Cctv news：Look at the economy through data, and look at achievements through the economy. On May 10th, "News Network" reported new initiatives in the fields of original technology source layout construction, aerospace and people’s livelihood, as well as new achievements in fixed assets investment construction and consumption promotion activities. At the same time, combined with the good news released by the Ministry of Finance, the Ministry of Agriculture, the National Development and Reform Commission and other departments, the achievements in various fields boosted confidence and China’s economy was "uplifting".

All walks of life work hard to help China’s economy "pull up"

The layout and construction of the second batch of original technology sources of central enterprises started.

A few days ago, the State-owned Assets Supervision and Administration Commission of the State Council launched the layout construction of the second batch of original technology sources of central enterprises. 58 central enterprises have built 97 original technology sources. At the same time, the overall layout of 201 directions in 60 fields in 8 categories has been optimized. Among them, in 36 fields such as quantum information, brain-like intelligence and bio-manufacturing, 40 central enterprises are supported to lay out 52 original technology sources.

In the next step, the State Council State-owned Assets Supervision and Administration Commission will implement 11 action plans, such as "Strengthening Applied Basic Research", and strive to achieve a number of original achievements in the fields of quantum information, 6G, deep sea, controlled nuclear fusion and cutting-edge materials, accelerate the development of new quality productivity, and effectively lead and support the construction of modern industries.

30 billion yuan savings bonds will be issued on the 10th.

From May 10th to May 19th, the Ministry of Finance issued the third and fourth issue of this year’s voucher-style savings bonds, with a total amount of 30 billion yuan. Among them, the third and fourth periods are 3 years and 5 years respectively, and the annual coupon rate is 2.38% and 2.5%.

2024 China Brand Day was launched in Shanghai.

On May 10th, 2024 China Brand Day was launched in Shanghai with the theme of "China Brand, World Sharing; Domestic products are trendy, and products build the future. " The exhibition covers an area of 70,000 square meters, with nearly 1,800 enterprises participating. In the meantime, the first show of new products and the beautiful market of brands will be held, and the activities will last until the 14th.

The 7th Digital China Construction Summit will open on May 24th.

The State Council Press Office held a press conference on May 10th to introduce that the 7th Digital China Construction Summit will be held in Fuzhou from May 24th to 25th. With the theme of "releasing the value of data elements and developing new quality productivity", this summit will set up an opening ceremony, a main forum, 13 sub-forums and a live experience area.

In the first four months of this year, the national railway completed 184.9 billion yuan in fixed assets investment.

The reporter learned from China State Railway Group Co.,Ltd. on May 10th that since the beginning of this year, China State Railway Group Co.,Ltd. has given full play to the leading role of railway investment, focused on networking, supplementing the network and strengthening the chain, and promoted railway engineering construction with high quality. In the first four months, the investment in fixed assets has continued to grow.

Data show that from January to April this year, the national railway completed 184.9 billion yuan in fixed assets investment, up 10.5% year-on-year, and the construction of a modern railway infrastructure system was accelerated. In April, a number of key projects under construction achieved phased results: the track laying of Meizhou-Longchuan high-speed railway was completed, the tunnel of Chongzuo-Pingxiang section of high-speed railway was connected to the south, the track laying of Wuhan-Yichang section of Shanghai-Chongqing-Chengdu high-speed railway began, the Tianjin hub project of Tianjin-Weifang high-speed railway began to pour box girders, and the Heizhigang tunnel of Shenyang-Baihe high-speed railway was successfully connected; The Lanzhou-Wuwei section of Lanzhang high-speed railway and the Bazhong-Nanchong high-speed railway started the joint debugging test, and the operation entered the countdown; Chizhou-Huangshan high-speed railway officially opened for operation, injecting new kinetic energy into the development of tourism economy along the route.

The energy structure was further optimized.

In the first quarter of this year, new energy power generation increased significantly.

The reporter learned from the China Coal Industry Association that in the first quarter of this year, while China’s electricity consumption was increasing, coal-fired power generation declined, the proportion of new energy power generation further increased, and China’s energy structure was further optimized.

The data shows that in March, China’s raw coal output above designated size was 400 million tons, down 4.2% year-on-year. In the first quarter, the output of raw coal above designated size in China was 1.11 billion tons, down by 47 million tons or 4.1% year-on-year. At the same time, the power generation of renewable energy has steadily increased. In the first quarter, the national renewable energy power generation reached 687.5 billion kWh, accounting for about 30.7% of the total power generation. Among them, the photovoltaic power generation of wind power reached 425.3 billion kWh, a year-on-year increase of 25%.

Good news in the fields of aerospace and science and technology

Chang ‘e-6 carried Pakistan CubeStar to complete the first data handover.

On May 10th, the international payload Pakistan CubeStar, which was carried to the moon by Chang ‘e-6 probe, completed the first data handover and released the latest space photos taken by the star. Chang ‘e VI carried four international payloads from France, ESA, Pakistan and Italy.

China’s first interplanetary scintillation monitoring telescope was officially built.

On May 10th, one of the major equipments in the second phase of Meridian Project, a major national science and technology infrastructure — — The first interplanetary scintillation monitoring telescope in China, located in Xilin Gol League, Inner Mongolia, was officially built. The telescope’s detection sensitivity and other performance indicators have reached the international leading level, which will monitor and capture the dynamic propagation process of solar storms in interplanetary space and provide key data support for China’s space weather forecast.

Take many measures to ensure people’s livelihood.

Seven departments issued opinions to strengthen the supervision of pre-payment of old-age care institutions

Seven departments, including the Ministry of Civil Affairs, recently issued opinions to strengthen the supervision of pre-payment of pension institutions, requiring that the period of pre-payment of pension service fees should not exceed 12 months at the longest, that pre-payment fees should not be used for high-risk investments such as securities, and that deposits and membership fees should be managed by means of third-party depository of commercial banks and risk deposits to ensure the safety of funds.

The state has allocated a total of 11.5 billion yuan for special investment in work-for-relief projects.

The reporter learned from the National Development and Reform Commission that China has issued a special central investment of 11.5 billion yuan in 2024, which will attract 250,000 rural people who will drive the project to achieve local employment.

According to reports, the special investment of the central government for work relief is mainly invested in underdeveloped areas such as 832 poverty-stricken counties, and at the same time, it is tilted to North China, Northeast China such as Beijing-Tianjin-Hebei, which is seriously affected by heavy rains and floods, and Gansu and Qinghai provinces related to the Jishishan earthquake-stricken area, giving priority to attracting low-income people to participate in project construction.

At the same time, the central fund for work-for-relief will also improve local infrastructure conditions. In 2024, it is planned to build 10,800 kilometers of roads, such as Tongcun Road and production service road, carry out farmland renovation of 154,800 mu, excavate or lay 83,500 kilometers of water supply and drainage networks, build 6,377 small bridges, culverts and ponds, build 4,230 kilometers of small dikes and main canals, and support 631 administrative villages to carry out renovation and upgrading of beautiful countryside.

Consolidate the harvest "bottom spirit"

According to the latest agricultural dispatch of the Ministry of Agriculture and Rural Affairs, at present, the summer grain harvest in Southwest China has reached 43.7%, with the progress being 1.4 percentage points faster than that of the same period last year. Among them, winter wheat has been harvested by 35.5%, and the progress is 1.3 percentage points faster than that of the same period last year.

Promoting "One Spray and Three Preventions" in Main Producing Areas to Promote Stable Production and Increase Production

At present, there are less than 20 days before the large-scale harvest of winter wheat in China, which is the key window period for implementing the technology of "one spraying and three prevention" to stabilize and increase production. The main producing areas should formulate technical plans according to local conditions, and make every effort to organize the "one spraying and three prevention" of wheat.

This year, for the first time, the central government fully allocated 1.6 billion yuan for "one spray and three defenses" in advance, leaving enough time for the implementation of policies and technical measures, effectively promoting stable wheat production and increasing production.

In the high-standard farmland of 10,000 mu of wheat in Guhe Street, Laixi, Shandong Province, the local agricultural machinery cooperative is jointly carrying out the operation of "one spray and three defenses". Wheat "one spraying and three prevention" is a technical measure to prevent disasters and increase production without disasters, which plays an important role in preventing diseases and pests at the ear stage, preventing premature aging of wheat, preventing dry-hot wind and ensuring stable and bumper harvest of wheat. In view of the short operation time and high technical requirements of "one spraying and three prevention" of wheat, Shandong Laixi Group sent capable technical force to carry out service guidance in time to ensure full coverage of spraying and prevention operations.

Bozhou, Anhui Province, relies on the Agricultural Machinery Cooperative to set up a spraying and control team in advance. In Shuanglou Village, Qiaocheng, the local agricultural machinery professional cooperative is spraying foliar fertilizer on wheat. Bozhou organized more than 500 agricultural technicians to guide households in Baocun to the field, focusing on implementing "one spray and three defenses" to ensure high yield and bumper harvest.

According to the dispatch of the Ministry of Agriculture and Rural Affairs, at present, under the instigation of the central financial subsidy funds, local governments at all levels have invested 1.59 billion yuan in the "one spraying and three prevention" subsidy funds, and the cumulative spraying operation area is 228 million mu, accounting for more than 60% of the winter wheat planting area.

　　CCTV News:In addition to high-standard farmland construction, China has actively promoted excellent varieties of food crops and strengthened technical guidance, effectively reducing disaster losses such as drought.

　　According to reports, this year, the Ministry of Agriculture and Rural Affairs selected and released 128 leading varieties of grain and oil production. In terms of excellent varieties, it achieved full coverage of improved varieties of grain crops, which strongly supported the stable production and increase of autumn grain this year. The reporter learned that some new varieties with high quality, high yield and drought resistance have played a role in some drought-stricken areas in the south.

　　Cao Zhibin, Head of High Temperature Resistant Rice Project of Jiangxi Academy of Agricultural Sciences:The new high-temperature resistant rice varieties we have developed can effectively solve the problem of low seed setting rate of rice under continuous high temperature, and our measured yield per mu should reach more than 1300 kilograms.

　　Qian Qian, Academician of China Academy of Sciences:Varieties with high quality, high yield and drought tolerance have played a very important role this year. When I went to Jiangsu, I found that these varieties are basically good in fruiting, and the overall (drought) impact is there, but the impact is controllable.

　　According to reports, in the critical period of autumn grain production, the Ministry of Agriculture and Rural Affairs has formulated and issued six technical guidance opinions on rice resistance to high temperature and heat damage and corn resistance to high temperature and drought in the south, and sent 25 contact guidance working groups, 10 expert guidance groups and 12 scientific and technological teams to provide in-depth production of first-line guidance services.

　　Zhu Juan, Director of Agricultural Information Division, Planting Management Department, Ministry of Agriculture and Rural Affairs:In view of the high temperature and drought in the south, the central government allocated 10 billion yuan to support the drought resistance of mid-season rice. The Ministry of Agriculture and Rural Affairs, together with relevant departments, tried every means to dispatch drought-resistant water sources, drill wells for irrigation, and implement measures such as "spraying drought-resistant water-retaining agent", replanting and replanting, which effectively reduced disaster losses.

In most people’s cognition, only sallow and emaciated, short stature and skinny bones are malnutrition, while the 2016 Global Nutrition Report released recently believes that malnutrition should also include obesity, diabetes, heart disease, hyperlipidemia and other nutrition-related chronic diseases. Moreover, the global malnutrition problem is particularly serious, which has become the biggest factor causing the global disease burden.

Then, what exactly is malnutrition, why obesity and diabetes are also malnutrition, and how can people correctly supplement nutrition in life? The reporter interviewedYou Xiangmei, Director of Nutrition Department, No.117 Hospital of PLA.

The global malnutrition problem is severe.

According to the 2016 Global Nutrition Report, the global nutrition report conducted research in 129 countries and found that one out of every three people in the world was malnourished.

The World Food and Agriculture Organization reported in 2013 that 923 million people in the world were undernourished in 2007; The World Health Organization reported in 2013 that malnutrition is the leading cause of child death worldwide, accounting for 45% of all child deaths; The Cancer Nutrition and Support Committee of China Anti-Cancer Association reported that the malnutrition rate of cancer patients in China was as high as 67%.

Malnutrition can be divided into two types.

Director You introduced that malnutrition usually refers to malnutrition caused by insufficient intake, malabsorption or excessive loss of nutrients, but it may also include overnutrition caused by overeating or excessive intake of specific nutrients. In other words, malnutrition includes undernutrition and overnutrition.

There are three forms of malnutrition: energy deficiency malnutrition, protein deficiency malnutrition and mixed malnutrition. The causes of malnutrition are improper feeding in infancy; Poor eating habits; Some diseases affect appetite, hinder food digestion and absorption, and increase the consumption of the body.

There are two typical symptoms of malnutrition.

1 emaciation type

Short stature, emaciation, loss of subcutaneous fat, weakness and fatigue in children caused by serious shortage of thermal energy.

2 edema type

It is caused by the serious lack of protein, with edema all over, dry and atrophied skin, fragile hair, loss of appetite, large liver and frequent diarrhea.

Overnutrition is actually another "malnutrition symptom". Due to the improvement of living standards, people tend to choose meat or high-fat food, as well as exquisite and sweet food, and the intake of high-fiber food is too small, which leads to overnutrition.

Why do chronic diseases such as diabetes and heart disease belong to malnutrition?

Director You explained that people are no longer facing food shortage, but food quality problems. Many people think they are full, but in fact they are in a state of "latent hunger". They lack necessary trace elements, such as iron, vitamin A and iodine, so their health is not good. Many people suffer from diseases such as heart disease, stroke and diabetes due to long-term nutritional imbalance.

Furthermore, many people are getting less and less exercise, but they are eating more and more fast food or processed food, which is often too high in calories and lacks other nutrients.

News playback

According to a survey conducted by China Youth Daily, nearly 60% of the respondents feel that there are many "ineffective social activities" in their circle of friends. Setting the message not to disturb and the number of days that the circle of friends can be seen is the main way for respondents to "reduce the burden" on their circle of friends. To establish high-quality social relationships, 68.3% of the respondents suggested setting a sense of boundaries for social interaction in leisure time, and dare to refuse certain social occasions. 53.6% of the respondents suggested distinguishing social accounts of work and life and dividing boundaries for different social interactions.

