In the face of the "cliff-like" decline in the price of centralized mining, how to deal with the heart stent enterprises?

Sheng: the "past lives" of heart stent

Cardiac stent, also known as coronary stent, is a high-value consumable commonly used in percutaneous coronary intervention (PCI), which has the function of dredging arterial blood vessels and is recognized as a conventional treatment for cardiovascular diseases. Since the first generation of stents went on the market in 1997, the development of cardiac stents has gone through three stages, the first generation is the balloon expansion era, the second generation is the bare metal stent era, the third era is the drug-eluting stent era, and it is now moving towards the fourth generation of completely degradable stents. With the continuous evolution of materials, the performance is more and more optimized. The main features of each generation of cardiac stents are as follows:

Fig. 1 development of cardiac stent

At present, non-degradable drug eluting stent,DES) is still the mainstream choice for clinical application, and fully degradable stent is still in the early stage of product development and clinical application. At present, the mainstream cardiac stents in the market are still drug-eluting stents, and the market share has remained at around 99% since 2012, and balloons and bare metal stents have been completely replaced by them. Biodegradable stents (BRS) can be gradually absorbed in the body, which can significantly reduce the formation of stent thrombosis and restenosis, at the same time, it will not affect MRI and CT scanning, and also facilitate the re-intervention process. It is the main direction of stent research and development in the world, and has attracted extensive attention from medical device companies at home and abroad. At present, the fully degradable heart stents put into research and development are mainly divided into two categories: degradable metal materials and degradable polymer materials.

Fig. 2 Types of mainstream cardiac stents currently in use

(A) In recent years, the demand for cardiac stents has been increasing, and the scale has steadily increased.

1. The number of PCI interventions in China ranks first in the world, and the number of PCI interventions has increased by over 15% annually in recent five years.

From 2015 to 2019, the number of cases of percutaneous coronary intervention (PCI) in China increased steadily, with an average annual increase of 16.0%. Among them, the number of percutaneous coronary intervention (PCI) in China in 2019 was 1.03 million, ranking first in the world, with an increase of 12.6% compared with 2018. It is conservatively estimated that there will be nearly 1.2 million cases of percutaneous coronary intervention (PCI) in China in 2020.

Fig. 3 Trends of PCI operation volume in China from 2015 to 2020 (data source: analysis by Health Research Institute).

In 2020, the market value of heart stents in China is close to 17.5 billion yuan.

From 2015 to 2019, the number of cardiac stents implanted in China showed a steady growth trend year by year, with an annual growth rate of 15%-20%. In 2019, the number of cardiac stents implanted in China was 1.6 million. In terms of market value, the market value of heart stents in China increased from 9.75 billion yuan to 15.97 billion yuan from 2015 to 2019, with an average annual growth rate of 15.2%. It is estimated that the market value will be close to 17.5 billion yuan in 2020.

Fig. 4 Trend chart of cardiac stent implantation quantity and scale in China from 2015 to 2020 (data source: analysis by Health Research Institute).

(B) The "market just needs+policy orientation+technology promotion" troika escorts the rapid development of the cardiac stent industry.

1. The market just needs:The two major trends of younger coronary heart disease and aging population have once again "expanded" the cardiac stent market.

Younger coronary heart disease:Cardiovascular disease has become the number one health killer in the world, accounting for nearly 30% of the total global deaths. According to China Cardiovascular Health and Disease Report 2019, the number of cardiovascular patients in China reached 330 million, accounting for more than 45% of the deaths of residents, ranking first among all diseases. Among them, the number of patients with coronary heart disease has reached 11 million, with more than 3 million new patients each year and more than 1 million patients with sudden infarction. In addition, the younger trend of coronary heart disease (CHD) is increasing. According to a survey of cardiovascular diseases among more than 20,000 people in Shanghai, the number of patients with CHD accounts for nearly 30%, of which 27.0% are over 70 years old, 40.0% are 51-70 years old, and 33.0% are under 50 years old. CHD is no longer a "patent" for the elderly, and it is obese, stressful and stressful.

Figure 5 Proportion of cardiovascular disease population structure (data source: public information)

Aging:According to statistics, in 2019, the population aged 65 and above accounted for 12.6% in China. From the development trend, the population aging speed and scale in China are unprecedented. After 2022, China will enter a deeply aging society with a proportion of over 14.0%, a super aging society with a proportion of over 20.0% around 2033, and then it will continue to rise to 35.0% in 2060. The arrival of the era of deep aging will undoubtedly raise the "ceiling" of the heart stent industry.

