In the application of Internet-based tendering system, some shortcomings have turned up. At the same time, countermeasures in four aspects that should be taken by medical organizations and suppliers are introduced to improve its features of convenience and efficiency.

Ventral hernia is a very common surgical problem with its incidence gradually increasing due to aging population,and it has significantly threat to quality of life.Laparoscopic hernia repair is a kind of minimally invasive surgery based on tension-free hernia repair,which has become an effective way for treatment of ventral hernia after decades of development.Besides,the classic surgical approaches for adult inguinal hernia include intraperitoneal onlay mesh,transabdominal peritoneal and totally extraperitoneal repairs.However,some related complications including vascular injury and bleeding,postoperative pain,nerve damage,seroma,intestinal obstruction,infection and relapse have been increasingly reported with the extensive applications of laparoscopic ventral hernia repair.Surgeons still need to pay more attentions and take appropriate measures to prevent such events.Complications could be reduced by strictly following the indications of different laparoscopic hernia repair surgeries with a careful consideration of the advantages and disadvantages,understanding their pathogenesis,improving the laparoscopic operation techniques,getting familiar with the local anatomical structures and standardizing the surgical procedures.Establishing a correct and standard surgical training system will further shorten the learning curve of surgeons to promote the progression and development of hernia surgery in China.

Objective To study the relative factors of hypotension after recanalization of infarction related artery(IRA) during emergency PCI for patients with acute myocardial infarction.Methods We retrospectively analyzed the clinical information and the coronary angiograph of 245 consecutive patients with primary acute myocardial infarction undergoing emergency PCI at the first affiliated hospital of China Medical University from January 2003 to September 2006.Twenty seven patients with blood pressure elevated higher than 140/90 mm Hg after reperfusion were excluded.The remaining 218 patients were catagorized into the hypotension group(BP≤90/60 mm Hg,n=102) and the normal blood pressure group(n=116) according to the blood pressure level after reperfusion during emergency PCI.The relative factors of hypotension were analyzed through logistic regression test.Results Compared with the normal blood pressure group,patients in the hypotension group had higher incidences of old age(age ≥60 yrs),heart failure(killip grades≥grade 2),inferior wall or right ventricular infarction,right coronary artery lesions,proximal or total occlusion lesions,multivessal disease and TIMI blood flow≤grade 1 in the IRA after recandization.Mortality rate was also higher in the hypotension group(P1).Conclusion Old age(age ≥60),inferior wall infarction,killip grades≥2,right coronary artery lesions,proximal or total occlusion lesions are the risk factors of hypotension after recanalization of IRA during emergency PCI.The presence of hypotension is correlated with the increase of in hospital mortality.

Objective: To investigate the changing trends in the burden of cardiovascular diseases (CVD) in Zhejiang Province from 1990 to 2019, so as to provide insights into CVD control in the province. Methods: Based on the data of the Global Burden of Disease Study (GBD) 2019 (GBD 2019), the years lived with disability (YLD), years of life lost (YLL), disability-adjusted life years (DALY), YLD rate, YLL rate and DALY rate due to CVD were estimated to assess the burden of CVD in Zhejiang Province from 1990 to 2019. The changing trends in the burden of CVD were using annual percent change (APC) in Zhejiang Province from 1990 to 2019, and compared to China and global regions with different socio-demographic indexes (SDI). Results: The YLL rate (APC=-0.50%, F=22.366, P<0.001) and DALY rate due to CVD (APC=-0.20%, F=5.212, P=0.030) appeared a tendency towards a decline in Zhejiang Province from 1990 to 2019, while the YLD rate showed a tendency towards a rise (APC=1.92%, F=1 117.891, P<0.001). The YLL rate (APC=-1.09%, F=56.871, P<0.001), YLD rate (APC=1.92%, F=922.541, P<0.001) and DALY rate (APC=-0.60%, F=28.974, P<0.001) appeared the same tendency among women relative to among the whole populations, while only the YLD rate showed a clear-cut change among men, appearing a tendency towards a rise (APC=1.82%, F=1 238.423, P<0.001). Both the YLL rate and DALY rate appeared a tendency towards a decline among subjects at all age groups, with the most significant reduction among subjects at ages of 50 to 69 years (YLL rate: APC=-4.40%, F=1 443.608, P<0.001; DALY rate: APC=-3.82%, F=1 519.452, P<0.001). Among all types of CVD, the highest burden was measured in cerebrovascular diseases, with a standardized DALY rate of 1 359.7/105, and the most remarkable reduction in the standardized DALY rate was seen in rheumatic heart diseases. The burden of CVD in Zhejiang Province was lower than that in China and the majority of the world, with consistent changing trends with that in China and global regions with different SDI. Conclusions The overall burden of CVD appeared a tendency towards a decline in Zhejiang Province from 1990 to 2019, which was in agreement with that in China and global regions with different SDI. A remarkable reduction in the burden of CVD was seen among women, residents at ages of 50 to 69 years and cases with rheumatic heart diseases.