Host language

Man is a social animal. Efficient and deep social communication and the division of labor and cooperation arising from it are second nature of human beings. However, the history of technological progress has always been accompanied by the process of opposing technological alienation. People invented the circle of friends, and suddenly found that it has increasingly become a performance social show. Returning to common sense and looking back at the initial heart may be more important than measuring the effectiveness of social interaction.

Youth theory

Low-quality social interaction is far less than high-quality solitude.

In the information age, it is difficult to avoid the "invalid" part in social interaction, because there is no guarantee that everyone you meet will not come and go in the future, and there will be no place to ask for help in the future. Therefore, it is the best way to maintain the circle of friends with painstaking efforts. Low-cost courtesy, praise from friends and mass holiday blessings have become the best way.　

The development of the Internet has brought convenience to social interaction, but the pervasive network has made social interaction lose its sense of boundary and brought invisible pressure. The circle of friends visible to everyone can no longer share their lives as they please; Most of the group chat messages that keep popping up have nothing to do with themselves, but they are afraid of missing important notices; I can’t get rid of the dinner and meaningless greetings, and I’m afraid of saying the wrong thing, which takes my brain and trouble. Modifying the visible range of friends circle, folding group chat, setting grouping and other functions came into being. These are silent resistance to ineffective social interaction and awakening of self-awareness. Instead of creating people to please others, they set aside boundaries for their own lives and pay attention to their own feelings.

Rejecting ineffective social interaction and focusing on your heart is the most important thing. Low-quality social interaction is far less than high-quality solitude. In fact, taking interests and hobbies as social orientation rather than benefits is not only relaxing and enjoyable, but also can actively learn and accept more things, so that social interaction can return to its own meaning. High-quality social interaction requires first determining one’s social goals and goals, choosing social scope, conducting social activities in a directional way, and focusing time and energy on important people and things in order to establish a deep social relationship with them. In addition, spending time in high-quality solitude is also a way to communicate with yourself. You are the one who knows your own advantages and disadvantages best. Examining and refining yourself is also an important way to improve yourself. (Liang Shuang Guangxi University for Nationalities Xiangsihu College, 2020 undergraduate)

China Education News, July 18th, 2023, 2nd edition.　

Image source: interface gallery

"In 2023, the central power generation enterprises strengthened the management of thermal coal inventory, and the thermal coal inventory was always at a high level. The coal-fired generating units maintained safe and efficient operation, generating a total of 5.35 trillion kWh of electricity throughout the year, accounting for 52% of the national installed capacity and contributing 63% of the national power generation."

On January 24th, Li Bing, Deputy Secretary-General of SASAC, Director of Financial Supervision and Operation Evaluation Bureau and spokesperson, said at the press conference of the State Council Press Office.

This means that the proportion of coal-fired power generation in China has stopped the downward trend in recent years and returned to the level of 2019. From 2019 to 2022, the proportion was about 63%, 60.8%, 60% and 58.4% respectively.

The direct reason for the rebound in the proportion of coal-fired power generation is the increase in installed capacity and utilization hours of coal-fired power.

On January 30th, 2023-2024 National Power Supply and Demand Situation Analysis and Forecast Report issued by China Electric Power Enterprise Federation (hereinafter referred to as China Electricity Council) showed that by the end of 2023, the installed capacity of coal-fired power generation was 1.16 billion kilowatts, up 3.4% year-on-year, accounting for 39.9% of the total installed capacity.

Due to the drought in southwest China and the shortage of incoming water, the hydropower generation in power plants above designated size in China decreased by 5.6% in 2023. In the same period, the power generation of thermal power and nuclear power in power plants above designated size increased by 6.1% and 3.7% respectively.

According to the data of China Electricity Council, coal-fired power generation accounts for nearly 60% of the total power generation in 2023. "Coal-fired power is still the main power supply in China at present, effectively making up for the decline in hydropower output." China Electricity Council said.

In 2023, the utilization hours of power generation equipment in power plants of 6000 kilowatts and above nationwide were 3592 hours, down 101 hours year-on-year. Among them, hydropower was 3,133 hours, a year-on-year decrease of 285 hours; Thermal power was 4,466 hours, up 76 hours year-on-year.

In the past three years, the speed of coal-fired power approval in China has been accelerated.

In 2021-2022, the coal price in China rose sharply, and power cuts occurred in some areas, so ensuring supply became an important task for the coal industry. After that, the National Development and Reform Commission and other departments carried out various controls to optimize coal production and promote the approval and construction of advanced coal production capacity in an orderly manner.

According to Global Energy Monitor, a global energy monitoring organization, the amount of coal-fired power approved in China in 2022 is four times higher than that in 2021, reaching more than 106 million kilowatts, which is equivalent to approving two coal-fired power projects every week.

In 2023, China coal-fired power continued to be launched. Greenpeace’s Analysis on the Progress of Low-carbon Transformation in China Power Sector in the First Half of 2023 shows that in the first half of 2023, the total approved installed capacity of coal-fired power in China was 50.4 million kilowatts, accounting for 55.56% of the approved installed capacity in 2022, far exceeding the total approved capacity in 2021.

Last year, the installed capacity of wind power and photovoltaic in China increased significantly, but the contribution to the proportion of power generation was still limited.

According to the data of the National Energy Administration, by the end of 2023, the cumulative installed capacity of solar power generation was about 610 million kilowatts, up 55.2% year-on-year; The installed capacity of wind power was 440 million kilowatts, up 20.7% year-on-year.

Based on this calculation, the installed capacity of wind and light in China will be 1.05 billion kilowatts in 2023, which is about 38.2% higher than that in 2022, exceeding the predicted value of 1 billion kilowatts by China Electric Power Enterprise Association (hereinafter referred to as China Electricity Council) and accounting for nearly 36% of the total installed capacity.

Scenery has become the main source of the overall power installed growth in China. According to the data of the National Energy Administration, from January to November last year, the newly installed capacity of solar energy and wind energy was 205 million kilowatts, accounting for 72.5% of the newly installed capacity in China.

Although the installed capacity is gratifying, the wind power generation has not increased at the same rate. The National Energy Administration has not released the specific data of scenery power generation last year. In the first three quarters of last year, renewable energy accounted for about 49.6% of the total installed capacity, but the power generation accounted for only 31.1%.

Renewable energy includes non-fossil energy such as wind energy, solar energy, hydro energy, biomass energy, geothermal energy and ocean energy. Installed capacity refers to the sum of the rated effective power of the actually installed generator set, which is the theoretical upper limit of power generation; Power generation refers to the amount of electric energy generated by generator through energy conversion.

At the capacity market discussion seminar held by Greenpeace on January 25th, Yin Ming, director of China Power Project of Agora Energy Transformation Forum, pointed out that wind power generation is a kind of contractible power source with high installed capacity and low power consumption. Contraction power supply refers to those power supplies that have greater influence on the installed structure of power supply than on the generated structure, that is, high installed capacity and low generated capacity.

The conversion coefficient of installed power is the ratio of installed power generation to power generation. The larger the coefficient is, the smaller the influence of the change of installed power supply ratio on the change of power generation ratio is. As a contractible power source, the conversion coefficient of wind-solar power generation is greater than 1.

At the same time, Yin Ming said that in recent years, the conversion coefficient of installed capacity of wind power and photovoltaic has shown a downward trend, indicating that the influence of the change of installed structure of wind power generation on the change of power structure has shown a strengthening trend.

Alva Wang, a invited researcher at the 50-person Forum on Carbon Neutralization in China, pointed out at the meeting that the increase of new energy installed capacity has brought about an increase in power generation, but it has not brought about an increase in the effective capacity of the power system.

Capacity value refers to the power generation capacity that can be called by power supply to ensure the power supply adequacy of power system. Due to the low output of new energy guarantee, it can’t provide effective capacity, so it can only be replaced by electricity.

"If the electricity load increases, new energy can only provide electricity, and it still needs the corresponding installed support of traditional energy sources such as hydropower or coal power." Alva Wang said.

From the utilization hours, the utilization hours of scenery are lower than the average utilization hours of power generation equipment in power plants of 6000 kW and above in China.

Last year, the average utilization of power generation equipment in power plants with 6000 kilowatts and above nationwide was 3592 hours. Among them, the utilization hours of domestic grid-connected wind power are 2225 hours, up by 7 hours year-on-year; Grid-connected solar power generation was 1286 hours, a year-on-year decrease of 54 hours.

　　The development concept of innovation, coordination, green, openness and sharing put forward by the Fifth Plenary Session of the 18th CPC Central Committee is a strategic choice made by our party to grasp the general trend of world development and focus on the overall development of China. It is a concentrated expression of China’s development ideas, development direction and development focus during the 13th Five-Year Plan and even a longer period. It is a powerful ideological weapon and scientific action guide to lead the new normal of economic development and win the victory in building a well-off society in an all-round way. It is also a new concept, new idea and new strategy of the Party Central Committee with the Supreme Leader as the general secretary. We should deeply understand the outstanding theoretical contribution and great practical value of the new development concept in upholding and developing Socialism with Chinese characteristics and enriching and developing Marxism under the new historical conditions from the development context of history, reality and future, and from the issues of the times faced by contemporary China and the world today.

　　First, the new development concept is the ideological guide and action guide to lead the development of Socialism with Chinese characteristics.

　　Since the 18th National Congress of the Communist Party of China, the CPC Central Committee, with the Supreme Leader as the general secretary, has unswervingly adhered to and developed Socialism with Chinese characteristics, been brave in practice and good at innovation, and constantly deepened its understanding of communist party’s laws of governance, socialist construction and the development of human society, forming a series of new ideas, ideas and strategies for governing the country. The new development concept is a concentrated summary of the new ideas, new ideas and new strategies of the CPC Central Committee governing the country with the Supreme Leader as the general secretary. It focuses on highlighting contradictions, reveals the law of development, creatively answers the major issues of what and how to achieve development under the new situation, deepens and expands the theoretical understanding and practical requirements of some major propositions in Socialism with Chinese characteristics’s theoretical system, and provides the whole party with an ideological orientation and a behavioral orientation of managing the overall situation and managing the long-term issues.

　　Deepen the essential requirement of "taking economic construction as the center". The Third Plenary Session of the Eleventh Central Committee of the Communist Party of China put forward taking economic construction as the center, which achieved a historic shift in the focus of the work of the party and the state and opened a great historical process of reform and opening up. Over the past 38 years, our Party has unswervingly adhered to this center, concentrated on construction and development, and created the "China Miracle" that attracted worldwide attention. The new development concept, based on the basic national conditions that China is in the primary stage of socialism and the main social contradictions have not changed for a long time, and according to the new changes in the situation, the new requirements of practice and the new expectations of the people, emphasizes that we must unswervingly adhere to the economic construction as the center, and further puts forward the people-centered development idea and the development requirements of improving quality and efficiency, which endows the economic construction as the center with a clearer goal orientation, a more effective realization way and a more scientific measurement standard. Unswervingly adhere to economic construction as the center, we must take improving people’s well-being and promoting people’s all-round development as the starting point and the end result, fully mobilize people’s enthusiasm, initiative and creativity, and take quality and efficiency as the core and key to push China’s economy onto a higher quality, more efficient, fairer and more sustainable development path.

　　It enriches the practical connotation of "development is the last word". More than 20 years ago, based on the reality of China, Comrade Deng Xiaoping summed up the international and domestic experiences and lessons, and loudly put forward the famous assertion that "development is the last word", stressing that the key to seizing the opportunity and developing oneself is to develop the economy. This assertion has further broken down the ideological barriers that constrain development and further focused the work of the whole party on seeking development and grasping development. Based on this conclusion, our party puts forward that development is the top priority of the party in governing and rejuvenating the country, adheres to the important ideas of people-oriented, comprehensive, coordinated and sustainable development, and promotes the continuous leap of China’s economic and social development. With the profound changes in the world, national conditions and party conditions, the connotation of the important strategic opportunity period has undergone profound changes, and it is urgent to establish new development ideas and directions, development motivation and focus. In the new development concept system, innovation is the core and soul of development, coordination is the basic method of development, green is the inherent requirement of development, openness is the characteristic of the times of development, and sharing is the starting point and fundamental destination of development. It has further deepened our party’s understanding of development, enriched and upgraded the party’s development theory, not only made the principle of adhering to development more "hard", but also made the "truth" of what kind of development and how to develop more distinct and systematic, which not only included the requirements of development speed, but also focused on the transformation of development power and mode.The pursuit is the organic unity of development speed and creativity, balance, inclusiveness and sustainability of development.

　　It highlights the value soul of promoting the overall layout of the "five in one". Since the reform and opening up, our party has deepened its understanding and improved its development pattern and target system in the practice of promoting the cause of Socialism with Chinese characteristics. From the construction of material civilization and spiritual civilization to the trinity of economic construction, political construction and cultural construction, to the integration of social construction, and to the establishment of the overall layout of economic construction, political construction, cultural construction, social construction and ecological civilization construction at the 18th National Congress of the Communist Party of China, all these reflect the evolution and deepening of our party’s understanding of the cause of Socialism with Chinese characteristics. The proposal of the new development concept further highlights the value orientation of coordinating and promoting the five major constructions, clarifies the value standards for testing the effectiveness of career development, and condenses our party’s new practice and new understanding of what socialism to build and how to build socialism under the new situation. To promote the continuous development of Socialism with Chinese characteristics’s cause is to integrate the new development concept into the overall layout, so that our cause will always have an endless source of power, always maintain a good momentum of coordinated, balanced, sustainable development and progress with the times, and bring more and more real sense of gain to the people.

　　Second, the new development concept is the scientific application and vivid development of the basic principles of Marxist political economy in today’s era.