Figure 6 Structural trend of population aging in China (data source: public information)

With the development of younger coronary heart disease and aging population, and considering the impact of centralized procurement on the price of cardiac stents and the improvement of people’s health awareness, the number of PCI operations per capita in China will be in line with that of developed countries in the future (the number of PCI operations per million population in China is 736, that in the United States is about 3,135, and that in Japan is about 2,047, which is 4.3 times and 2.8 times that in China, respectively). According to the extreme analogy method (referring to the number of PCI operations per million people in Japan, mainly considering that China and Japan are similar in race and incidence), it is estimated that the peak number of PCI operations will reach 2.87 million in the future. Considering the average number of stents implanted in PCI (about 1.5 stents/case), the corresponding peak number of cardiac stents implanted is about 4.3 million, which has a large long-term permeability and market space.

Fig. 7 Comparison of the number of percutaneous coronary intervention (PCI) between China and major developed countries (data source: analysis by Health Research Institute).

2. Policy orientation:Front-end encouraging innovation and end-collection specification help the market demand of cardiac stents to be released continuously.

In recent years, the state has launched a series of favorable policies for the medical device industry to support the rapid development of enterprises:

innovateEncourage the acceleration of the transformation and upgrading of medical devices, develop high-end interventional products such as fully degradable vascular stents, and stimulate the development of new cardiac stents market segments; Priority is given to the review and approval of qualified innovative medical devices. Under the promotion of innovation policy, the fully degradable polymer matrix drug (rapamycin) eluting stent system (NeoVas) independently developed by Lepu Medical and the fully degradable polylactic acid stent (Xinsorb) independently developed by Academician Ge Junbo of China Academy of Sciences have all entered the special approval procedures for innovative medical devices.

circulateFrom the national level to the provinces and cities, the centralized purchasing scheme of high-value consumables has been launched one after another, constantly rationalizing the price system of high-value medical consumables and improving the supervision and management of the whole process. In October 2020, coronary stents became the first batch of purchased varieties, and the national level started the collection of high-value medical consumables.

Table 1: Main policies related to high-value consumables such as cardiac stents from 2016 to present:

3. Technology promotion:The iterative upgrading of products and the improvement of interventional surgery level greatly enhance patients’ confidence and willingness to receive interventional therapy.

Iterative upgrade of products: cardiac stent has experienced the development from balloon expansion to drug-eluting stent, and the restenosis rate of stent implantation has decreased by nearly 20%, and the incidence of thrombosis in stent has decreased to about 1%, which effectively reduces the risk of complications for patients;

Improving the level of interventional surgery: China has successively established the training base of cardiovascular interventional diagnosis and treatment of the Ministry of Health and the national quality control center of PCI, and adopted a unified training model to carry out systematic training nationwide, and issued certificates after passing the examination, and carried out quality control and index monitoring on related work. In 2018, the mortality rate of interventional therapy for patients with coronary heart disease was 0.26%, far lower than that in the United States.

(III) Competition pattern: Domestic substitution in the cardiac stent industry has basically been completed.

After decades of development, the technical generation gap among major enterprises has gradually narrowed, and the industry pattern has been basically stable, mainly relying on the launch of new products to enhance market share. Judging from the competition pattern, the concentration of cardiac stent industry is high, and the market share of domestic drug stent products exceeds 70%, and the domestic substitution is basically completed. Among them, domestic brands such as Weichuang, Lepu and Jiwei rank among the top three, with a total market share of over 65%.

Figure 8 Market share of domestic cardiac stent brands in 2019 (data source: analysis by Health Research Institute)

In 2019, the revenues of cardiac stents (including balloons, catheters and other ancillary products) of minimally invasive medical care, Lepu medical care and Jiwei medical care were 1.83 billion yuan, 1.79 billion yuan and 1.74 billion yuan respectively, with growth rates of 33.0%, 26.7% and 24.9% respectively. As can be seen from the figure, cardiac stents of minimally invasive medical care showed a trend of "double high" in sales growth rate and market share.

Figure 9 Market share and revenue growth rate of cardiac stent head enterprises (data source: analysis by Health Research Institute)

Change: the national "group purchase" triggered a major change in the heart stent industry.

