This article systematically introduced the development of Smart Healthcare mode in Hangzhou. From the aspects of connotation, pattern, characteristics and the change of medical treatment mode, the authors pointed out that the development of Smart Healthcare must follow such principles as satisfaction of the people, enhanced inter-departmental synergy, government-guided social participation, and full involvement of medical workers.

CDKs proteins are a kind of cell cycle protein-dependent kinases, which serve as important roles in controlling cell division and transcriptional stages. Among them, CDK9, as a key regulator responsible for the transcriptional elongation of cells, drives the development of various malignant cells and is considered as an important target in the field of anti-tumor drug development. However, the CDK family proteins feature high conservativeness and similarity in structure, leading to the poor selectivity and severe side effects for traditional small-molecular CDK9 inhibitors, which has limited their clinical applications. In view of this, there is an urgent need to investigate CDK9 targets through a novel strategy. The PROTAC is an emerging drug discovery strategy that the degrader could specifically recognize the target protein through indirect linkage with ubiquitin ligases and ultimately eliminate the target protein through the ubiquitination degradation system. This paper provides a brief overview of the structure and function of CDK9 protein, its relationship with the poor prognosis of clinical diseases, as well as the currently reported small molecular inhibitors. The latest research progress on the targeted degradation of CDK9 protein based on PROTAC technology is highlighted. Finally, the development prospects of this target protein in this novel technology field are summarized and prospected, aiming to provide a reference for the development of antitumor drugs in this direction.

Objective To investigate the value of remifentanil IV PCA joint doula in labor analgesia.Methods 480 single fetus at term vaginal delivery of maternal patients were randomly divided into four groups:120 cases voluntary implementation of remifentanil IV PCA joint doula maternity paternity were selected as the experimental group; 120 cases in control group an order to carry out the studies in our hospital childbirth select one to one Doula paternity maternal; 120 cases voluntary implementation of the control group 2 intravenous analgesia with remifentanil maternal;120 cases in control group three normal deliveries in our hospital does not take any measures of maternal.The analgesic effect,labor time,postpartum hemorrhage,cesarean section rate,neonatal asphyxia,the medical staff satisfaction were compared in four groups.Results Analgesic effect of experimental group and control group 2 was significantly better than the control group 1 and the control group 3,the differences were statistically significant (t =4.34,4.76,4.94,5.32,6.32 ;4.42,4.71,4.86,5.28,6.26,all P ＜ 0.05).The first,second,third labor stage of experimental group were (516 + 123)min,(29 + 10)min,(8 + 4)min,which were shorter than those of the other groups (t =3.76,4.21,4.18,all P ＜ 0.05).Conclusion Remifentanil IV PCA joint Doula is safe and easy for labor analgesia.

Objective To evaluate the relationship between vascular endothelial function of coronary heart disease and the severity of coronary artery disease(CHD).Methods 73 patients undergoing coronary angiography were divided into two groups:CHD group(n=39)and non-CHD group(n=34)according to the result of coronary angiography.13 healthy subjects without risk factor of CHD were chosen as normal control group.FMD and NTG-MD of endothelial-dependent and independent dilatation of brachial artery were measured by using of high frequency linear-array uhrasonography for assessment of the vascular endothelial function.and the relationship between the vascular endothelial function and the severity of coronary artery stenosis was analyzed.Results A significant difference was obtained in the FMD among the CHD group,non-CHD group and control group[(4.81±2.33)%vs.(9.29±3.88)%vs.(13.58±1.80)%,F=48.012,P＜0.01).Significant difference was shown in NTG.MD among the three groups[(13.72±3.27)%vs.(15.64±2.65)%vs.(16.54±2.98)%,F=6.015,P＜0.01]and significant difference was shown between CHD group and the other two group(P＜0.05).The FMD was negatively correlated with the basdine value of the brachial artery.tlle number of stenotic coronary ateries and the severity of coronary artery stenosis(r=-0.224,-0,316,-0.721,P=0.038,0.003 and ＜0.001).NTG-MD was also negatively correlated with the baseline value of the brachial artery,the number of stenotic coronary arteries and the severity of coronary artery stenosis(r=-0.483,-0.258,-0.372,P＜0.001,0.027,0.001).Stepwise regression analysis displayed a linear relationship between FMD and the severity of coronary artery stenosis,the baseline value of the brachial artery(r=-0.012,-0.022,P＜0.001).NTG-MD was linearly related to the baseline value ofthe brachial artery and the severity of coronary artery stenosis(r=-0.032,-0.0073,P＜0.001).Conclusion The degree of damage of endothelial function of coronary heart disease is linearly correlated with severity of coronary arteIT stenosis.