　　Marxist political economy is a science that uses dialectical materialism and historical materialism world outlook methodology to study economic movement, which profoundly reveals the laws and historical trends of economic movement in human society, especially capitalist society. Our Party has always adhered to the standpoint, viewpoint and method of Marxist political economy in every period of revolution, construction and reform, and enriched and developed it according to the practice of China. The new development concept is a model for contemporary the Communist Party of China (CPC) people to solve the China issue by using Marxist standpoint and viewpoint, and it is the latest achievement of contemporary Marxist political economy. It embodies the Marxist theoretical character of seeking truth from facts and keeping pace with the times, the comprehensive, dialectical and systematic overall thinking, and the basic principles of scientific socialism. It is the fundamental choice to solve the outstanding economic problems in China and lead the long-term development in the future, and has written a new chapter in Socialism with Chinese characteristics’s political economy.

　　Highlight the fundamental task of liberating and developing productive forces more clearly. Emancipating and developing productive forces is the fundamental mission of socialism and the basic proposition of Marxist political economy. Comrade Deng Xiaoping pointed out that, in the final analysis, the superiority of socialism lies in the fact that its productivity develops faster and higher than that of capitalism, and on the basis of developing productivity, it constantly improves people’s material and cultural life. The new development concept firmly focuses on the fundamental task of liberating and developing productive forces, focusing on realizing the overall leap of China’s social productive forces, taking innovation as the first driving force to lead development and placing it at the core of the overall development of the country, emphasizing the great potential contained in improving the ability of independent innovation, liberating and stimulating science and technology as the primary productive forces, protecting productive forces by protecting ecology and developing productive forces by improving the environment, promoting economic restructuring, creating and cultivating new industries, and promoting high-level opening up, grasping and leading the wave of scientific and technological revolution. All these have grasped the key to developing social productive forces and improving labor productivity under the new situation, and reflected that our party’s understanding and grasp of the development law of productive forces has reached a new height and a new realm.

　　More clearly highlight the internal contradictions in adjusting productive forces and relations of production. Productivity determines relations of production, and relations of production must meet the requirements of productivity development, which is the basic principle of Marxism. Since the founding of New China, especially since the reform and opening-up, our party has made great efforts to eliminate the ideological obstacles and institutional obstacles that restrict the development of productive forces, greatly liberated and developed the productive forces, and gradually established production relations that meet the requirements of the development of productive forces, and the social productive forces and comprehensive national strength have been rapidly improved. It should be noted that the development of China’s social productive forces has stood at a new level at present, and a new round of scientific and technological revolution and industrial revolution around the world is emerging and ready to go. In particular, it is increasingly urgent to solve the old problems accumulated by China’s rapid economic and social development and encounter new problems, improve the socialist system, and promote the modernization of the national governance system and governance capacity. The development of productive forces has put forward new and higher requirements, which requires us to make up our minds to update our development concepts, persist in leading the reform of institutional mechanisms with new ideas, and strive to improve production relations. The new development concept focuses on further removing the institutional obstacles that hinder the development of productive forces, emphasizing the construction of an institutional framework to promote innovation, emphasizing the reform direction of the socialist market economy, and emphasizing the improvement of the governance capacity of the governance system that adapts to economic and social development and the expectations of the people. This is a deep-seated change in the development mode and an all-round adjustment of production relations.

　　More clearly highlight the coordination and sustainability of improving social reproduction. Marxist political economy believes that the smooth realization of social reproduction is based on the coordination of production, distribution, exchange and consumption. In the long-term practice of leading the people to build socialism, our party has formed a series of ideas and strategies on coordinated development, balanced development and sustainable development. The new development concept, in view of the outstanding problems of unbalanced, uncoordinated and unsustainable development in China, firmly grasps the main contradictions and central links that affect social reproduction, highlights the adjustment of production relations and economic structure, highlights the improvement of relations between people, people and nature, highlights the overall balance between supply and demand, production and consumption, and focuses on coordinating the current and long-term, local and overall, and key and non-key relationships. Efforts will be made to promote coordinated regional development, coordinated urban and rural development, and coordinated development of material civilization and spiritual civilization, which has pointed out the goal and provided guarantee for expanding the scale of social reproduction, optimizing the structure and improving efficiency.

　　More clearly highlight the core position of people in the economic movement. The focus of Marxist political economy is to regard the people as the purpose of production. An important reason for the crisis of capitalist economic development is that the proliferation and expansion of capital are regarded as the fundamental purpose of production, and only "things" do not see "people", let alone people. As the main body of society, people, especially the masses of the people, have alienated into tools for producing surplus value, and even formed a "1% and 99%" differentiation and opposition in society. History and reality have repeatedly proved that if social production does not aim at the people, it is not only unjust, but also against the law of social development and unsustainable. The new development concept adheres to the fundamental position of Marxist political economy, clearly puts forward the people-centered development idea, insists that development is for the people, development depends on the people, and development results are shared by the people. It not only takes realizing, safeguarding and developing the fundamental interests of the overwhelming majority of the people as the fundamental purpose of development, but also takes mobilizing the enthusiasm, initiative and creativity of the people as a powerful driving force for development, and strives to form a vivid situation in which everyone participates, tries his best and enjoys.

　　Three, adhere to the five development is a profound change in the overall development, is the only way to build a well-off society in an all-round way.

　　Advocating innovation, paying attention to coordination, advocating green, cultivating openness and promoting sharing is a profound change that touches all aspects of social practice led by the ideological revolution in the depths of the soul. Looking back on the course we have gone through since the reform and opening up, from reforming the planned economic system to establishing a socialist market economic system, from joining the WTO to actively leading the development of economic globalization, every time we emancipate our minds and change our concepts, we have stirred up a rolling wave of reform, which has brought about a thorough transformation of development and a rapid economic leap. At the historical juncture of building a well-off society in an all-round way, the CPC Central Committee with the Supreme Leader as the general secretary will coordinate and promote the "four comprehensive" strategic layout and put forward new development concepts according to the situation, which will surely lead to a profound change from the ideological level to the social practice level, the institutional mechanism level, and from the economic field to all fields. This all-round and profound change will surely open up a bright realm in the development of Socialism with Chinese characteristics and on the road of the great rejuvenation of the Chinese nation.

　　Walk out of a correct path to adapt, grasp and lead the new normal. Adapting to the new normal, grasping the new normal and leading the new normal are the great logic that runs through the overall situation and the whole process of development during the 13 th Five-Year Plan period. The new development concept, scientifically analyzing the long-term world economy and the characteristics of China’s development stages and their interactions, focusing on solving development problems, cultivating development advantages and filling development shortcomings are the ideological compass and action signposts guiding China’s economic and social development under the new normal. Adhering to the five major developments is to completely get rid of the long-established mindset, path dependence and behavior habits, and abandon the "speed complex" and "shift anxiety" that are not adapted to the new normal of economic development; That is, we must persist in guiding new practice with new ideas, seek, move and advance according to the situation, not only resolutely implement new ideas politically, but also master and apply new ideas in knowledge and specialty, and completely change the phenomenon of "not knowing what to do", still "not wanting to do it" and "doing things indiscriminately"; It is necessary to face the profound structural contradictions on the supply side, intensify the structural reform on the supply side with firm determination and tenacious will, focus on correcting the distortion of factor allocation, and promote de-capacity, de-inventory, de-leverage, cost reduction and short-boarding, continuously strengthen endogenous power, activate growth potential, and push China’s economy to a new level.

　　Realize the historic leap of the country and the nation. Building a well-off society in an all-round way embodies the Millennium quest and century-long struggle of the Chinese nation, which will be an epoch-making great leap in the history of China. After our Party led the people of all ethnic groups in the country to unite as one and forge ahead by relay, the face of socialist China and the face of the people of China have undergone tremendous changes, and the necessary preconditions and sufficient conditions have been met for a well-off society in an all-round way. This historic goal will be achieved in our generation in the next five years. However, we should also see that although China’s economic aggregate ranks second in the world, the problem of being big but not strong and puffiness is prominent, and we are facing many risks and challenges, which requires us to keep a clear head, establish new ideas and promote new actions. The new development concept focuses on building a well-off society in an all-round way, adhering to the unity of goal orientation and problem orientation, highlighting innovation to lead and drive development, promoting the transformation of China’s scientific and technological level from running with others to running with others, and improving China’s overall economic quality and international competitiveness; Highlight the integrity, coordination and balance of development, make overall plans to fill the shortcomings and advantages of thick planting, and strive to promote the all-round progress and all-round development of fields, populations and regions; Highlight green development and sustainable development, and make a good ecological environment a growth point for economic and social development and people’s happiness; Highlight the internal and external linkage of development, actively adapt to and actively lead the world development trend; Highlight the people-oriented and inclusive nature of development, promote universal sharing, comprehensive sharing, joint construction sharing and gradual sharing, and unite and stimulate the deepest power of national development. The new development concept has taken root in China and become a common practice.It will profoundly change and reshape China’s economic and social development, and will have a far-reaching impact on China’s modernization process and national destiny. The well-off society in an all-round way led by it will surely realize the historic leap of the country from big to strong, and lay a deeper and more solid foundation for moving towards the goal of "the second century" and then realizing the Chinese dream of the great rejuvenation of the Chinese nation.

　　Show the great superiority and vitality of socialism. Classical Marxist writers have made socialism a great leap from fantasy to science, and the birth of scientific socialism has spanned the 19th and 20th centuries to the 21st century. The people of China chose socialism. Under the leadership of the Communist Party of China (CPC), they combined the basic principles of scientific socialism with China’s reality and the development of the times, actively explored, persisted and constantly explored the road of Socialism with Chinese characteristics. It is on this road that we have created a miracle in the history of world development. China’s development strategy, development direction and development model have had a wide and profound impact in both developed and developing countries. The new development concept clearly highlights the fundamental tasks and essential requirements of socialism, bases itself on the reality of contemporary China, grasps the world development trend, focuses on the outstanding problems facing the domestic and international in the 21st century, gives a new creative answer to opening up a new realm of Socialism with Chinese characteristics’s career development, and puts forward a "China plan" and a "socialist plan" for the world economy to get out of the downturn. Under the guidance of the new development concept, socialist China will stand in the east of the world with a brand-new look. Innovative development, coordinated development, green development, open development and shared development will become the most appealing and distinctive signs of China Road and the most epoch-making great victory of socialist practice.

　　General Secretary of the Supreme Leader delivered an important speech at the seminar for leading cadres at the provincial and ministerial levels, pointing out: "On the basis of long-term exploration and practice since the founding of New China, especially since the reform and opening up, and through theoretical and practical breakthroughs since the 18th National Congress of the Communist Party of China, we have successfully promoted and expanded Chinese-style modernization." "The modernization we promoted is the socialist modernization led by the Communist Party of China (CPC), and we must persist in promoting the great rejuvenation of the Chinese nation with Chinese-style modernization." In the 10 years of the new era, the CPC Central Committee with the Supreme Leader as the core United and led the whole party and the people of all nationalities to make historic achievements and changes in the cause of the party and the country, successfully promoted and expanded Chinese modernization, and realized the great rejuvenation of the Chinese nation, which entered an irreversible historical process.

　　Chinese modernization is based on the leadership of the party.

　　General Secretary of the Supreme Leader stressed: "Upholding the overall leadership of the Party is the foundation for the prosperity of the country and the nation and the happiness and well-being of the people of all ethnic groups in the country." Adhering to the party’s overall leadership is the fundamental guarantee for Chinese modernization to always adhere to the fundamental direction of socialism and forge ahead towards the goal of realizing the great rejuvenation of the Chinese nation.

　　Ensure that Chinese modernization always has a strong leadership core. As a developing country with a large population, China is bound to bear all kinds of pressures and severe challenges that other countries have never encountered in the historical process of modernization. Only by adhering to the Communist Party of China (CPC)’s leadership can Chinese modernization have a strong leadership core and overcome various risks and challenges on the road ahead. It is under the strong leadership of the party that the top-level design of China’s socialist modernization has been continuously improved and the political guarantee has become stronger. It took decades to complete the industrialization process that developed countries have gone through for hundreds of years. Since the 18th National Congress of the Communist Party of China, under the strong leadership of the CPC Central Committee with the Supreme Leader as the core, socialist modernization has marched with great success, and historic achievements and changes have taken place in the cause of the party and the state, which has laid a solid development foundation and created many favorable conditions for building a socialist modern country in an all-round way.

　　Ensure that Chinese modernization always advances in the right direction. Socialist modernization is an unprecedented undertaking, and there is no ready-made experience to follow, so it is bound to advance in exploration. Only by upholding the party’s leadership can we ensure that Chinese modernization will always move forward firmly in the right direction. In the new era, the Party’s overall leadership has been fully implemented and reflected in various fields such as reform, development and stability, internal affairs, foreign affairs and national defense, and the management of the party, the country and the army. The Party’s core role of overall planning and coordination of all parties has been fully exerted, and the Party’s ruling ability and leadership level have been continuously improved, which has provided the correct direction for promoting and expanding Chinese modernization.

　　Ensure that Chinese modernization will always maintain strong vitality. The Communist Party of China (CPC) is the backbone of the people of Chinese and the Chinese nation. In the course of long-term struggle, our party has continuously promoted the development of the cause of the party and the state with the sobriety and firmness of "rushing to the exam". Since the 18th National Congress of the Communist Party of China, the CPC Central Committee with the Supreme Leader as the core has persisted in strictly administering the Party in an all-round way, effectively coping with the "four major tests" and resolutely overcoming the "four dangers", and the Party’s political leadership, ideological leadership, mass organization and social appeal have been significantly enhanced. Our Party leads the great social revolution with the great self-revolution, leads the cause of Socialism with Chinese characteristics to win new victories, and injects great vitality into Chinese modernization.

　　Chinese modernization takes socialism as the fundamental direction.

　　General Secretary of the Supreme Leader pointed out: "The modernization we are promoting is the socialist modernization led by the Communist Party of China (CPC)". The essential attribute of socialism determines the fundamental nature and direction of Chinese modernization, and highlights the unique advantages of Chinese modernization.

　　Adhere to the people-centered development thought. The people’s position is the fundamental political position of Marxist political parties. Different from the capital-centered modernization in the west, Chinese modernization always adheres to the people-centered development thought, thus forming a correct concept of development and modernization. The Chinese-style modernization concept of development and modernization is embodied in the people’s sense of gain, happiness and security, which is more substantial, more secure and more sustainable. Since the 18th National Congress of the Communist Party of China, we have won the battle against poverty as scheduled, built a well-off society in an all-round way as scheduled, and the Millennium expectation of China people has come true. The people-centered development thought has condensed great power for the successful promotion of Chinese modernization; The continuous advancement of Chinese modernization has brought visible and tangible benefits to the broad masses of the people, which are beneficial to both the present and the long-term.