With the landing of the national heart stent collection, the "suicide" price reduction of enterprises has also brought infinite reverie to the future direction of the industry. Will the heart stent industry under centralized procurement be a "broken wrist" or a "rescue" in the future? Is it "price for quantity" or "innovation and transformation"?

(A) the change in scale

Centralized procurement of cardiac stents directly affects the purchase price. According to the recent centralized purchasing list published by the Medical Insurance Bureau, the number of intentional purchases in the first year exceeded 1.07 million, involving 27 products. Based on the published average price quoted by the winning bidder (1682 yuan/piece) and the amount of coronary stents implanted in 2021, the market value in 2021 is about 3.19 billion yuan. It should be emphasized that the market value forecast here does not consider the impact of the decline in centralized purchasing price on the improvement of patients’ willingness to operate.

Fig. 10 Market value forecast of cardiac stent in 2021 (data source: analysis by Health Research Institute)

According to the previous estimation of the amount of cardiac stent implantation in China, when the amount of PCI operation per 100 people reaches the Japanese level, the peak amount of cardiac stent implantation in China is 1400 x 2047 x 1.5 = 4.3 million. According to the heart stent of 1682 yuan/piece (the average price of centralized procurement), the corresponding market value of heart stent is 7.23 billion yuan:

Fig. 11 Market value of China cardiac stent corresponding to peak value (data source: analysis by Health Research Institute)

From the above analysis, it can be seen that under the influence of centralized procurement policy, the market value of heart stents in China in the next 1-3 years is expected to be in the range of 3-7 billion yuan.

How much money can patients save after centralized collection?

As we all know, the "floor price" of centralized purchasing has a great influence on patients who are unwilling to undergo interventional surgery because of the high price. This paper analyzes the payment situation of patients before and after centralized purchasing (according to the conventional reimbursement policy):

Fig. 12 Comparison of patients’ self-funded amount before and after centralized purchasing (data source: analysis by Health Research Institute)

As can be seen from the above figure, according to the same reimbursement policy, the out-of-pocket medical expenses of patients decreased from 6520 yuan to 308 yuan before and after centralized purchasing, and the personal burden was only 4.7% of the original, which greatly eased the economic burden.

(2) Changes in business

In addition to the industry scale being affected, the business tentacles of heart stent enterprises will also be adjusted:

1. Stent market: form a low-cost medical insurance centralized procurement market+off-standard non-medical insurance high-end alloy stents+medical insurance stainless steel stents+non-medical insurance ultra-high-end degradable stents.

In the short term, the market of cardiac stent products will form a pattern of low-cost medical insurance centralized procurement market+off-standard non-medical insurance high-end alloy stent+medical insurance stainless steel stent+non-medical insurance ultra-high-end degradable stent:

On the one hand, from the current attitude of centralized mining, bare metal stents are not included in the list of centralized mining, and the price of stainless steel stents will be under pressure due to the price reduction of centralized mining in the short term, and the price inversion with alloy stents will not last long; In the long run, stainless steel stents are not as good as alloy stents in terms of support and passability. As a more backward technology than Co-Cr alloy and Pt-Cr alloy, stainless steel stents will face marginalization in the future. However, in view of the fact that the use of stainless steel coronary stents still accounts for about 40% of the market share in 2019, stainless steel coronary stents will be coasting for a period of time in the future.

On the other hand, with the continuous promotion of cardiac stent collection, the trend of differentiation and stratification of end patients will become more obvious, and the group of self-paid high-priced stents may expand. Degradable stents and metal stents belong to two price bands, so it is impossible to talk about the market share substitution after the huge change of centralized purchasing price. Moreover, the proportion of consumables in the cost of PCI surgery has further decreased, and the audience’s marginal willingness to pay for innovative products is likely to increase. In the medium term, the development rhythm of fully degradable stents will continue to be stable, in order to get as much clinical data as possible, enhance the recognition and acceptance of products by more experts, doctors and patients, and enhance the high-end market share.

Figure 13 Future product layout of cardiac stent

2. Business reshaping: cultivate and expand new medical formats around the cardiovascular field, and make a forward-looking and diversified layout.