Objective To establish a method of reverse hybridization to detect five subfamilies of low risk Human Papillomaviruses(HPV6,11,42,43 and 44)and eighteen subfamilies of high risk HPV (HPV16,18,31,33,35,39,45,51,52,53,56,58,59,66,68,73,83 and MM4)in one reaction.Methods Special probes for twenty-three HPV subfamilies were fixed on nylon membrane bars,biotin labeled general primers mediated polymerase chain reaction(GP-PCR)were applied in HPV DNA amplification.PCR amplified DNA fragments were reversely hybridized with special probes that were fixed on the membranes. All samples(136)detected by reverse hybridization method were paralleled with the methods of Hybridization Capture Ⅱ(HC-Ⅱ)and sequencing.Results Positive rate of the 136 samples detected by reverse hybridization was 41.9%,while HC-Ⅱ 42.6% and sequencing 40.4%.Reverse hybridization detection indicated coherence with the other two methods(Kappa 0.8644 and 0.9089,respectively).While sequencing was lab standard for DNA test,the sensitivity was 96.36%,specificity was 95.06%,accuracy was 95.59%.Conclusions Method of reverse hybridization is adaptable to 23 kinds of HPV subfamilies, which can confirm the exactly subfamilies of HPV infection.This method is adaptable in clinical detection of HPV,with high sensitivity,high specificity,simply and convenient operation and the results are easily to be read.

AIM: To determine the contents of ephedrine、laetrile、glycyrrhizic acid and liquiritin in Huagai Powder traditional decoction and granule decoction(Herba Ephedrae,Semen Armeniacae Amarum,Radix et Rhizoma Glycyrrhizae,etc.) by HPLC. METHODS: An Agilent SB-C_(18) column was used for ephedrine,the mobile phase was acetonitrile-0.1% phosphoric acid(4∶96),detection wavelength at 207 nm;An Agilent XDB-C_(18) column was used for laetrile,the mobile phase was methanol-water(23∶77),detection wavelength at 215 nm;An Agilent XDB-C_(18) column was used for glycyrrhizic acid,the mobile phase was methanol-0.2 mol/L ammonium-acid(67∶33∶1),detection wavelength at 250 nm; An Agilent XDB-C_(18) column was used for liquiritin,the mobile phase was acetonitrile-0.5% acetic acid(20∶80),detection wavelength at 276 nm. RESULTS: There were discrepancies between traditional decoction and granules in the contents of four ingredients,the average contents in granules were more than those in the traditional decoction. CONCLUSION: The peaks of the four ingredients are(segregated)(effectively),and the method is simple,conveient,exact and has good reproducibility,the other ingredients do not have interferences for the determination.

Objective To evaluate the effect of hydrogen-rich saline on the expression of phosphor-p38 mitogen-activated protein kinase (p-p38MAPK) during cerebral ischemia-reperfusion (I/R) in rats.Methods Seventy-two adult male Sprague-Dawley rats,weighing 220-250 g,were randomly divided into 3 groups (n =20 each) using a random number table:sham operation group (group S),I/R group and hydrogen-rich saline group (group I/RH).Cerebral ischemia was induced in chloral hydrate-anesthetized rats by 2 h middle cerebral artery occlusion in I/R and I/RH groups.The artery was only exposed but not occluded in group S.At 3 days before operation and immediately after onset of reperfusion,hydrogen-rich saline (0.6 mmol/L) 10 ml/kg was intraperitoneally injected in group I/RH,while the equal volume of normal saline was given in S and I/R groups.Neurological deficits were blindly assessed and scored at the end of 24 h reperfusion.The animals were then sacrificed,and brains were removed for microscopic examination and for determination of the cerebral infarct size (by TTC),brain water content,cell apoptosis (by TUNEL),and expression of p38MAPk and phosphor-p38MAPK (p-p38MAPK) (by immunohistochemistry and Western blot).Apoptosis index was calculated.Results Compared with group S,neurological deficit score,apoptosis index,brain water content and cerebral infarct size were significantly increased,and the expression of p38MAPK and p-p38MAPK was up-regulated in I/R and I/RH groups.Compared with group I/R,neurological deficit score,apoptosis index,brain water content and cerebral infarct size were significantly decreased,and the expression of p38MAPK and p-p38MAPK was down-regulated in group I/RH.The pathological changes of cerebral tissues were significantly attenuated in group I/RH as compared with group I/R.Conclusion Hydrogen-rich saline can reduce cell apoptosis through inhibiting p-p38MAPK expression,thus attenuating cerebral I/R injury in rats.