　　Unswervingly push for common prosperity. Common prosperity is the essential requirement of socialism. Chinese modernization is committed to promoting social fairness and justice and gradually realizing the common prosperity of all people by consciously and actively solving the regional gap, the urban-rural gap and the income distribution gap. In the new era, the CPC Central Committee with the Supreme Leader as the core has deeply studied the goals of different stages in the process of leading and promoting Chinese modernization, emphasizing the promotion of common prosperity by stages. In the process of modernization, it constantly promotes common prosperity, profoundly embodies the socialist essential stipulation of Chinese modernization, and highlights the distinct advantages of Chinese modernization compared with western polarized modernization.

　　Promote the all-round development of people and the all-round progress of society. It is the unremitting pursuit of socialism to promote the all-round development of people and the all-round progress of society. Chinese-style modernization aims at promoting the all-round development of human beings and the all-round progress of society, and is committed to promoting the coordinated development of material civilization, political civilization, spiritual civilization, social civilization and ecological civilization, thus surpassing the modernization of western materialism. Since the 18th National Congress of the Communist Party of China, the CPC Central Committee, with the Supreme Leader as the core, has persisted in taking economic construction as the center, promoted the overall layout of "five in one" and coordinated the promotion of "four comprehensive" strategic layouts, laying a solid foundation and providing a strong guarantee for promoting the all-round development of people and social progress.

　　Adhere to the path of peaceful development. Chinese-style modernization adheres to the path of peaceful development, benefits the world while developing itself, promotes the building of a community of human destiny, and constantly injects strong positive energy into world peace and development, which not only embodies the law of socialist construction, but also embodies the law of human social development, and realizes the transcendence of modernization of western expansion and plunder. Since the 18th National Congress of the Communist Party of China, under the guidance of the concept of a community of human destiny, China has held high the banner of peace, development, cooperation and win-win, promoted the common values of all mankind, promoted global development and global security, enriched the path selection of human civilization towards modernization, and expanded the way for developing countries to modernize.

　　Chinese modernization aims at national rejuvenation.

　　General Secretary of the Supreme Leader pointed out: "In the past 100 years, all the struggles, sacrifices and creations that the Communist Party of China (CPC) has led the people of China in unity have come down to one theme: realizing the great rejuvenation of the Chinese nation." Realizing the great rejuvenation of the Chinese nation is the historical aspiration of Chinese people and the great dream of the Chinese nation, and it is also the goal of Chinese modernization.

　　National rejuvenation has become the mission pursuit of Chinese modernization. After modern times, China was passively involved in the process of world modernization led by the West, and the Chinese nation, which suffered unprecedented disasters, began to explore a modernization road suitable for itself and made unremitting efforts to realize the great rejuvenation of the Chinese nation. It can be said that China’s exploration of the road to modernization has the dual connotation of realizing modernization and realizing the great rejuvenation of the Chinese nation from the beginning. Realizing the great rejuvenation of the Chinese nation has anchored the goal of Chinese modernization. Under the strong leadership of the Communist Party of China (CPC), the people of China have successfully embarked on the road of Chinese modernization, and the Chinese nation has ushered in a great leap from standing up, becoming rich and becoming strong, and the great rejuvenation of the Chinese nation has entered an irreversible historical process.

　　National rejuvenation highlights the internal logic of Chinese modernization. All the struggles that our Party unites and leads the people of China are aimed at building our country into a modern power and realizing the great rejuvenation of the Chinese nation. In the historical process of promoting the great rejuvenation of the Chinese nation, our party keeps pace with the times to promote theoretical innovation and practical innovation, deepen its understanding, mature its strategy and enrich its practice in building a socialist modern country, and always firmly grasp the internal logic of Chinese modernization. In the new era, the CPC Central Committee with the Supreme Leader as the core proposed to build a prosperous, strong, democratic, civilized, harmonious and beautiful socialist modernization power in two steps in the middle of this century, and defined a series of new features of Chinese modernization, which provided a more perfect institutional guarantee, a more solid material foundation and a more active spiritual strength for realizing the great rejuvenation of the Chinese nation.

　　National rejuvenation stimulates the spiritual power of Chinese modernization. Exploring the road to modernization is a hard course, which cannot be separated from the support of strong spiritual strength. Over the past hundred years, our party has always regarded the great rejuvenation of the Chinese nation as its historical mission, and the realization of modernization as the historical ambition, unswerving goal, powerful motive force for continuous struggle and mission of seeking happiness for the people, which has provided lasting and strong spiritual motivation for promoting Chinese modernization. Inspired by this powerful spiritual power, our party united and led the people of China to successfully embark on the road of Chinese modernization and create a new form of human civilization. Pushing forward the great rejuvenation of the Chinese nation with Chinese modernization and strutting along the right path of our own choice will surely build China into a prosperous, strong, democratic, civilized, harmonious and beautiful socialist modernization power.

　　(Written by: Chen Shuo Guo Guangyin)

　 　 　 　As we all know, infection is almost inevitable in plasma cell disorders (PCD). Although infection is not the diagnostic standard of PCD, it is a common complication of most patients, and it is also an important cause of morbidity and mortality of patients, especially the elderly and immunocompromised patients. In addition, the increasing use of immune-based therapeutic drugs in multiple myeloma may also have a negative impact on infection epidemiology and clinical outcome.

　 　 　 　According to statistics, the risk of infection in patients with multiple myeloma is 7 times higher than that in the general population; 10% patients died within 60 days after diagnosis, of which 45% were attributed to infection, and most of them occurred in elderly patients; 17% of multiple myeloma deaths are attributed to infection, and before the first-line treatment, the highest death rate was caused by infection (46%)1.

　 　 　 　In addition, infection, inflammation and pathogens also play an important role in the pathogenesis of plasma cell disease. Infectious cancer factors can be divided into direct carcinogens and indirect carcinogens. The former expresses viral oncogenes that directly contribute to carcinogenic transformation, while the latter causes cancer through chronic inflammation and acquired driven mutation. The mechanism of pathogen carcinogenesis includes pathogen as the direct carcinogen of PCD (oncogenic virus assists the occurrence of immunosuppressive cancers, such as Kaposi sarcoma and HHV8) and pathogen as the indirect carcinogen of PCD (chronic inflammation can enhance cell proliferation, and abnormal immune response to self-protein or infectious pathogens increases the risk of gene change and subsequent malignant transformation into dominant MM, Long-term antigen stimulation may also promote the genomic instability of MM by combining cytidine deaminase) and pathogens as regulators of PCD immune monitoring (Th17 cells secrete inflammatory cytokines, and promote the growth of plasma cells through IL-6-STAT3 signaling pathway and local activation of eosinophils; Intestinal flora may affect the response and toxicity of immunotherapy, and the principle is that immunosuppressants and broad-spectrum antibiotics can significantly change the composition of microbial flora.

　 　 　 　As mentioned earlier, infection is still the main cause of morbidity and mortality of patients with multiple myeloma due to the cumulative effect of disease, treatment and host-related factors. In view of the cumulative risk of infection in the whole course of disease, it is very important to prevent infection. At present, the best prevention strategies include vaccination against common pathogens, antibacterial prevention, infection management and immunoglobulin replacement for a small number of patients. But in general, there is no universally accepted infection prevention guideline for multiple myeloma.

　 　 　 　In view of this, the International Myeloma Association convened 36 experts from all over the world to jointly review the existing literature and guidelines, and solve the problems related to the infection risk and prevention of infectious complications of multiple myeloma under the emerging treatment background, including providing personalized infection treatment strategies for MM and providing suggestions for preventing infectious complications. The consensus statement was published in Lancet Haematology in February.

　

Panel1: Summary of key points and key suggestions for preventing infection in patients with multiple myeloma

Infection is still the main cause of death in patients with multiple myeloma. Risk factors include immunosuppression, treatment, age and complications (such as renal failure and weakness) of multiple myeloma.

The period with the highest risk of infection is the first 3 months after diagnosis and when treating relapsed/refractory multiple myeloma.

Patients with newly diagnosed multiple myeloma are more likely to prevent potential infections (such as Streptococcus pneumoniae or Haemophilus influenzae).

Most infections in patients with multiple myeloma are caused by viruses and bacteria: bacterial infections are most often manifested as pneumonia and bacteremia, while viral infections are usually manifested as seasonal viruses, especially influenza and herpes zoster.

If the risk of infection increases, levofloxacin can be considered for prevention (NCCN 2A level). Patients with seropositive herpes simplex virus and varicella-zoster virus (such as detection) can be given acyclovir for prevention. It is recommended that patients who receive proteasome inhibitors or targeted monoclonal antibodies, especially CD38 targeted monoclonal antibodies, use acyclovir for prevention (NCCN level 1). Trimethoprim-sulfamethoxazole can be reserve for patients at risk of pneumocystis Yersinia pneumonia, such as patients with relapsed/refractory myeloma or patients receiving large doses of dexamethasone (for example, ≥40 mg/ day, 4 days a week). For patients with sulfur allergy, alternative drugs such as dapsone (NCCN 2A grade) can be considered.

It is suggested that patients with multiple myeloma should be vaccinated with inactivated influenza vaccine (preferably with two doses of influenza vaccine, regardless of age) and inactivated streptococcus pneumoniae vaccine (PCV13) every year, and then with PPSV23(NCCN 2A level) every five years.

Only patients with multiple myeloma are recommended to be vaccinated with inactivated vaccine.

The ability to produce protective response after immunization depends on the immunosuppressive status of patients (such as disease load, remission status, cumulative immunosuppression of anti-tumor treatment) and vaccination time.

Conventional chemotherapy can significantly impair the response of patients with multiple myeloma to vaccination.

Vaccination at the early stage of the disease (such as MGUS or SMM), before the start of treatment or when it reaches remission can get the best protection.

Lenalidomide monotherapy can improve the response of patients with multiple myeloma to vaccination, provided that dexamethasone is not given at the same time. At present, the immune response after receiving new drugs (such as monoclonal antibody, panobinostat and Cellini) has not been determined.

After autologous hematopoietic stem cell transplantation, patients with multiple myeloma may lose immunity to the pathogens they were vaccinated against, and these patients should be vaccinated again 6-24 months after HSCT. The data show that it is safe and effective to inoculate recombinant herpes zoster vaccine after autologous HSCT. Therefore, it is recommended to inoculate recombinant herpes zoster vaccine after autologous HSCT (NCCN level 1).

It is suggested that the recombinant herpes zoster vaccine should be extended to all patients with multiple myeloma. It is suggested to continue to use varicella-zoster vaccine for prevention according to the indications, regardless of the vaccination status (NCCN 2b level).

It is suggested that patients with multiple myeloma should use passive immunization after being exposed to hepatitis A, chickenpox or measles (NCCN 2b).

It is suggested that close contacts of patients with multiple myeloma should be routinely vaccinated with inactivated vaccine, and patients should avoid close contact with live vaccine vaccinators as much as possible (NCCN 2A level).

Encourage the medical care and family members of patients with multiple myeloma to receive all designated immunization, especially seasonal influenza virus (NCCN 2A level).

Intravenous immunoglobulin is suitable for specific situations, such as life-threatening infection and IgG concentration below 400mg/dL with recurrent infection (NCCN 2A level).

For patients with multiple myeloma who go to infected epidemic areas, it is recommended to receive vaccines and antibacterial prevention at the destination, and consult infectious disease experts or medical institutions at the destination.

Risk factors of infection in patients with multiple myeloma

Disease factors

　 　 　 　Plasma cell diseases can increase the susceptibility of patients to viral and bacterial infections. The increased risk of infection in newly diagnosed patients with multiple myeloma is caused by the common global immune insufficiency paralysis in this patient, including the dysfunction of B cells in hypogammaglobulinemia, the destruction of global T cell diversity, and the significant changes in the functional activities of dendritic cells, natural killer cells and alternative complement pathways.

　 　 　 　Although rare at the time of seeing a doctor, neutropenia associated with bone marrow infiltration can also increase this risk. Of course, other related complications such as renal failure are also risk factors. The highest risk of infection is in the first 3 months after diagnosis and when treating recurrent or refractory multiple myeloma.

Therapeutic factors

Basic principles of treatment and infection of multiple myeloma

　 　 　 　The main therapeutic drugs for multiple myeloma are shown in Table 1. These treatments significantly improved the patient’s outcome, and transformed myeloma from a rapidly fatal disease to a chronic disease with multiple recurrences (usually successfully saved), but it also led to cumulative immunosuppression and increased risk of infection. For example, CD4 cell count drops sharply with the increase of chemotherapy cycle, which is closely related to opportunistic infection. Even so, the deep and lasting remission achieved by the combined regimen will generally lead to the reversal of immunosuppression and improvement of outcome.

　 　 　 　The immune status of patients with multiple myeloma is related to many factors, including the disease state and treatment stage (such as induction, remission vs first relapse vs relapse or refractory to multiple types and drugs), the degree of previous treatment (such as single drug vs multiline) and the intensity of treatment (such as triple induction vs autologous HSCT myeloablative regimen). In addition, continuous treatment can cause mild persistent immune suppression, which leads to an increase in the risk of infection. Immunomarkers can be used to determine whether there is cumulative immunosuppression.

glucocorticoid

　 　 　 　The cumulative dose of dexamethasone is an independent risk factor for infection, both during induction and at the time of recurrence. In addition, high-dose accumulation of glucocorticoids (for example, dexamethasone ≥40 mg/ day, 4 days per week) will increase the risk of opportunistic infections, including pneumocystis Yersinia.

Cytotoxic chemotherapy

　 　 　 　Conventional chemotherapy drugs, such as cyclophosphamide, etoposide, cisplatin, anthracyclines, melphalan and bendamustine, can enhance the susceptibility of patients with multiple myeloma to infection by inducing neutropenia, T cell dysfunction and mucosal damage.