On the one hand, it conforms to the latest concept of "intervention without implantation" of the current interventional instruments, and extends upstream and downstream around the coronary intervention chain:

Product chain: the price reduction of metal stents will be the norm in the future, and the fully degradable stents and drug balloons with "intervention without implantation" will become the core of future development. Facing the policy impact of centralized stent mining, it will be an effective hedging means to extend the layout of coronary intervention chain. In addition to completely degradable stents, a new generation of drug-coated balloon (DCB) has also become the core of future development under the new concept of "interventional non-implantation". The data shows that the usage of drug-coated balloons in some hospitals or individuals in Europe has reached 50%-90% of all PCI, and Japan has reached 4,000 per month, accounting for about 15% of Japanese PCI. In addition, auxiliary consumables (balloons, catheters, guide wires, etc.) related to coronary intervention will also become the profit growth point that enterprises pay attention to.

Technical service chain: The further decline in the proportion of consumables in the cost of PCI surgery has prompted enterprises to speed up the layout of medical services and health management sectors. Conditional enterprises will cooperate with primary hospitals to provide equipment consumables, drugs and medical technical services needed for interventional diagnosis and treatment, and promote the grassroots promotion and popularization of new interventional technologies, which will become an important exploration for coronary intervention enterprises to face the centralized procurement of high-value consumables.

On the other hand, the centralized procurement of cardiac stents has prompted enterprises to expand from coronary intervention to peripheral intervention, and continuously enrich their product lines:

Make full use of enterprise stent balloon design and precision manufacturing platform technology, constantly innovate and develop, expand the company’s products from coronary intervention to peripheral intervention, continuously enrich the cardiovascular disease product line, and concentrate on improving the company’s marketing network structure to cope with market risks brought about by policy uncertainty.

Figure 14 Possible business development direction of cardiac stent enterprises under the background of centralized procurement

(C) changes in the market

Under the general trend and background of medical insurance fee control and national centralized procurement, it has a great influence on the competition pattern of domestic medical industry. Medical device enterprises will face more fierce market competition, as well as the realistic problems of product prices and product profit margins falling sharply. For the leading enterprises in the industry, although they can seize more market share by winning the bid at a low price, the problem of shrinking scale and declining profit rate cannot be underestimated.

In the foreseeable future, the scope of domestic medical insurance control fees will only increase, so as to more effectively reduce the pressure of medical insurance expenditure, reduce the prices of drugs and devices and benefit the people’s livelihood. In addition, the situation in the field of devices may appear in the previous pharmaceutical field, and importers may take more aggressive quotations to seize the domestic market after they are familiar with the rules.

For domestic cardiac stent enterprises, facing the policy risks of centralized procurement and medical insurance control, they need to seize the domestic share, turn their attention to the international market and participate in the international market competition. In fact, domestic heart stent head enterprises have also started the international strategic layout, among which minimally invasive medical care, Lepu medical care and Lan Fan medical care are typical representatives.

Turn: Transforming into a strategic choice for heart stent enterprises to overtake in corners.

In the face of major changes in the national medical device policy, cardiac stent enterprises actively predict the development trend, plan ahead, and focus on developing products and new businesses related to centralized procurement while strengthening product technology innovation. For domestic heart stent enterprises, what transformation layouts have been made at present? What is the possible key direction of development in the future?

(1) Adjust the business strategic map and form a multi-sector support system.

1. Diversification of business lines-minimally invasive medical treatment

Through business diversification, we will continuously broaden profit points and enhance comprehensive competitiveness. In recent years, Minimally Invasive Medical Devices Co., Ltd. (hereinafter referred to as "Minimally Invasive Medical") has continuously enriched its product line and expanded its business field through outreach acquisition and endogenous development. Products gradually changed from early cardiovascular stents to diversified business systems covering cardiovascular intervention, orthopedic medical devices, heart rate management (pacemaker), arterial and peripheral vascular intervention, and nerve intervention products.

In 2019, the business revenue was 5.55 billion yuan, of which 33.4% came from cardiovascular interventional products, 29.3% from orthopedic medical devices, 26.3% from heart rhythm management business, 6.1% from arterial and peripheral vascular interventional products, and 3.5% from neurological interventional products. In 2012, the revenue of minimally invasive medical cardiovascular interventional products (stents) accounted for 83.8%.

Figure 15 Comparison of the proportion of minimally invasive medical business segments in 2012 and 2019 (data source: minimally invasive medical annual report)

2. Product line "from one to four", and build a platform business model of "equipment+medicine+medical service+new medical care"-Lepu Medical.

