Objective:To study the current process and steps of government procurement in China, analyze the key factors affecting fair competition in the process of government procurement in public hospitals, and put forward feasible operational suggestions to promote fair competition in government procurement.Methods:Delphi method was used to construct the index system of the key factors affecting fair competition during the process of government procurement of public hospitals. The weight of the index system was determined by the analytic hierarchy process, and the key factors were quantitatively analyzed.Results:The index system affecting fair competition in the process of government procurement of public hospitals included 1 first-level index, 8 second-level indexes and 21 third-level indexes. Through calculation and analysis, it was concluded that the key factors affecting fair competition were feasibility study, market research, contract performance acceptance, procurement demand confirmation and project approval, with their comprehensive weights of 0.228 5, 0.144 0, 0.085 9, 0.072 9 and 0.060 4, respectively.Conclusions:We should properly expand the scope of feasibility study, fully carry out market research, reasonably set government procurement demand parameters, and strengthen contract performance acceptance and payment management, so as to promote the fair competition of government procurement in public hospitals.

Objective To analyze the anatomical relationship between Zuckerkandl's tubercle (ZT) and the recurrent laryngeal nerve(RLN),to reduce the incidence of RLN injury risk.Methods 280 patients undergoing total thyroidectomy from Jan.2008 to Jan.2013 were included in our study.A meticulous technipue of excapsular dissection was used to dissect thyroid.ZT's size,classification,and its relationship with RLN were studied and classified.Results A total of 280 thyroid gland lobes were dissected.ZT identified in the left was 94.1％(128/136),right 96.4％(160/166),and bilateral 72.8％(220/302).ZT grades were as the following:Grade 0,left 11.8％(16/136) and right 11.4％(19/166);Grade I,left 30.1％(41/136) and right 25.3％(42/166);Grade II,left 44.1％(60/136) and right 43.4％(72/166);Grade III,left 8.1％(11/136) and right 16.3％(27/166).There was no significant difference on ZT classification between the left side and right side.For ZT with grade I or above,112 cases were at the left side,among which type A was 90.2％(101/112),type B 0.9％(1/112),type C 7.1％(8/112),and type D 1.8％(2/112),and 141 cases were at the right side,among which type A was 92.9 ％ (131/141),type B 0.7％(1/141),type C 5.0％(7/141),and type D 1.4％(2/141).There was no significant difference between the left side and the right side in terms of type.Type A of ZT was the most common type.Conclusion As an important anatomic landmark,ZT is essential for locating and dissecting RLN during thyroid surgery,however,due to its complex anatomical relationship with adjacent organs and the variability of RLN and its branches here,from which to reveal RLN has the possibility of increasing the injury risk.

Objective To evaluate different methods to explose recurrent laryngeal nerve (RLN)based on the location of thyroid diseses and anatomic path of the RLN,to avoid the RLN damage in thyroid surgery.Methods A total of 755 cases underwent total lobectomy was studied retrospectively.RLN was explosed in each case.Results A total of 963 RLN was exposed in 755 cases,among those 658 RLN were exposed by lateral approach,106 by inferior approach,and 199 by superior approach.It was showed that 694 RLN traveled deep to the inferior throid artery and 119 superficial to the artery,98 through between two branches of the artery,and 62 with the cross of the nerve branches and the artery branches.Before entering larynx,578 RLN gave off branches and 385 had no branches.Non-recurrent laryngeal nerves were found in 2 cases.There were 6 cases who presented with hoarseness after thyroidectomy and undergoing reexploration,among them RLN were legated in 4 cases and severed in 2 cases.Conclusions The anatomic relation of RLN is relatively complicated.Lateral,inferior or superior aproach may be used for exposure of RLN to decrease risks of injury to the nerve.