Autologous hematopoietic stem cell transplantation

　 　 　 　High-dose melphalan combined with autologous HSCT (the standard treatment of multiple myeloma) can cause severe neutropenia and gastrointestinal mucositis, thus making patients susceptible to severe infections (mainly bacterial infections). Long-term T cell immune deficiency after implantation is rare, but it can increase the risk of virus infection and pneumocystis acquisition and reactivation.

Proteasome inhibitor

　 　 　 　Bortezomib can deplete T cells and impair viral antigen presentation, and the incidence of reactivation of varicella-zoster virus is relatively high in seropositive patients, so the preventive treatment of acyclovir is very important (NCCN grade 1). Caffezomib and Isazomib are also powerful immunosuppressants and have the same risk of viral infection. EMN guidelines recommend stopping antiviral preventive treatment 6 weeks after stopping PI. The authors suggest that the duration of prevention should be adjusted according to the immunosuppressive status of patients and whether other immunosuppressants (such as glucocorticoids or monoclonal antibodies) that increase the risk of varicella-zoster virus are given subsequently.

immunomodulator

　 　 　 　Lenalidomide and pomadomide can cause neutropenia, especially when combined with monoclonal antibodies. Granulocyte colony stimulating factor does not seem to reduce the risk of infection during lenalidomide treatment, but it can be used intermittently to fight chronic neutropenia. Thalidomide alone will not increase the risk of infection in patients with newly diagnosed multiple myeloma unless it is combined with other immunosuppressants (especially dexamethasone).

monoclonal antibody

　 　 　 　Monoclonal antibodies are associated with severe lymphopenia, pneumonia, reactivation of viral infection (especially varicella zoster virus) and opportunistic infection (especially in patients with intensive pretreatment). Clinical neutropenia may occur when monoclonal antibody is used in combination with lenalidomide or pomadumide, so the dosage needs to be adjusted. The neutropenia rate of CD38-targeted monoclonal antibody was higher than that of elotuzumab.

Selinexor in Cellini.

May lead to neutropenia-related infections.

New immune drugs

　 　 　 　Methods of targeting mature antigens of B cells, such as cell therapy (e.g. chimeric antigen receptor T cells), bispecific T cell adapters and antibody drug conjugates (e.g. belanatmab mafodotin), will all lead to immunosuppression because of targeting antibody-producing B cells and plasma cells. Therefore, patients with multiple myeloma who receive this treatment may need immunoglobulin replacement therapy. In addition, these treatments can lead to neutropenia and bone marrow suppression, and in some cases preventive use of antibiotics, antiviral coverage and antifungal coverage are needed.

Inhibition of bone resorption therapy

　 　 　 　Most patients with multiple myeloma will use anti-bone resorption therapy to prevent bone diseases. Rarely infected mandible and maxilla lead to jaw necrosis. Poor oral hygiene, poor denture fit, advanced periodontal disease and recent alveolar surgery are the risk factors. If infection occurs in the case of jaw necrosis, it is suggested to start using broad-spectrum antibiotics active against anaerobic bacteria, including actinomycetes spp46 and drug-resistant Bacteroides fragilis, such as clindamycin, carbapenems or β -lactamases or β -lactamase inhibitors. If the response to antibiotics is slow or unsatisfactory, or osteomyelitis is suspected, it is suggested to biopsy the lesion through staining and culture. Limited debridement may be required at this time; However, for refractory multiple myeloma, surgical resection should be reserve.

Kyphoplasty and vertebroplasty

　 　 　 　Vertebral kyphoplasty and vertebroplasty are generally well tolerated and are essential to control the pain associated with multiple myeloma of the vertebral body. In rare cases, spondylitis caused by Gram-positive bacteria (such as Staphylococcus aureus) can develop and evolve into paravertebral abscess. It is suggested that antibacterial prevention should be used 24 hours before operation and during operation when planning such operations for patients with high risk of infection.

Host factor

　 　 　 　Multiple myeloma mainly affects elderly patients with aging immune system (age ≥65 years old), whose antibody responses to pneumococcal and influenza vaccines are reduced, and the possibility of clinically significant complications is increased.

What factors can predict early and severe infection in MM patients?

　 　 　 　A considerable number of newly diagnosed patients with multiple myeloma will die prematurely before they can benefit from effective treatment, and the main reason is infection. Predictors of early and severe infection in newly diagnosed patients with multiple myeloma include high tumor load (ISS score II–III), abnormal increase of IDH, poor physical fitness and renal insufficiency.

　 　 　 　The prognosis model developed in 2018 divided patients into high-risk (infection rate was 24% during tertiary treatment) and low-risk (infection rate was 7%). In addition, men and high tumor load (ISS scores II-III and IDH increased) were risk factors for pneumonia, while high tumor load (ISS scores II-III) and increased serum creatinine concentration could independently predict the risk of sepsis.

Immune reconstruction after successful treatment

　 　 　 　Effective control of multiple myeloma can usually improve immunity. Immune reconstruction after autologous HSCT may provide an opportunity window for vaccination that may produce protective response.

Infection spectrum of patients with multiple myeloma

　 　 　 　With the introduction of new therapy, the types, severity and time of infection complications in patients with multiple myeloma have changed, and the complications mostly occur in the first few months of induction therapy and reach the peak in 4-6 months. The pathogens are mainly Gram-positive bacteria (such as coagulase-negative Staphylococcus, Staphylococcus aureus, Streptococcus pneumoniae and Enterococcus faecalis) and Gram-negative bacteria (such as Haemophilus influenzae and Escherichia coli). In addition, tracheobronchitis and pneumonia caused by respiratory viruses (such as influenza and respiratory syncytial virus) are also common.

　 　 　 　Infection can reach its peak again during the treatment of recurrent diseases, so the immunity of patients with multiple myeloma is seriously damaged. In addition, the uncommon infections in patients with multiple myeloma include invasive pulmonary aspergillosis and viral infections, such as cytomegalovirus, hepatitis B virus (HBV) or hepatitis C virus (HCV) and parvovirus B19, and tuberculosis and other opportunistic infections are also rare.

Prevention and treatment strategies of multiple myeloma infection

　 　 　 　The key to reduce the burden of infection complications in patients with multiple myeloma is to carry out comprehensive staging in diagnosis and recurrence, so as to adjust individualized treatment strategies according to risks. Staging includes collecting clinical history (especially vaccination and past infection), checking physical health and evaluating the functional status of patients over 65 years old (that is, healthy, moderately healthy or weak).

　 　 　 　It is suggested to optimize the dose intensity in patients with high risk of severe infection (that is, high disease load or increased IDH) and clinically significant complications (especially renal insufficiency). In addition, it is suggested that the preventive strategies of immunosuppression state should be considered when using various previous treatment lines to treat recurrent patients, including vaccination against common pathogens (Table 2), paying attention to the time of vaccination (panel 2), and educating patients and nurses to take measures to reduce exposure to potential pathogen sources, including traveling (panel 3). In addition, it is suggested to carry out risk-adaptive antibacterial prevention in a small number of patients (Table 3), and consider immunoglobulin replacement and possible myeloid growth factor support. Careful monitoring during high immunosuppression therapy and after autologous HSCT may predict the risk and type of infection.

　

　

Panel 2: Vaccination Opportunity of Inactivated Vaccine for Multiple Myeloma Patients

MGUS, SMM or asymptomatic MM

These patients can respond to immunization.

Vaccination may be more effective for the following patients: MGUS with low concentration of M protein and SMM may need to be vaccinated repeatedly to be effective.

MM in need of treatment

MM status is related to insufficient immune response, and the precautions are as follows:

Inoculate as soon as possible

Vaccinate patients 14 days before starting treatment (preferred)

In partial remission (especially immune reconstruction)

Good remission is usually associated with immune reconstitution, with unaffected immunoglobulin returning to normal.

Inhibition of uninvolved immunoglobulin is a risk factor for insufficient response to repeated vaccination.

When the immunomodulator is used alone or in combination with proteasome inhibitor,

Immunomodulators alone or in combination with proteasome inhibitors are associated with increased possibility of serological response.

Maintenance therapy with a single immunomodulator (lenalidomide) can enhance immunity to some pathogens, but it will not enhance immunity when combined with dexamethasone.

Non-influenza respiratory tract infection in influenza season

Avoid immunization for the time being, because the response to the vaccine may not be sufficient, and the overall infection risk of patients with active multiple myeloma may increase.

During routine chemotherapy

Avoid vaccination until the disease is controlled, because the response of cancer patients may be insufficient, and the higher the load of multiple myeloma, the higher the risk of infection.

When high-dose myeloablative therapy combined with autologous HSCT

Avoid vaccination before autologous HSCT, because the response to the vaccine cannot be sufficient.

Patients were replanted 6-12 months after autologous HSCT, because patients would have severe humoral and cell-mediated immune deficiency after autologous HSCT, but the immune reconstruction was rapid.

The recovery of ?CD4 cell count is a marker of immune recovery.

Recurrent/Refractory Multiple Myeloma

Avoid immunization during active diseases, because the response to vaccines cannot be sufficient, especially in patients who have received several lines of treatment in the past.

Cumulative immunosuppression after extensive treatment can increase the net state of immunosuppression and the risk of severe infection.

The possibility of vaccine response decreases in descending order. There are no vaccine response data for monoclonal antibodies, Papi and Cellini.

　

Panel 3: Travel Notes for Patients with Multiple Myeloma

To evaluate the immune status, it is not recommended for patients with severe immune dysfunction to travel to potentially severe infection epidemic areas.

Update the patient’s immune status and verify the drug.

Patients are advised to use general protective measures, insect repellents, mosquito nets and protective clothing to minimize the risk of mosquito bite infection (such as malaria, dengue virus, Chikungunya fever, Zika virus and West Nile encephalitis) and ticks (such as Borrelia Lyme disease, tick-borne encephalitis and relapsing fever).

Provide relevant country-specific and region-specific vaccination according to the risk, including drugs against Neisseria meningitidis, hepatitis A virus and hepatitis B virus, and poliovirus.

Provide antibacterial prevention in specific countries and regions, including malaria and tuberculosis.

Provide antibiotics (such as fluoroquinolones or macrolides) that can be used for self-administration for persistent diarrhea with fever (> 48h), and actively encourage patients to seek medical treatment when the situation occurs.

Immunoglobulin seronegative and high-risk groups of hepatitis A virus infection should consider hepatitis A immunoglobulin, including those who go to areas where hepatitis A virus is prevalent.　

Educate patients and nursing staff as follows:

Understand specific risk areas, focusing on malaria and tuberculosis.

Avoid raw food, eat peelable fruits and vegetables, prevent travelers from diarrhea, and only drink bottled or boiled drinks.

Avoid bad cooking of meat

Avoid close contact or long-term contact with crowded tuberculosis patients and closed environments (such as hospitals or clinics); If you plan to travel, check for tuberculosis (skin or blood) before leaving and after returning home.

Avoid activities that increase the risk of fungal infection (such as digging) to prevent endemic fungal pneumonia.

Detection of infection

　 　 　 　Fever is regarded as the most important sign of infection in patients with multiple myeloma. Patients without fever should be highly suspicious, especially those receiving corticosteroids. It is suggested to obtain the vaccination history, past infection, virus serum status, disease status, recent treatment and related complications of patients to determine possible pathogenic pathogens, and of course, local epidemiology should also be considered.

　 　 　 　It is suggested that patients with febrile neutropenia and patients with infection should start empirical broad-spectrum antibiotic treatment when they are diagnosed and tested. In addition, it is suggested to choose drugs active against Streptococcus pneumoniae and Gram-negative pathogens, especially Escherichia coli and Pseudomonas aeruginosa. Antibacterials should be recommended according to clinical, imaging and microbiological results.

　 　 　 　Diagnostic tests of infection include complete blood cell count and classification, liver and kidney function examination, electrolyte examination and microscopic examination or culture of blood and other parts according to clinical indications. It is also recommended to obtain rapid pneumococcal antigen detection in urine, blood and cerebrospinal fluid samples when there are indications.

　 　 　 　For patients with respiratory manifestations, it is suggested to scan the chest and sinuses with CT, collect nasopharyngeal samples for respiratory pathogens detection, microscopic examination or culture of respiratory secretions, and detect Legionella urine antigen. For persistent fever with lung infiltration for more than 3-4 days, it is suggested to consider bronchoscopy combined with bronchoalveolar lavage or bronchial biopsy to determine conditional pathogens. Fungal infection markers, such as galactomannan and β-glucan, can be used when there are clinical indications.

　 　 　 　For abdominal symptoms and diarrhea, it is recommended to start using broad-spectrum antibiotics immediately. In addition, it is suggested that the infection of Clostridium difficile can be confirmed by stool samples. If it can be confirmed, it is suggested to add oral vancomycin because its activity is better than metronidazole. There is evidence that fidamycin is at least as effective as oral vancomycin for the confirmed Clostridium difficile infection, and may be related to the lower risk of recurrent infection, especially when it is used as extended pulse therapy for 25 days. Empirical treatment should be considered when severe colitis exists, especially when the infection index of Clostridium difficile is suspected to be high, until the diagnosis and detection results are obtained.

　 　 　 　It is suggested that the abdomen and pelvis should be scanned by CT to find severe focal signs and symptoms. According to local epidemiology, it is suggested to obtain PCR of fecal culture and intestinal pathogens, as well as other tests of intestinal parasites (such as Giardia and Cryptosporidium).

　 　 　 　If the fever persists and the cause is unknown, further diagnostic imaging examination is suggested to determine the existence, location and degree of infection. Once an infection cause is ruled out, other causes of fever diseases related to multiple myeloma should be considered, such as tumor fever, venous thromboembolism, adrenal insufficiency or implantation syndrome synchronized with bone marrow recovery after autologous HSCT. Other patients with stable clinical signs should consider non-infectious causes if their fever persists after the best exploration and antibacterial treatment. Tumor fever should be considered when the concentration of serum LDH and other markers of multiple myeloma in blood and urine increases abnormally. Fever associated with venous thromboembolism should be excluded by Doppler or ultrasound examination of limbs, ventilation or perfusion scanning or CT scanning, especially in patients at risk of venous thromboembolism, such as patients receiving immunomodulatory imide drugs or recombinant erythropoietin, patients with restraint (due to fracture or spinal cord compression) or patients with other known risk factors. Patients with fever of unknown origin should always consider drug-induced fever. Fever under the background of new immunization strategy may also be a symptom of cytokine release syndrome and should be treated appropriately.