Lepu (Beijing) Medical Devices Co., Ltd. (hereinafter referred to as "Lepu Medical"), as one of the earlier enterprises engaged in the research and development of cardiovascular interventional medical devices in China, has been accelerating the business integration, optimization and layout in recent years, and has developed from a single stent business in 2013 to four business segments covering "devices+drugs+medical services+new medical care" at present, with the goal of building a platform-based business model around the whole life cycle service for cardiovascular patients.

Figure 16 Main contents of each business segment of Lepu Medical

Dual track of medical devices and medicines: In terms of revenue, the revenue of Lepu Medical in 2019 was 7.80 billion yuan, a year-on-year increase of 22.6%. Among them, the medical device sector achieved operating income of 3.62 billion yuan, accounting for 46.4%, and the pharmaceutical sector achieved revenue of 38.5%, accounting for 49.4%. Among them, the revenue of coronary stent system only accounts for 20% of the total revenue of Lepu Medical. In addition, the market share of the company will be directly increased after winning the bid, and the negative impact of centralized procurement is relatively limited.

Figure 17 Revenue Ratio of Lepu Medical in 2019 (Source: Lepu Medical Annual Report)

3. "Health protection+medical equipment" two-wheel drive-Lan Fan Medical

Lan Fan Medical Co., Ltd. (hereinafter referred to as "Lan Fan Medical") is a leading enterprise in the field of medical gloves in the world, accounting for 22% of the global market. In 2018, it successfully acquired the fourth-ranked cardiac stent company in the world, Singapore Baisheng International Group, and realized its layout in the field of medical devices. Subsequently, Lan Fan Medical implemented the "A+X" industrial strategy, and set up four business divisions with a total of seven tracks:

Figure 18 Layout of Lan Fan Medical Industry

At present, Lan Fan Medical has two business series products, namely health protective gloves and heart stents, which are continuously extended to the whole chain of emergency care, cardiovascular and cerebrovascular diseases, forming a multi-business sector collaborative model combining low-value, medium-value and high-value consumables products, with complementary modes and risk hedging. In 2019, Lan Fan Medical achieved a revenue of 3.48 billion yuan, of which the revenue of health protective gloves was 1.68 billion yuan, accounting for 48.3%, and the revenue of cardiac interventional devices (including self-produced and agents) was 1.74 billion yuan, accounting for 50.0%.

Figure 19 Revenue Ratio of Lan Fan Medical in 2019 (Source: Lan Fan Medical Annual Report)

(2) Expand the cardiovascular product chain and form a diversified ecological closed loop.

1. Strategic positioning of big heart-minimally invasive medical treatment

Based on its own existing technology and platform, minimally invasive medical care constantly lays out big heart tracks: coronary heart disease, arrhythmia, structural heart disease and heart failure.

Development contextMinimally invasive medical care started from coronary stent, then cut into radiofrequency ablation, and then extended to pacemaker business. Later, with the further development of interventional technology, structural heart disease entered the era of minimally invasive surgery, and minimally invasive medical care opened up the technical path of completing heart valve replacement by interventional method (representative product VitaFlow transcatheter aortic valve system). Compared with these business units with mature products, Minimally Invasive has begun to "plan the layout" of the treatment solution for heart failure, which is also an important pawn for the future layout of Minimally Invasive and the key to completing the closed loop of the big heart business.

2. Optimize iterative coronary medical devices, enrich and innovate the implantable product line-Lepu Medical.

Lepu Medical has built a rich product group of devices in the cardiovascular field:

1) Accelerate the industrial chain matching of coronary intervention devices. In 2019, Lepu medical coronary stent products achieved operating income of 1.53 billion yuan, a year-on-year increase of 23.3%; Supporting auxiliary consumables (balloon catheter, guide wire, etc.) realized an operating income of 260 million yuan, up 51.0% year-on-year. Under the background that most of the auxiliary PCI interventional materials such as balloon catheter guide wire are monopolized by foreign capital, Lepu Medical is the only R&D and manufacturing enterprise in China that can provide all the consumables for coronary intervention. At present, more than ten necessary consumables such as pre-expanded and post-expanded balloon catheter, PTCA guide wire, guide catheter, contrast guide wire, contrast catheter, sheath, Y valve, triple tee, pressure extension tube, pressure pump, ring handle syringe, pressure sensor and hemostasis compressor have all been mass-produced.