Objective To explore the clinical feature and diagnosis of the X linked adrenal hypoplasia congenital (X-AHC). Methods The clinical data and gene detection results of one case of AHC were retrospectively analyzed. The related literatures were reviewed. Results Two-month-old male infant was suffered with slow weight gain, vomiting, and salt craving of adrenal insufifciency after birth. Gene detection found a new missense mutation on NROB 1 gene. The diagnosis of X-AHC was conifrmed. Conclusions X-AHC is a kind of rare disease and is diagnosed by clinical manifestation, laboratory testing, and NROB 1 gene detection.

This study was aimed to explore a new method to identify the original plant of Plantaginis Semen and its adulterants by the ITS2 regions. The second internal transcribed spacer (ITS2) of ribosomal DNA was amplified and sequenced by bidirectional sequencing of PCR products. Sequence assembly and consensus sequence generation were performed by using CodonCode Aligner. The ITS2 secondary structure was predicted using ITS2 database and web-sites. The phylogenetic tree was constructed by MEGA5. The results showed that the maximum intraspecific K2P dis-tance of Plantago asiatica was 0.009 9, while the minimum interspecific K2P distance was 0.497 6; the maximum in-traspecific K2P distance of P. depressa was 0.005 2, while the minimum interspecific K2P distance was 0.519 1. The ITS2 secondary structure showed that P. asiatica and P. depressa can be differentiated obviously from its adulterants. Different samples of P. asiatica and P. depressa were gathered together and can be distinguished from its adulterants by NJ tree. It was concluded that the ITS2 sequence was able to identify original plant of Plantaginis Semen and its adulterants correctly. It provided a new method for the identification of original plant of Plantaginis Semen.

Pancreatic cancer is one of the most malignant tumors with a high mortality rate attributed to its widespread metastasis.A number of cellular signal transduction pathways involved in multiple genes play an important role in regulating this complex metastatic cascade of pancreatic cancer.NF-kappa B is one of the crucial signaling pathways.Studies has indicated that NF-kappa B could modulate a series of biological events relevant to tumor progress by controlling multiple targeted genes expression,such as cell proliferation,anti-apoptosis,angiogenesis,epithelial-mesenchymal transition,inflammation,stress response,etc.Furthermore,it can also up-regulate Hedgehog and MMPs signaling pathways.To help us better understand the potential mechanism and identify more sensitive tumor markers and selective targets,this review will underline the significant roles of NF-kappa B signaling pathway in regulatory network of pancreatic cancer metastasis.

Objective To detect the expression of long non-coding RNA (lncRNA) CCAT1 in human papillary thyroid cancer, and to observe the effect of CCAT1 down-regulation on the invasion and migration of human papillary thyroid cancer.Methods The expression of CCAT1 was detected in human normal thyroid Nthy-ori 3-1 cells and human papillary thyroid cancer TPC-1 cells.CCAT1 siRNA plasmid was transfected into TPC-1 cells.The effect of CCAT1 down-regulation on cell invasion and migration was observed by Transwell chamber assay and scratch test, and the expressions of BRAF, MUC15 and RKIP proteins were detected by Western blot.Results The level of CCAT1 in human papillary thyroid cancer TPC-1 cells was significantly higher than that in human normal thyroid Nthy-ori 3-1 cells.CCAT1 down-regulation significantly inhibited the invasion and migration of TPC-1 cells.The Transwell invasion assay revealed that the number of migrated TPC-1 cells in the CCAT1 down-regulation group was significantly lower than that in the control group.The scratch test showed an increased distance between cells in the CCAT1 down-regulation group compared to the control group, suggesting a reduced cell motility.The expressions of BRAF and MUC15 proteins were decreased in the CCAT1 down-regulation group, while that of RKIP protein was increased.Conclusions The expression of CCAT1 in papillary thyroid cancer cells is significantly higher than that in normal human thyroid cells.Down-regulation of CCAT1 in papillary thyroid cancer cells may inhibit the cell invasion and migration by regulating the expression of BRAF, MUC15 and RKIP proteins.