Consider infection treatment according to the disease state and treatment period.

Newly diagnosed MM

　 　 　 　Because pneumococcus is a common pathogen when multiple myeloma is first diagnosed, it is suggested that pneumococcus vaccine should be inoculated as soon as possible (Table 2), and if there is fever or other infection, broad-spectrum antibacterial drugs active against pneumococcus should be given.

Induction treatment period of newly diagnosed MM

　 　 　 　A considerable proportion of newly diagnosed patients with multiple myeloma died in the first few months after diagnosis, mainly due to infection complications, so we should actively manage them by starting fast active drugs and treating complications related to multiple myeloma, such as renal failure. Levofloxacin can be considered for antibacterial prevention in the first 3 months of treatment, especially in patients with high risk of early infection, although its benefits are still unknown under the current triple and quadruple treatment strategies (NCCN 2A level). The benefits of using fluoroquinolones (such as levofloxacin) should be weighed, because these drugs are rarely associated with tendinopathy with rupture, especially Achilles tendon. The risk factors of tendinopathy include old age (> 60 years old), concomitant use of corticosteroids and renal insufficiency. Table 3 lists other antibacterial prevention suggestions according to disease stages and anti-tumor treatment types. The use of quinolones should be considered according to the degree and duration of neutropenia.

Autologous HSCT consolidation period

　 　 　 　Multiple myeloma patients with autologous HSCT are at risk of serious infection (mainly bacterial infection), so it is suggested to use antibacterial drugs to prevent it, and the immune deficiency after autologous HSCT may lead to clinically significant infection. It is recommended to monitor infection and prevent pneumocystis carinii for 3 months and prevent herpes simplex virus or varicella zoster virus for 1 year (NCCN 2A level) according to global guidelines. Antibacterial prevention is not a routine practice in all transplant centers around the world. Although its use reduces the incidence of fever and bloodstream infection, it does not translate into a reduction in mortality. Antibacterial prevention also needs to consider the risk of drug resistance.

Maintenance treatment period

Severe infection during maintenance treatment is mainly due to neutropenia, but the risk is low and the mortality rate is lower than 1%.

Treatment period of recurrent MM

　 　 　 　Patients with recurrent and refractory myeloma are at high risk of life-threatening broad-spectrum pathogen infection, including bacterial and viral infections (such as herpes simplex virus or varicella-zoster virus, cytomegalovirus, HBV and HCV). Fungal pneumonia, including invasive pulmonary aspergillosis and pneumocystis, may also occur.

Infection screening

　 　 　 　For relapsed/refractory MM with positive cytomegalovirus serum reaction, it is suggested to detect HBV (cytomegalovirus antigenemia or quantitative PCR) or circulating HBV DNA(NCCN 2B grade) before starting treatment. Patients with high suspicion suggest that serum Aspergillus galactomannan antigen should be tested before symptoms appear to detect invasive pulmonary aspergillosis. The effect of serum (1,3)-β-D- glucan on invasive pulmonary aspergillosis is not clear, but it may be a useful auxiliary means to diagnose pneumocystis disease.

　 　 　 　According to the patient’s serum status, HBV reactivation can lead to severe complications and death in patients with multiple myeloma, and usually occurs after autologous HSCT. In addition, HBV reactivation was rarely observed after treatment with CD38-targeted monoclonal antibody. It is suggested that patients should be managed according to their HBV serum status and the type and duration of immunosuppressive therapy (Table 3). It is suggested that antiviral prevention should be used for patients with HBV reactivation or high risk of disease, or early preemptive treatment should be used for patients with low risk. Only in the presence of clinically relevant diseases (such as cytopenia and cytomegalovirus diseases) can cytomegalovirus disease be treated.

　 　 　 　The effect of chronic HCV on the course of multiple myeloma is not very clear, but it is known that it will be reactivated after chemotherapy, and it may be necessary to reduce or stop taking drugs, but acute liver failure or death is not the outcome of chronic HCV infection. It is suggested that HCV serum status should be evaluated when multiple myeloma is diagnosed, and interferon α-free treatment schemes, such as direct antiviral drugs (such as sofebuvir, cimetivir and redipavir), should be used during the whole treatment period, and serum alanine aminotransferase and HCV viral load should be closely monitored.

Before stem cell mobilization, it is very important to monitor HCV viral load and treat infection. Chronic HCV infection may cause three-line hemocytopenia and lead to poor mobilization. Cancer patients may rarely lose HCV seropositivity, so it is suggested to measure HCV viral load when the patient’s serum status is unknown. It is recommended to seek help from infectious disease experts in complex situations.

vaccine

General principle of multiple myeloma vaccine

　 　 　 　Although the response to vaccination is usually very small, partial protection may still reduce the infection rate and hospitalization rate, but it should also be noted that the duration of benefit is unknown and may vary with vaccination time. Although the safety of most vaccines has not been tested in patients with multiple myeloma, inactivated vaccines such as influenza and pneumococcal vaccines are safe. Patients with multiple myeloma strongly recommend vaccination against Streptococcus pneumoniae and seasonal influenza virus, as well as vaccines necessary for local epidemiology (such as HBV). Splenectomy patients are also vaccinated against Haemophilus influenzae.

　 　 　 　It is suggested that patients with multiple myeloma should be vaccinated with pneumococcal vaccine, including one dose of pneumococcal conjugate vaccine (PCV13) and another dose of polysaccharide vaccine (PPS V23) at least 8 weeks later. If the patient has been vaccinated with PPSV23 before, it is recommended to be vaccinated with PCV13(NCCN 2A grade; Table 2). The protective titer of pneumococcus is unknown, which may vary according to serotype. If a breakthrough pneumococcal infection occurs after vaccination, it is suggested to try to identify the serotype of the strain to report the non-response to the vaccine (if possible). The purpose of serotype identification is to determine whether this serotype is included in the PCV13 vaccine-for example, patients vaccinated with PCV7 or PCV10. In this case, consider vaccination with PCV13 vaccine.

　 　 　 　Because the antibody response of pneumococcal vaccine may not be ideal, it may be useful to prolong antibiotic prevention in patients with recurrent pneumococcal infection and patients with invasive pneumococcal disease. Although penicillin G is the standard treatment, antibiotics based on strain sensitivity and local drug resistance patterns that have caused invasive pneumococcal diseases in the past can be used. Fluoroquinolones (such as levofloxacin), azithromycin or second-generation penicillin or cephalosporin are reasonable substitutes (NCCN 2B grade). (panel 1)。

　 　 　 　Vaccination against seasonal influenza virus is necessary because cancer patients are at increased risk of infection and death. It is suggested that patients with multiple myeloma be vaccinated with two doses of inactivated tetravalent influenza vaccine instead of standard vaccine, regardless of age (NCCN 2A level). The initial dose should be given as early as possible in the flu season, and the second high-dose booster vaccination should be carried out one month later. For patients with inactivated influenza vaccine in serious adverse events, two doses of recombination vaccines can be considered.

　 　 　 　It is generally recommended to vaccinate against HBV, especially for patients with high risk of virus infection (NCCN 2A level). Other potentially useful vaccines for patients with multiple myeloma include vaccines against Neisseria meningitidis, tetanus, diphtheria and pertussis, and inactivated poliovirus vaccines.

　 　 　 　Because of the increased risk of reactivation of varicella-zoster virus during the treatment of multiple myeloma, vaccination should be considered to reduce the risk of infection and post-herpetic neuralgia. It is suggested that patients with multiple myeloma should be vaccinated with recombinant herpes zoster vaccine instead of live herpes zoster vaccine, because it is safe (that is, non-live vaccine) and can provide higher and longer-lasting prevention of herpes zoster, thus preventing post-herpetic neuralgia (NCCN grade 1). However, even after vaccination, patients treated with proteasome inhibitors or CD38-targeted monoclonal antibodies should continue to receive acyclovir preventive treatment, because the degree of protection provided by vaccination is difficult to assess (NCCN 2A level). Specifically, patients with multiple myeloma have different immune responses and are highly dependent on their immune status, so they cannot be prevented by vaccination alone. For patients who have been vaccinated with live herpes zoster vaccine in the past, it is recommended to vaccinate with 2 doses of recombinant herpes zoster vaccine at least 8 weeks after vaccination.

　 　 　 　Generally speaking, due to the lack of safety or efficacy data, live vaccines are not recommended for patients with multiple myeloma. For patients with MGUS and SMM, considering their relatively healthy immune system, we can consider vaccination with live vaccine. Measles, mumps and rubella vaccines and live herpes zoster vaccine have been used after HSCT. If patients are in remission, they can be considered for use under certain circumstances.

Vaccination of non-immune close contacts

　 　 　 　Patients with multiple myeloma, especially those receiving treatment, may not be able to produce immune response to pathogens, and close contacts vaccinated with inactivated vaccine may also provide group immunity for patients. Therefore, according to vaccination history, age and exposure history, it is suggested that non-immune close contacts should be vaccinated with vaccines that are usually suitable for individuals with normal immune function, and it should be emphasized that inactivated vaccines (NCCN 2A level) should be used. Encourage the medical care and family members of patients with multiple myeloma to receive all designated immunization, especially seasonal influenza virus immunization.

Immunoglobulin substitution

　 　 　 　Immunoglobulin replacement can be administered intravenously, subcutaneously or intramuscularly. Intravenous immunoglobulin is recommended for patients with plateau multiple myeloma who have hypogammaglobulinemia and recurrent bacterial infection and have no response to pneumococcal immunization. However, immunoglobulin substitution supports the scarcity of contemporary data, high cost, limited availability and the possibility of complications (including acute renal failure and cardiovascular events). It is suggested that replacement therapy should be limited to patients with serum IgG concentration below 400 mg/dL and severe and recurrent infection caused by capsular bacteria (or other pathogens reasonably thought to be caused by hypogammaglobulinemia), even with antibacterial prevention and immunization (NCCN 2A level).

　 　 　 　Another potential consideration includes patients with insufficient antibody production, especially pneumococcal vaccine. Using immunoglobulin replacement therapy can only benefit patients infected with pathogens, which may respond according to the specific antibody titer against the target pathogen in intravenous immunoglobulin preparation; For example, it is used for infection caused by severe parvovirus B19 in patients with multiple myeloma.

　 　 　 　When planning to use intravenous immunoglobulin, it is necessary to evaluate the patient’s immune status and infection history (especially recurrent infection), and carry out laboratory examination of immune parameters (including specific antibody response) to determine the patients who can benefit from early intravenous immunoglobulin intervention.

　 　 　 　Immunoglobulin infusion is usually well tolerated, and most reactions are frequency dependent. But serious complications may also occur, including acute renal failure and rare cardiovascular events (such as myocardial infarction, stroke or venous thromboembolism). It is suggested to give standard preoperative medication to reduce the severity of infusion-related reactions, and to replenish water before infusion, especially in patients with hyperviscosity, risk factors of renal complications and receiving sucrose-containing preparations. It is suggested that intravenous immunoglobulin therapy should be started at a slow rate of 0.01 mL/kg/min and gradually increased to a maximum rate of 0.08 mL/kg/min according to the tolerance. If the serum IgA concentration cannot be detected, it is recommended to use intravenous immunoglobulin to remove IgA.

Post-exposure prevention of immunosuppressed MM patients

　 　 　 　 Immunoglobulin prevention may have protective effect on patients with multiple myeloma who are immunosuppressed after exposure to chickenpox, herpes zoster and hepatitis A (NCCN 2B grade). Serious diseases after exposure to herpes zoster, especially chickenpox, are very high, so it is very important to determine the risk level. The infectious stage begins 1-2 days before the rash occurs, so patients can appear several days after exposure. Except the recipients of autologous HSCT, all immunocompromised patients with a history of chickenpox infection can be considered immune. For patients with no history of varicella infection, risk assessment includes determining the susceptibility and exposure duration of patients. Risk factors include recent use of proteasome inhibitors, previous vaccination against varicella, severe immunosuppression, and close face-to-face or indoor contact for more than 1 hour. Post-exposure prevention depends on varicella-zoster immunoglobulin, ideally within 96 hours after exposure, but the benefit can be extended to 10 days. If immunoglobulin of varicella-zoster is not easily available, it is recommended to use acyclovir after exposure. The typical incubation period of chickenpox is 14-16 days. However, since the immunoglobulin of varicella zoster may prolong the incubation period, it is recommended to monitor the evidence of varicella for up to 28 days after exposure in the recipients of this therapy.

　 　 　 　For patients with multiple myeloma who travel to areas where hepatitis A virus is prevalent, it is recommended to give 0.02 mL/kg of hepatitis A immunoglobulin within 2 weeks of travel, and give the initial dose of hepatitis A vaccine. It is recommended to give a dose of hepatitis A immunoglobulin to patients with known exposure.

　 　 　 　For patients who have not been vaccinated against HBV or whose anti-HBV titer is less than 10 IU/L after vaccination, it is suggested to use tenofovir or entecavir for prevention to avoid the need for HBV immunoglobulin.

　 　 　 　Patients may occasionally need tetanus immunoglobulin 138 or human rabies immunoglobulin 139 after specific high-risk exposure. For patients at risk of respiratory syncytial virus infection in virus season, it is not recommended to use intravenous immunoglobulin or palizumab, that is, humanized monoclonal antibody against respiratory syncytial virus F glycoprotein.

Myeloid growth factor

　 　 　 　Prophylactic granulocyte macrophage colony stimulating factor (granulocyte colony stimulating factor is better) is recommended for patients without fever, and the risk of fever and neutropenia in these patients is at least 20%(NCCN 2A grade). The decision on whether to use granulocyte colony stimulating factor to prevent treatment delay (such as treatment delay related to lenalidomide) should be considered individually. Chronic neutropenia occasionally needs the support of growth factors.

references

1. Jessica Caro, Marc Braunstein, Louis Williams, et al. Inflammation and infection in plasma cell disorders: how pathogens shape the fate of patients. Leukemia . 2022 Feb 2. doi: 10.1038/s41375-021-01506-9.