2) Coronary balloon products and NeoVas bioabsorbable stents are expected to form new growth points. In February 2019, NeoVas, an international second-generation bioabsorbable drug stent independently developed by Lepu Medical, was approved for listing in China, and opened a new era of PCI technology "intervention without implantation". In July 2019, the first-generation coronary balloon was approved by GMP for the first time. Three products of the second-generation drug balloon series are about to start clinical trials, and the third-generation rapamycin drug balloon technology has made breakthrough progress, and animal experiments will be carried out soon.

In addition, in recent years, Lepu has actively developed peripheral products of degradable and drug balloons based on the Group’s coronary stent and balloon platform technology, and its business scope has expanded from coronary intervention to peripheral intervention.

3. Layout of coronary artery, valve, nerve intervention and peripheral intervention-Lan Fan Medical.

At the time when the medical device industry entered the golden period of development, Lan Fan Medical continuously accelerated the overall layout of cardiovascular and cerebrovascular devices based on the leading edge of Baisheng International Cardiology Department:

In the field of coronary intervention: all kinds of stent products produced by Singapore Baisheng International are sold to more than 90 countries and regions around the world, with a sales volume of 400,000. At present, BioFreedom, a drug-coated stent of BA9? without polymer carrier, has been introduced into European and Japanese markets, and it is expected to be listed in the United States and China in the near future. From the perspective of stent technology, the upgrading of technology is still the theme of stent industry and the driving force of sales growth. The increase in the proportion of high-end stents such as BioFreedom and Excrossal, as well as the development of foreign markets, have helped to enter the new product bonus period. In addition, taking the cardiac stent as the fulcrum, we will enrich, expand and improve the product line combination related to PCI surgery, such as contrast guide wire, contrast catheter, guide wire, guide catheter, pre-expanded balloon, post-expanded balloon, puncture needle, arterial sheath and pressure extension tube.

Cardiovascular related product lines: Apart from coronary artery, valve, nerve intervention and peripheral intervention are also the tracks that Lan Fan Medical keeps cutting in. By continuously expanding and expanding related product lines such as valve, nerve intervention, peripheral intervention and drug balloon, the competitiveness of product portfolio will be enhanced. The capital is undoubtedly the quickest way for Lan Fan Medical to broaden the track. In June, 2020, Lan Fan Medical acquired the fifth manufacturer of TAVR in the European market. NVT’s main business is the research and development, production and sales of interventional valves for structural heart disease. Through the acquisition of TAVR, a gold track for medical devices, NVT officially entered the field of minimally invasive interventional structural heart disease therapy with broad prospects.

(C) the implementation of internationalization strategy to enhance the international market share of products.

1. Actively deploy the global mainstream market-minimally invasive medical care.

Since 2014, minimally invasive medical care has set its sights on overseas and accelerated the export of China native coronary stents to overseas markets. In 2019, the overseas business of minimally invasive medical drug-eluting stents achieved revenue of 160 million yuan, a year-on-year increase of 72.4%. Sales in 25 countries or regions and registration certificates in 13 countries or regions. Among them, Firebird2TM’s overseas revenue increased by 186.9% year-on-year, FirehawkTM’s revenue increased by 54.6% year-on-year, and it has been sold in several major European countries. In addition, the group has also submitted the application for registration of FirehawkTM stent to the Japanese medical device review and approval authority, and actively deployed the global mainstream market.

Figure 20 Sub-regional Income Ratio of Minimally Invasive Medical Care in 2019 (Source: Minimally Invasive Medical Annual Report)

2. Establish an international business department to increase the market share of international innovative products-Lepu Medical.

Lepu Medical put internationalization on the agenda after the first round of domestic drug collection in 2018, and proposed to further increase the market share of international innovative products. At present, the original foreign trade business and departments of all subsidiaries have been integrated, and the international business department has been established to strengthen the international influence on the upstream and downstream of the medical industry chain in the cardiovascular field. Explore the possibility of setting up R&D centers and production bases overseas. Overseas R&D centers have been planned to accelerate the clinical registration of innovative products (degradable stents, TAVR3.0, renal artery ablation, artificial intelligence ECG and artificial intelligence monitoring) in the world.