BACKGROUND:MicroRNAs (miRNAs) play an important role in a variety of diseases. Investigation of miRNA expression profile in degenerative lumbar scoliosis is beneficial for understanding its pathogenesis, providing a novel therapeutic target. Therefore, we tested the hypothesis that miRNAs promote intervertebral disc degeneration through the interleukin-10/STAT3 signaling pathway, a potential regulator of intervertebral disc degeneration.
OBJECTIVE:To compare the differentialy expressed miRNAs in the intervertebral disc tissues from patients with degenerative lumbar scoliosis and normal controls and to identify specific miRNAs in degenerative lumbar scoliosis folowed by functional validation.
METHODS: An initial screening of miRNA expression in nucleus pulposus tissues by miRNA Solexa Sequencing was performed in samples from 10 patients with degenerative lumbar scoliosis and 10 controls, respectively. Subsequently, differentialy expressed miRNAs were validated using qRT-PCR. The level of differentialy expressed miRNAs in degenerative nucleus pulposus tissues was investigated. Then, functional analysis of the miRNAs in regulating type II colagen expression was carried out. Western blot and luciferase reporter assay were used to further confirm the target gene.
RESULTS AND CONCLUSION: We identified 30 miRNAs that were differentialy expressed (16 upregulated and 14 downregulated) in patients with degenerative lumbar scoliosis compared with controls. Folowing qRT-PCR confirmation, Has-let-7f was significantly down-regulated in degenerative nucleus pulposus tissues as compared with controls. Moreover, its level was correlated with the severity of disc degeneration. Overexpression of Has-let-7f promoted type II colagen expression in nucleus pulposus cels. Knockout of interleukin-10 induced effects on nucleus pulposus cels similar to Has-let-7f. Bioinformatics target prediction identified interleukin-10 as a putative target of Has-let-7f. Furthermore, luciferase reporter assays demonstrated that Has-let-7f altered the expression of STAT3 and matrix metaloproteinase-2. These findings indicate that the downregulation of Has-let-7f induces type II colagen loss by directly targeting inleukin-10, thereby resulting in intervertebral disc degeneration and degenerative lumbar scoliosis. Has-let-7f is likely to be a novel therapeutic target for degenerative lumbar scoliosis.

BACKGROUND:MicroRNAs are widely involved in the regulation of protein expression, and play a critical role in many physiological and pathological processes in the body. But microRNA expression profile in degenerative lumbar scoliosis is rarely reported and understood. OBJECTIVE:To compare the microRNA expression profile in the normal intervertebral disc and degenerative lumbar scoliosis and to identify degenerative lumbar scoliosis-specific microRNAs, folowed by functional validation. METHODS: Total RNA samples were extracted from the nucleus pulposus tissues of 57 patients with degenerative lumbar scoliosis as experimental groups and the normal nucleus pulposus tissues of 42 patients with lumbar fractures as control group. An initial screening of differentialy expressed microRNAs in the nucleus pulposus tissues by microRNA microarray was performed in 10 samples from each group. Subsequently, differentialy expressed microRNAs were validated using real-time quantitative RCR. The level of differentialy expressed microRNAs in the degenerative nucleus pulposus tissues was investigated. Then, the functional analysis of microRNAs in regulating colagen II expression was carried out. Western blot and luciferase reporter assay were also used to detect target genes. RESULTS AND CONCLUSION:We identified 22 microRNAs that were differentialy expressed (17 upregulated and 5 downregulated) in degenerative lumbar scoliosis patients compared with the controls. Folowing real-time quantitative RCR confirmation, miR-491-5p was significantly down-regulated in degenerative nucleus pulposus tissues in comparison with the controls. Moreover, its level was closely correlated with the pathological grading of disc degeneration. Overexpression of miR-491-5p promoted type II colagen expression in nucleus pulposus cels. Bioinformatics target prediction identified matrix metaloproteinase-9 as a putative target of miR-491-5p. Furthermore, luciferase reporter assays demonstrated that miR-491-5p directly targeted matrix metaloproteinase-9 and affected its protein expression in nucleus pulposus cels. These results show that the downregulation of miR-491-5p induces type II colagen loss by directly targeting matrix metaloproteinase-9, thereby resulting in degeneration of the intervertebral disc and degenerative lumbar scoliosis. This study also underscores the potential of miR-491-5p as a novel therapeutic target in degenerative lumbar scoliosis.