2. Noopur S Raje, Elias Anaissie,Shaji K Kumar, et al.Consensus guidelines and recommendations for infection prevention in multiple myeloma: a report from the International Myeloma Working Group. Lancet Haematol . 2022 Feb; 9(2):e143-e161. doi: 10.1016/S2352-3026(21)00283-0

The windward slope of the Himalayas is the place with the most precipitation in the world. The annual precipitation exceeds 10,000 mm, which is about 10 meters. And to the north of the Himalayas, the whole place is barren and completely desert.

Many people are thinking, if I blow a big hole in the Qinghai-Tibet Plateau or the Himalayas and put water vapor in it, will the climate of the whole Qinghai-Tibet Plateau and the whole northwest change fundamentally and become a land of plenty?

Text | Wei Ke Associate Research Fellow lasg

This article was reprinted from WeChat WeChat official account "Yi Xi Club" (ID: yixiclub). The original article was first published on June 7, 2021. The original title was "If we blow a big hole in the Himalayas, will the whole northwest become a land of fish and rice?" | Wei Ke’s 771st Speaker does not represent the viewpoint of a think tank.

Why is the northwest unusually dry?

Hello, I’m Wei Ke, from lasg. The Institute of Atmospheric Physics was formerly the Institute of Meteorology, Academia Sinica during the Republic of China, and its first director was Mr. Zhu Kezhen, so the research on climate in China has a history of more than 90 years since then.

Our institute of atmospheric physics has an observation station in the Gobi desert, which is about 200 kilometers away from Dunhuang city. It is very dry around this observation station, as it was a few days ago.

On May 24th, this observatory in Gobi ushered in the nth sandstorm this year, where n is a relatively large number.

If the wind speed will decrease a little in a few days and wait until summer, then it is likely to be like this.

As you can see, whether it’s spring or summer, no matter how full of green is in our eastern region,This place seems to be deserted forever, very, very dry.

Let me make some comparisons here. For example, as many of us know, Yan ‘an and Yulin are above the Loess Plateau and seem to be relatively dry areas. But in fact, from the annual average precipitation, we can see that the upper left picture shows the precipitation in Yan’ an, with an annual average of more than 500 mm. The average annual precipitation in Beijing is close to 600 mm, so Yan ‘an is not much different from Beijing.

But when we compare it, we know that the annual precipitation in Dunhuang is about 40 mm, which is less than one day’s precipitation in the eastern region. It is normal for a rainstorm in the eastern region to reach 100 mm. Take a look again. Yinchuan is 193mm, Xining is 387mm and Urumqi is 270mm. These places are very dry.

Recently, some people may have seen a news that the Mu Us Desert in northern Shaanxi seems to be disappearing soon. But in fact, the average annual precipitation in places like Maowusu is close to 400 mm, and ecological restoration in those places is possible.The annual precipitation in Dunhuang is less than 50 mm, so it is basically impossible to turn these places into a place of full of green.

If you want to know the climate of China, it is actually very simple. You can basically divide China into two parts by drawing a line from the northeast to the southwest.

Southeast China is a land of plenty, with a large population, active economy and a lot of precipitation. The whole northwest region is relatively dry, and its economic activity is not as good as that of the eastern region. This is a very typical climate dividing line.This climatic dividing line is often called "Hu Huanyong Line", which basically runs along the dividing line with an average annual precipitation of 400 mm..

If we push the dividing line further west, we will find that there is an area where the average annual precipitation does not exceed 200 mm at most, which is in this orange area.

▲ Average annual precipitation

Comparing the precipitation in South China, the average annual precipitation can often reach 1600 mm, which is very large.

It’s just that there is little precipitation. The evaporation in this place is very large.There is basically no cloudy weather all year round, and the sun is direct, which is very suitable for evaporation, so the annual evaporation is very large, basically above 1000 mm.

▲ Annual potential evaporation

In Dunhuang and other places I circled in red, the evaporation is even close to 2000 mm. Then let’s think about the balance of water-the precipitation is 200 mm, but it is possible to evaporate 2000 mm. It is strange that this place is not dry.

Why is this place so dry? In fact, the reason is very simple.Geographically, this place is inland and lacks water vapor. Water vapor comes from the ocean, but it is very far from any ocean.

If we want to find a place on the earth, which is the farthest from the ocean, I guess it must be in the northwest. Whether it is from the Pacific Ocean in the east, the Indian Ocean in the south, the Atlantic Ocean in the west or the Arctic Ocean in the north, it is very far away. So even if there is water vapor flow and atmospheric circulation, it can’t come in the middle.

We made such a numerical simulation. If there is only land, but there is no Qinghai-Tibet Plateau, no Pamirs Plateau and no barrier of these landforms, the simulated climate is the same, and there is very little precipitation in Central Asia.

This arrow represents the wind direction, which means the direction of water vapor transportation. We don’t think the water vapor from the Indian Ocean will go directly to the north, but it will turn east when it walks and turn to the eastern part of our country.

Another reason, we call it the foehn effect in meteorology.The distribution of water vapor on the earth satisfies relatively simple physical laws, which we call Clabolon-Clausius equation. The higher the temperature, the closer it is to the ground, the more water vapor can be contained in the air. The lower the temperature and the higher the distance from the ground, the lower the water vapor content in the atmosphere.

If there is a mountain, on the windward side of the mountain, the wind comes with water vapor and then climbs gradually. In the process of climbing, the temperature of the air gradually decreases, and soon it will condense to form rainfall, and then precipitation will form on the windward slope.

Because the water has been lowered in the process of climbing the mountain, it becomes dry air after climbing the mountain. So we can see that,In the windward slope, it is generally very humid, while in the leeward slope, dry and hot valleys often form.

The whole northwest of China is surrounded by mountains.The Qinghai-Tibet Plateau in the south, the Pamirs and Tianshan Mountains in the west, and the mountains in the north. The east is very, very far from the sea, so if there is airflow over the mountains, no matter where you come from, it will definitely dry up there.

If the air flows from the Indian Ocean to the northwest, then you can think about which mountains it will cross-Himalayas, Gangdise Mountains, Tanggula Mountains and Karakorum Mountains. This series of mountains is turned over, and each mountain is like a dehydrator.

The airflow rushed directly to the height of more than 6,000 meters in the sky, and it was continuously dehydrated during the mountain climbing. The remaining water vapor continued to take off when passing through the next mountain range until it reached the northwest, and it became very dry, and no water vapor could fall down.

On the other hand, there is the role of atmospheric circulation.. If our land and sea distribution does not change, one side is Eurasia, the other side is the Pacific Ocean, and the south is the Qinghai-Tibet Plateau, at this time, a high pressure center will definitely form in the high altitude of this place in the northwest, just like the dark area I gave in the picture.

Where the high pressure area is located, the air sinks, and when it sinks, it will easily make the clouds dissipate, and the sinking will form a warming.So even if there is a little cloud in that place, it will dissipate in the process of sinking and become cloudless weather. Therefore, the northwest region is basically the region with the strongest solar radiation and the richest solar energy resources in our country.

Then these points are combined, far away from the ocean, deep inland and surrounded by mountains-the foehn effect after the formation of mountains makes this place very dry.

Let’s compare. This picture is along the north and south of the Himalayas. We can see that in the south of the Himalayas, it is a green country. The whole Indochina Peninsula, as well as South Asia, is very humid and the precipitation is very high.

▲ North and South Himalayas

The windward slope of the Himalayas is the place with the most precipitation in the world. The annual precipitation exceeds 10,000 mm, which is about 10 meters.And to the north of the Himalayas, the whole place is barren and completely desert.

In addition, if you look at the contrast between the north and the south of Tianshan Mountain, you can see that it is humid on the windward side of Tianshan Mountain, but it is very dry and deserted on the leeward side.

▲ North and South Tianshan Mountains

If we match the terrain and precipitation in the whole country, we can see that,The precipitation in the eastern part of our country comes from the Pacific Ocean. In the process of westward advancement, the water vapor in the Pacific Ocean first forms precipitation in Nanling, Lingnan and the area south of Wuyishan in South China.. The average annual precipitation in these places can reach 1600 mm.

After dehydration of a series of ups and downs in Nanling and Wuyishan,In the Yangtze river basin, the average annual precipitation will drop to 1000 ~ 1200mm.. These mountains in Nanling are not particularly high, only a few hundred meters at the highest, so this dehydration effect can be achieved.

Then when we go west from the first step to the second step of our country, we have to cross Wushan, Yunnan-Guizhou Plateau and Taihang Mountains. After this series of mountain dehydration,In places like Shaanxi and Shanxi, the average annual precipitation drops to 500-700 mm.

Note that even when the precipitation drops to 500 and 700 in this place, we haven’t encountered a particularly decent mountain. For example, Huashan Mountain, the highest mountain in the Five Mountains, is only over 2,000 meters above sea level, which is less than halfway up the Qinghai-Tibet Plateau, because the average ground height of the Qinghai-Tibet Plateau is above 4,500 meters. You can imagine how dry this water vapor will become when it goes west and passes through a series of mountains.

one

How long is the history of drought in northwest China?

Northwest China is not so dry just now. If we look at the history of northwest China, we will know that the dry history of this place is very long. We know that there are coal and oil in many places in Xinjiang, which shows that the ecological conditions in this place were very good before, and there may have been forests and lake bottoms.

In fact, this place is a place called the Deputy Tethys Sea in history. This sea has gradually shrunk and become the present Mediterranean, while the western region has gradually retreated from the coastal area to the inland area.

When that place becomes dry, the wind will scrape out the soil on the ground and then fall down in other places, forming the loess plateau with a very large area in our country. Therefore, by investigating the history of the Loess Plateau, we can know how long the history of drought in northwest China is.According to the current research, the Loess Plateau has a history of about 22 million years, so the drought in the northwest has such a long history.

With the uplift of the Himalayas and the uplift of the whole Qinghai-Tibet Plateau, the whole northwest has become drier. Some numerical simulations made by scientists confirm this process.

For example, if we assume that there is only land, but there is no Qinghai-Tibet Plateau and the whole Pamirs, we will gradually increase the altitude, the scale of the Qinghai-Tibet Plateau will gradually increase, and the altitude will gradually increase, and the height is only 20%, 40%, 60% and 80% of the current height. Then we will simulate its climate.

It is found that during the uplift of the Qinghai-Tibet Plateau, the precipitation in Central Asia and northwest China depicted by the red circle is gradually decreasing, while the precipitation in the southern region is gradually increasing. That is to say, that place is already in the inland area, which is very dry, and the uplift of the Qinghai-Tibet Plateau has reduced the precipitation in that place and made it drier.

2

Blow a big hole in the Himalayas

So many people are thinking,If I blow a big hole in the Qinghai-Tibet Plateau or the Himalayas and put water vapor in it, will the climate of the whole Qinghai-Tibet Plateau and the whole northwest change fundamentally and become a land of plenty?

In fact, scientists have thought about this idea. In a speech recorded by Mr. Li Ruihuan in 1995, it was mentioned that some scientists also mentioned this idea, including Mr. Qian Xuesen and Mr. Qian Sanqiang.

The scientific community has had a serious discussion on this topic.Although the Himalayas is a long mountain range, it actually has many mountain passes and many small openings, one of which is the entire Yarlung Zangbo River Grand Canyon, which looks like this.

▲ Natural water vapor channel-Yarlung Zangbo Grand Canyon

The Yarlung Zangbo River flows from west to east, turns through the Grand Canyon, and then flows south and out of the border.

This is a natural incision.Can this cut bring about a better climate in the whole Qinghai-Tibet Plateau? The answer is no.

Even if there is such a hole, it has not brought about fundamental climate change in the whole Qinghai-Tibet Plateau.The only influence is that there are many towering snow-capped mountains on both sides of the Yarlung Zangbo River Grand Canyon, and the scale and number of snow-capped mountains are more than those in other places.

Many people may say that this cut in the canyon looks a little small, and we want to make a bigger one. Then if you open your mouth a little wider, will it fundamentally change the climate? Scientists have done some numerical simulations about this problem. We simulated a big hole-about 1000 kilometers wide, 1000 kilometers wide, and driving from Beijing is almost to Wuhan; It is about 1000 meters deep.

The result is that after opening such a hole, there will be some increase in precipitation in the southern and central areas of this hole, but the precipitation in the northern part of this hole will decrease.

The reason is very simple. After the opening, the dry air from the north will go south along the opening and meet the air from the south in the opening, thus increasing some precipitation in the southern and central regions, while the precipitation in the northern region will decrease due to the influence of the dry air. This does not seem to bring more water resources to the whole northwest region.

Then someone may have said, can you drive a little deeper? It seems that you have only dug 4000 meters. Can you dig further? OK, our researchers have done some numerical simulations.

If an incision is made, it is 300 kilometers wide, as far as driving from Beijing to Shijiazhuang, and the depth reaches zero meters above sea level, that is, it is as deep as the sea level. From the Bay of Bengal, whether Bangladesh agrees or not, Nepal agrees or not, no matter what, it will push all the way from the seaside there to dig through the Qinghai-Tibet Plateau.

The simulation results are basically similar to the previous results, with precipitation increasing in the southern part of the passage and still decreasing in the northern part.The reason is simple: dry air from the north came in. Then this gives us a revelation: we may shake mountains easily, but it is difficult to shake the whole atmospheric circulation, and the whole circulation will not change fundamentally.

The reason why Kaizi can’t change the climate of the Qinghai-Tibet Plateau and northwest China is that even if such a hole is opened, it can’t change the root cause of drought in northwest China.First, it is far from any ocean; Second, the mountains are all around, and any airflow over the mountains will sink, which will form a warming, and the warming will become very dry.

There is another point. Even if there are no mountains, as long as there is a normal distribution of land and sea in Eurasia and the Pacific Ocean, a high-pressure area will be formed in this place, and the high-pressure area is a sinking airflow.

Last year, we wrote some popular science articles in Voice of Chinese Academy of Sciences, discussing with you why the proposal of Himalayan mountain mouth is not reliable. At this time, many people contacted us and said that you might have opened your mouth in a wrong position. It is said that the water vapor in the northwest of China does not come from the south, does not pass through the Qinghai-Tibet Plateau, but passes through the Pamirs from the west. So you shouldn’t open your mouth in the south, you should open it in the west, and make a big hole in the Pamirs, which may make the northwest moist.