Objective To summarize and discuss the diagnostic and treating experiences of chronic pancreatitis with mass in the head. Methods Eight patients of chronic pancreatitis with mass in the head who were misdiagnosised as carcinoma of head of pancreas were analyzed retrospectively in the past 10 years. Results All the patients exhibited abdominal pain,5 of whom were with jaundice and 3 with anorexia. All the patients were misdiagnosised as carcinoma of head of pancreas before the operation,but the pathology after operation indicated chronic pancreatitis. The pancreaticoduodenectomy was performed in 5 patients,the choledochojejunostomy in 2 patients,while the exploratory laparotomy in 1 patient. After the operations,the abdominal pain was relieved in 7 patients, while 2 patients who accepted pancreatoduodenectomy suffered from pancreatic fistula,1 of whom died in the end. Conclusion It’s hard to differentiate the chronic pancreatitis with mass in the head from the carcinoma of head of pancreas before operation. If the carcinoma of head of pancreas can’t be excluded during the operation,the pancreatoduodenectomy should be performed,while the duodenum-preserving total resection of the head of the pancreas or any intra-drainage operations should be done if chronic inflammation is found in the whole pancreas with a negative result of the biopsy of the pancreas through the needle aspiration.

Objective To evaluate the effect of hydrogen on the activation of caspase-3 in brain tissues during cerebral ischemia-reperfusion (I/R) in rats.Methods Thirty-six healthy adult male Sprague-Dawley rats,weighing 220-250 g,were divided into 3 groups (n=12 each) using a random number table:sham operation (group S),I/R group and hydrogen group (group H).Cerebral ischemia was induced by occlusion of the middle cerebral artery followed by reperfusion in I/R and H groups.In group H,hydrogen-rich saline 5 ml/kg (0.6 mmol/L) was injected intraperitoneally at 3 days before establishment of the model and immediately after the onset of reperfusion.At 24 h of reperfusion,the rats were sacrificed,and hippocampal tissues were obtained for determination of neuroapoptosis (by TUNEL),apoptotic neuron count and expression of activated caspase-3 (by Western blot).The brain tissues in the ischemic area were obtained and stained with haematoxylin and eosin for examination of the pathological changes.Results Compared with group S,the expression of activated caspase-3 was significantly up-regulated,and the apoptotic neuron count was increased in I/R and H groups (P<0.05).Compared with group I/R,the expression of activated caspase-3 was significantly down-regulated,the apoptotic neuron count was decreased (P<0.05),and the pathological changes of brain tissues were significantly reduced in group H.Conclusion The mechanism by which hydrogen inhibits neuroapoptosis during cerebral I/R is probably related to inhibited activation of caspase-3 in brain tissues of rats.

Objective:To investigate the relationship between serum microRNA-222(miR-222) and metabolism of glucose and lipid in women with polycystic ovary syndrome(PCOS).Methods:A total of 100 patients with PCOS (PCOS group) were enrolled from July 2018 to July 2020 in Puren Hospital Affiliated of Wuhan University of Science and Technology, and another 85 sterility patients were selected as control group. The levels of total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein (LDL-C), fasting insulin (FINS), fasting plasma glucose (FPG), insulin resistance index (HOMA-IR) as well as serum miR-222 were compared between two groups, and the correlation between serum miR-222 and metabolism of glucose and lipid was analyzed.Results:The levels of TC, TG, LDL-C, FPG, FINS, HOMA-IR, miR-222 in PCOS group were higher than those in the control group: (1.30 ± 0.25) mmol/L vs. (1.04 ± 0.21) mmol/L, (4.36 ± 0.91) mmol/L vs. (3.67 ± 0.61) mmol/L, (2.51 ± 0.89) mmol/L vs. (2.13 ± 0.42) mmol/L, (5.34 ± 1.56) mmol/L vs. (4.91 ± 0.84) mmol/L, (11.08 ± 3.83) mU/L vs. (7.49 ± 2.53) mU/L; the level of HDL-C in PCOS group was lower than that in the control group: (1.08 ± 0.47) mmol/L vs. (1.53 ± 0.50) mmol/L, and the differences were statistically significant ( P<0.05). The results from Logistic regression analysis showed that the levels of TC, TG, HDL-C, LDL-C, FINS, HOMA-IR, miR-222 were independent risk factors for abnormal of metabolism of glucose and lipid of polycystic ovary syndrome patients ( P<0.05). The correlation analysis showed that miR-222 expression had positive correlation with TC, TG, LDL-C, FINS, HOMA-IR ( r = 0.760, 0.737, 0.769, 0.749, 0.825, P<0.05), and had negative correlation with HDL-C( r = -0.743, P<0.05). Conclusions:The serum miR-222 shows abnormal increase in the PCOS patients, and is closely related to glucose and lipid metabolism. It can be used as a biomarker of abnormal glucose and lipid metabolism.