizations that have jointly established the Belt and Road Initiative, and signed 127 conformity assessment cooperation documents and agreements with more than 30 countries and regions, thus establishing a national cooperation and exchange platform with the Belt and Road Initiative.

"Promoting the" One Belt, One Road "initiative requires continuous pioneering and innovation in all walks of life, and it can also promote the common prosperity of the whole society." Bi Shunjie said that to continuously strengthen the "soft connectivity" of the "Belt and Road" international rules and standards, it is necessary to pay attention to and handle the multi-party relations, especially to give play to China’s guiding role.

"One Belt, One Road" intellectual property cooperation is mutually beneficial and win-win

In the past ten years, China has continuously expanded its opening to the outside world, and the layout of national intellectual property rights jointly built with the "Belt and Road" has been strengthened in both directions. The data shows that in the past ten years, a total of 115 countries that have jointly built the "Belt and Road" have applied for patents in China, with a total of 253,000 patents, with an average annual growth rate of 5.6%.

In 2022, the number of patent applications filed by enterprises in China in the countries jointly building the Belt and Road Initiative reached 12,000, up 16.4% year-on-year. Among them, the number of applications in the three technical fields of motors, electrical devices, electric energy, medicines, materials and metallurgy increased by more than 70% year-on-year. The continuous activity of patent applications shows the vitality of the "One Belt, One Road" initiative.

The picture shows the scene of the first meeting of directors of intellectual property offices in China-Central Asia. The meeting conducted in-depth exchanges on intellectual property cooperation between China and Central Asia and adopted the Joint Statement of the First Meeting of Directors of Intellectual Property Offices in China-Central Asia.

In the past ten years, strengthening communication and cooperation in the field of intellectual property rights has been supported and responded by countries that have jointly built the "Belt and Road". Up to now, China has signed cooperation agreements with 56 national intellectual property management institutions, and promoted the exchange of intellectual property information and business sharing among countries by providing "cloud patent examination" system accounts to nearly 30 countries.

Cai Zhonghua, a professor at beijing university of chemical technology, said that China and the co-construction countries continued to promote technical exchanges and cooperation between the co-construction countries on the basis of deepening intellectual property cooperation agreements and the rapid growth of two-way patent layout, which provided important support for the high-quality development of the Belt and Road Initiative.

　　Northeast Network June 28 News Entering the midsummer, the weather is hot, and drinking cold drinks and eating kebabs has become the first choice for many consumers. A few days ago, the Municipal Food and Drug Administration issued a food safety consumption reminder. The general public should not covet the delicious barbecue food. They should try to choose businesses with complete licenses and good sanitary conditions, and try to choose healthier electric roasting processing methods to be safe.

　　It is understood that eating electric kebabs is healthier than eating charcoal kebabs, because high-temperature cooking or putting food directly on a charcoal fire will produce harmful chemicals such as carbon monoxide, while electric kebabs can effectively control the baking temperature, avoid contact with naked flames, have uniform heat, prevent burning, and greatly reduce the generation of carcinogens. In addition, you should choose grilled kebabs. Some kebabs, though delicious, are difficult to be effectively sterilized due to uneven heating and low central temperature, and may contain pathogenic microorganism residues, which are all hidden dangers. Therefore, kebabs should pay attention to the heat before eating, and citizens should control their high appetite and not eat too much at a time.

　　In addition, if you choose to eat barbecue in the store, you should try to choose a restaurant with complete licenses and good sanitary conditions. If you make your own kebabs, you must keep in mind that fresh ingredients taste good, cut into small pieces and keep them at low temperature. It is necessary to clean the barbecue utensils frequently, and the seasoning is qualified. It is necessary to keep away from charcoal fire and turn them frequently, and smoke flames cannot be roasted.

Original Chen mo mo duo la Wen Yao

Hello, I’m Chen Mo, a clinical pharmacist who wants to fill in all the knowledge of pharmacy.

Now is the outbreak season of influenza. Xiaobian has written several related tweets one after another, but the backstage still receives many readers’ questions, such as: What is the difference between influenza and cold? So, today we will explore this problem together.

01/

What is the flu?

First of all, the flu is a cold, but not all of it.

How can I put it? The full name of influenza is influenza, which is a highly contagious acute respiratory disease caused by influenza virus. Every year, it causes seasonal epidemic in the world, and can cause unpredictable pandemics, with a high incidence rate, posing a huge threat to human health.

To put it bluntly, influenza is an acute respiratory infectious disease with strong infectivity and rapid spread.

According to the antigenicity difference between nucleoprotein and matrix protein M1, influenza viruses can be divided into four types: A, B, C and D, and their characteristics are shown in Table 2.

Influenza viruses can be divided into four types: A, B, C and D (see Figure 1. Click to view a larger image). Among them, influenza A viruses, such as H1N1 and H3N2 subtypes, are more likely to spread rapidly among people because of their easy mutation or rearrangement, and many large-scale outbreaks of influenza in history are related to influenza A viruses.

Fig. 1. Pathogenic classification and characteristics of influenza virus. Photo production: Chen Mo Pharmacist

02/

The common cold

The common cold, which we often say, is a disease confined to the upper respiratory tract. Its clinical manifestations are nasal congestion, runny nose, sore throat and cough, which can be caused by different kinds of virus infections. It is a self-limited disease, and the duration of symptoms is usually less than 10 days.

What are the common causes of the common cold?

The most common is rhinovirus (RV), others are coronavirus, parainfluenza virus, respiratory syncytial virus (RSV), adenovirus and so on.

In addition, human metapneumovirus, enterovirus, mycoplasma pneumoniae and chlamydia pneumoniae infection can also cause cold-like symptoms. Other new respiratory viruses, such as SARS-CoV-2ο and δ mutant, can also be the cause of colds.

Cold like symptoms

Cold symptoms mainly include sore throat, sneezing, headache, general malaise, chills, fever, runny nose, nasal congestion and cough, among which nasal congestion and runny nose are the most prominent symptoms that make patients feel uncomfortable.

03/

The difference between flu and common cold

Here is a table to show (Figure 2. Click to view a larger image):

Figure 2. The main differences between influenza and common cold. Photo production: Chen Mo Pharmacist

——–See you next time.

Original title: "Is the flu a cold? What’s the difference with the common cold? (collectible) "

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