And opening from the west has many advantages over opening from the south, one of which is opening in our country.

Why? There is an Ili Valley area in the northwest of our country, which is basically the area with the best environment in the northwest. We can see from this picture that it is a trumpet-shaped terrain, which opens to the west, allowing water vapor from the west to come in, and then gradually gathers along this trumpet-shaped mouth to form precipitation here.Because the mountains over there are very high, they not only converge, but also rise, forming a very good ecological environment and climate environment in the Ili Valley.

The average annual precipitation here can reach about 400 ~ 500mm, and even 600mm in some places, and there are 50mm and 100mm precipitation around, which is simply a paradise.

The opening they said is at this intersection. Open the middle place. In fact, let’s zoom in and have a look. Central Asia is very far away from the Atlantic Ocean, the Mediterranean Sea and so on, so there are already many deserts in West Asia itself. For example, the west side of the five Central Asian countries is the famous red desert and black desert. These arid areas.

The reason why Central Asia can form a little wet place is that the five Central Asian countries near China are windward slopes of Pamirs, and the terrain of this place rises directly from one or two kilometers above sea level to four or five kilometers, with very steep terrain uplift.

In the process of this uplift, even if the air is unusually dry, it can form some precipitation after such a large altitude change and strong dehydration. Therefore, the capitals of the five Central Asian countries are basically located at the bottom of the windward slope, and the environment is not bad.

If we shovel the whole Pamirs, the windward slope here will disappear. As long as the windward slope disappears, the precipitation in this place will disappear, so it is very likely that the rare wet areas of the five Central Asian countries will all disappear and Central Asia will become a desert.

Even if water vapor enters China, we will find that our place is a basin, with Junggar Basin in the north and Tarim Basin in the south. The elevations of both basins are lower than those around. The average elevation of Tarim Basin is 1,100 meters, while the average elevation of Junggar Basin is only over 600 meters.

You removed the windward slope over there, and after the water vapor came over, you still had to cross a low highland, and then it sank. You destroyed other people’s climate and there was still no precipitation in your place.Because it is still affected by the foehn, it will not change the climate here.

In fact, scientists have done some other numerical simulations. For example, in this picture, if there is no terrain, there is no Qinghai-Tibet high, there is no Pamirs, there are no Tianshan Mountains and Altai Mountains, and there are no mountains. As a result of the simulation, we can see that this white area is an arid area, and this place in northwest Central Asia, including Mongolia, is a very arid area.

▲ Zhang Ran et al., 2016, Quaternary research.

three

Is it getting warm and wet in the northwest?

Since last year, the topic of northwest becoming warm and humid has been brought up again. Some people say that our northwest has become more humid, and this place will soon become like the Tang Dynasty. If we go further, we will catch up with the Zhou Dynasty, and our whole northwest will become a relatively humid place.

We can see that these big media, Xinhua News Agency, Global Times, and especially Global Times, use this headline-"The real event, the cold and arid northwest is getting warmer and wetter". Everyone suddenly had an illusory idea, as if the ecology of northwest China had undergone a fundamental change in recent years. According to this change, that place will get better and better.

Many people think it is a new change, but in fact it is an old topic. In 2002 and 2003, scientists have already discussed this topic. The famous geographer Mr. Shi Yafeng has analyzed some changes that have taken place in the northwest. In some places, precipitation has increased slightly, and the amount of water in lakes has increased in some places. In some places, there will be some seasonal floods and so on.He pointed out the fundamental problem, that is, the climate in northwest China has its own limitations, so it is not appropriate to exaggerate its role.

We also made some analysis on the specific changes.The reason why many people think that the northwest is becoming humid is because they have observed an increase in precipitation in the northwest.. For example, the picture at the top left shows the annual precipitation changes from the 1960s to the present. The dark line curve shows its trend, and we can see that the precipitation has indeed increased in the past so many years.

In the past, the average precipitation was about 100 mm, and it increased to about 120 mm, which is a great increase.

However, we noticed that during this period, the temperature in the northwest increased faster than that in other parts of the world because of the global temperature increase. The picture on the upper right shows that the temperature in the northwest is increasing, and the increasing speed is two to three times faster than that in the eastern part of China.

The increase in temperature has brought about a great change, that is, the potential evaporation is also increasing rapidly.The increase of potential evaporation is greater than that of precipitation. This means that with the increase of precipitation, this place will become even drier.

Let’s look at the change of relative humidity in the picture at the bottom right: from 1980s to 1990s, the relative humidity in that place increased because of the increase of precipitation. However, from the 1990s to the present, because of the increase of temperature and potential evaporation, the relative humidity in that place has gradually decreased and become drier.

This is the drought index we analyzed. Red means getting drier, blue means getting wetter, and the bigger the red dot, the more serious the drought is. We see that among so many observation stations in the northwest, only one station has been slightly wetted, and all other stations have become drier.

Let’s compare the dry and wet changes in other different areas. If this dry and wet index is positive, it means that this place is getting drier and drier. We see that the dry-wet index of Tarim Basin has always maintained a relatively high value, about 1000, which means that the evaporation in this place is more than 1000 mm than the precipitation, and this value is still increasing, and this trend has been going up.

Hetao area is also a dry area, and its value is also positive, and it has been rising and becoming drier. The only place in the source region of the Yellow River seems to have a slight trend of drought relief, but this trend is not particularly obvious.

Let’s compare the changes between drought and humidity in our country. This shaded area indicates that these areas are becoming more arid. From H to SH, it means from humid to semi-humid, from SH to SA means from semi-humid to semi-arid, and from SA to A means from semi-arid to drought.

We see that in the northern part of our country, from the whole northeast to north China, and to the eastern part of the northwest, a large range of local droughts are still developing, and the droughts in these places have become more serious.Therefore, we can’t be optimistic that some areas in the northwest have increased precipitation and improved ecology, so we think that we seem to have entered the next stage, and the northwest seems to be getting wet.

In fact, our country as a whole is experiencing the development of drought, so we should deeply understand what the ecological environment changes in different places are because of. Many places, including northern Shaanxi and Hetao areas, including the Mu Us Desert, have enough precipitation, which is generally close to 400 mm, or more than 400 mm. As long as people don’t destroy it, the ecology in these places will gradually recover. Therefore, our various measures of returning farmland to forests and grasslands will change the ecology of that place.

However, if the precipitation in the northwest is 200 mm, it can’t be restored by returning farmland to forests and grasslands. The precipitation in that place is not enough to support the growth of trees or decent grass. It is a desert.

In other places, the mountains have become wetter, and more trees will be seen on the top of the mountain, or grass will flourish. This is probably because the glaciers on the mountains have melted.The melting of glaciers is due to global warming, which is not a good thing, but a sign of the decline of the whole ecosystem. What you see is that the place turns green, but what is actually hidden is a bigger crisis.

One more thing, the increase of precipitation in some places in northwest China is not like "spring rain moistens like oil", but in the form of heavy rain, two heavy rains suddenly, and then this year’s precipitation ended, so it not only did not alleviate the drought, but brought floods.

Like Dunhuang in July last year, where the annual precipitation was less than 40 mm, two rainstorms closed the Mogao Grottoes for several days, and the impact on this place was not positive.

The whole northwest is so dry, we told you the reasons and the changes in recent years. Some people may feel desperate, and that place seems to have no hope of change.

This is definitely not the case. This place is full of hope.We can change its ecology in various ways.For example, even in such a arid area of Xinjiang, the agricultural irrigation in many places is like the one on the left. The water from the snow-capped mountains is flooded, and a canal brings in the water from one end and comes out from the other, and the land is watered.

However, the way of flood irrigation is very wasteful, and it will be completely sunburned in two days, because the evaporation in that place is very large. There are a lot of water resources from snow-capped mountains in these places, and it would be a great waste if this way is adopted.

We all know that many melons and fruits in the northwest are very good, just because the environment there is enough to produce such an effect. To develop agriculture, if we can improve the whole water-saving irrigation technology, such as the application of drip irrigation and sprinkler irrigation, and strengthen the investment in this part of agriculture, this place will definitely change a lot.

There are still many people who think that there seems to be no vitality in the desert in the northwest. In fact, if the water resources in that place can be used reasonably, it can also glow with certain vitality in this place.

This photo is the scene in the desert that I took around the observatory mentioned at the beginning. We still found many small plants growing in the desert, and that place is not barren.

This little video shows that butterflies are still flying in the very arid Gobi Desert, so this place hides a lot of vitality and has its own ecosystem.Therefore, for such a very fragile area, our protection is the first, and development is the second.

Original title: "If you blow a big hole in the Himalayas, will the northwest become a land of fish and rice?" 》

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In the early 1970s, the first computerized tomography (CT) was born, and since then, the "secrets" of the human body have been unobstructed in front of doctors. With the rapid popularization of CT technology, CT examination has gradually become one of the important auxiliary tools for clinical disease diagnosis.

CT is actually the abbreviation of computerized X-ray tomography technology. According to the different absorption and transmittance of X-rays by different tissues in our body, we use high-sensitivity instruments to measure the human body, and then process the measured data through the computer, take a cross-section or three-dimensional image of the examined part of our body, and finally form a complete three-dimensional information, which can help doctors find some diseases in the human body. This is the basic principle of CT.

There is a saying among doctors that "CT is in hand, and I have it in the world". Although this sentence is ridiculous, it does reflect the increasingly widespread use of CT to some extent.

But everything has two sides, and the convenience brought by CT examination is unquestionable. At the same time, some worrying questions have emerged: for example, why are you required to have a CT examination as soon as you go to the hospital? Isn’t CT a bit rampant? Is there any radiation in CT examination? Will it cause cancer?

Perhaps many people have encountered a similar situation: a headache, to do a CT; I have a stomachache, so I have to do a CT. Leg hurts, arm hurts, or do a CT. …

The doctor said to do a CT. What can I do as a patient? Of course, I choose to obey. Even if I have complaints in my heart and my stomach is full of doubts, I still have to do CT.

Although the price of CT varies from region to region, it is generally several hundred. Especially when multiple parts need to be together, the price is doubled.

So a puzzling phenomenon appeared: I obviously went to see a doctor, but I only talked with the doctor for two minutes. I haven’t asked why, and the disease has not been diagnosed. Thousands of dollars have been spent.

Why is CT examination so rampant now? Is it really because doctors are not good enough? Or do doctors want to earn black-hearted money? Now I want to talk about a real case.

This is a 42-year-old male patient. At first, the patient’s stool became thinner and didn’t care. Later, the situation became more and more wrong. The stool not only became thinner, but also began to become more frequent, and it was also mixed with some oil.

The patient didn’t take it seriously, so he went to the drugstore to buy some medicine to help digestion, and the symptoms were relieved. Three months later, this symptom reappeared, and no relief was found in any medication, so I went to the hospital and explained the situation to the doctor.

At that time, the doctor advised him to improve the abdominal examination to see if there was anything wrong with the organs. The patient thought that the stool problem must depend on the intestines, and there is no need to do other tests, so it will be delayed for several months.

After several months, the patient couldn’t bear it anymore, and decided to improve the abdominal CT. As a result, he found that his pancreatic head occupied a space, which means that there was a nodular lesion of unknown nature in the pancreas. Finally, the patient was diagnosed with advanced pancreatic cancer.

This case not only tells us that we should seek medical treatment in time if we are unwell, but also explains why CT examination is becoming more and more common now.

Why do doctors always recommend CT examination when they go to the hospital?

This is really not the fault of doctors or hospitals, but is determined by many factors.

First of all, although there is still an examination method of "seeing, hearing and asking", this simple inquiry has a great risk of misdiagnosis, which is unbearable for both patients and doctors.

CT examination is different, not only the examination time is short, but also the accuracy is high, which is very suitable for screening patients or emergency examination. For example, if a patient has a headache, doctors can only infer the cause through experience, but in fact, there are many diseases that can lead to headaches, such as common colds and fever, headaches without good rest, headaches due to food poisoning, and headaches due to cerebral hemorrhage and brain tumors.

At this time, if you do a head CT scan, you can find out what the problem is in a short time, which not only speeds up the diagnosis, reduces the possibility of misdiagnosis, but also does not delay the illness. If in doubt, you can have another magnetic resonance examination.

Secondly, it is for accuracy. In the actual process of consultation, some patients may not tell the truth to the doctor out of some concerns. The doctor can only get a preliminary diagnosis based on the patient’s own medical history, symptoms and signs.

But even if there is only 1% doubt, patients need to be arranged for perfect examination, because only by getting scientific and authoritative reports can we judge accurately and objectively.

Finally, there is the issue of the scope of application. In fact, the scope of application of CT is very wide. It can be said that it can be examined from head to toe, except for special organs such as the gastrointestinal tract, which is almost "no dead angle". In contrast, other examinations do not have this advantage, such as magnetic resonance imaging, which is not suitable for the lungs, and the examination time is long, and some patients cannot cooperate to complete the examination; Another example is B-ultrasound, which has weak penetration and is not ideal for head and bones.

How much harm does a CT do to the body? Will it cause cancer?

Many people are worried about this problem. Some scholars have done special research, comparing 680,000 children who have received CT examination with 10 million children of the same age who have not received CT examination. The results show that the radiation dose per 1mSv can lead to an increase in cancer risk of 0.0017-0.002%.

According to this standard, a single dose of 50mSv or a lifetime dose of 100mSv will not cause health risks. Let’s take lung CT as an example. The dose at a time is about 8mSv, so it is in a safe range. Generally speaking, it is recommended that ordinary people do CT no more than 4-6 times a year.

Therefore, we need to be rational about whether CT causes cancer. Radiation does harm to human body objectively, but with the improvement of medical conditions and the progress of medical equipment, CT is also developing constantly. Now many hospitals have 128 rows, and even some hospitals need Shuang Yuan CT, so the radiation will only be greatly reduced, not increased.

Finally, I hope everyone can understand more. No matter which industry there are people who have no morality and bottom line, but they can’t generalize. Most doctors still stick to medical ethics. And what we need to do is to cooperate and trust.

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Original title: "How rampant is CT examination? The doctor finally told the truth.

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