It is reported that Lepu Medical’s business revenue from abroad in the first half of 2020 was 870 million yuan, an increase of 320 million yuan compared with the whole year of 2019. Guo Tongjun, senior deputy general manager and secretary of the board of directors of Lepu Medical, said at the reception of listed companies that the company’s overseas market target remains unchanged, and the proportion of overseas market revenue will continue to increase to 20%-30% in the next 3-5 years.

Figure 21 Lepu Medical Internationalization Strategic Measures

summarize

National centralized procurement is not only a reshuffle of the cardiac stent industry, but also an impetus to the cardiovascular segmentation field. Heart stent enterprises still have a long way to go, but whether they are facing the "change" of the industry calmly or actively responding to the "turn" of the industry, there are undoubtedly two ways to go: First, strengthen the technological innovation and product iteration of heart stents in order to obtain new user markets; The second is to realize business diversification and risk hedging with the heart stent as the fulcrum.

Play the villain and then the policeman! After Under the Sun, Peng Guanying took on a new play. Do you think it will be a play?

In Under the Sun, Feng Xiaosheng finally won a short victory, forcing Liang Yuze to go abroad and live a self-righteous and beautiful life with Ke Ying. Even, Ke Ying invited Feng Xiaosheng to have dinner together, and their relationship made progress in stages.

Ke Ying fed Feng Xiaosheng steak, and then withdrew it when he was about to get into the mouth. Feng Xiaosheng forcibly took her arm and ate the steak. The expression of the two people’s confrontation exposed the man’s possessiveness completely.

This flowing expressive force is attributed to the actor’s acting skills: I just saw A Ying’s surprise when she was feeding, and the meat was slowly handed to her mouth to show a spoiled smile. Ke Ying took back her hand and suddenly froze, and then she was fierce and overbearing when she grabbed her hand and ate it. There was nothing wrong with Peng Guanying. Taking this drama is undoubtedly the most correct choice he has made.

"Under the Sun" has aroused a thousand waves since it first announced that the novel was made into a film and television. For no other reason, the original novel "Things in the Palm" describes that the university lecturer He Yan still tries to get rid of the clutches after being imprisoned by the male host Fu Shenxing. In order to highlight the tense relationship between men and women, there are many explicit and cruel pictures. However, it is definitely impossible to film and television all the contents, so everyone’s attitude towards TV dramas is both tense and contradictory.

Sure enough, after the TV series was broadcast, a lot of content was added and deleted in order to be more practical, and even the male master was changed into a male two. But what hasn’t changed is that the role played by Peng Guanying is still an object of resentment.

But Peng Guanying’s acting didn’t disappoint everyone. Whether it is Shen Shijie’s diabolical cruelty in the early stage or the cruel cunning of Feng Xiao’s voice in the later stage, Peng Guanying interprets it perfectly and impeccably.

Theoretically speaking, Peng Guanying is a newcomer to film and television, but unfortunately he is a newcomer of great age.

Before, everyone could only think of Princess Lanling, which co-starred with Baby Zhang a few years ago. Although his acting skills were also praised in the play, there was no follow-up resources, and he seemed to disappear from the audience’s field of vision soon.

After that, when I think of him, I can only remember that he and Zhu Yilong, who have exploded in recent years, are close friends, and Peng Meimei and Zhu Meili are active in each other’s social platforms.

However, with the online drama "The Soul of the Town", Zhu Yilong made numerous rounds, followed by other works, and soon gained a firm foothold. And "Peng Beauty" is still an invisible man.

In 2020, Zhu Yilong and Liu Shishi’s new drama "Dear Yourself" landed in iQiyi, in which Peng Guanying played love rat, who betrayed his wife. After a long time, Peng Guanying’s acting remained at a certain level, and playing against Adi often made people hate it. I wish he would disappear immediately.

Later, when he lost his way and asked his wife to forgive him, his eyes were tearful, and the audience shouted, so pitiful that I even wanted to forgive him.

Peng Guanying finally became famous.

With the update of "Under the Sun" episode by episode, Feng Xiaosheng’s temperament is also slowly changing, from revenge on Ke Ying at the beginning to hopelessly falling in love with her later, all of which are manifested in the actor’s smiles, which also tests the actor’s acting skills.

But Peng Guanying has performed well from the beginning, and he is bound to play the role well from beginning to end.

Years ago, Peng Guanying’s new play "Backlight Man" started, with Zhang Yujian as his partner, both of whom played the role of police.

The online drama "Backlight" is adapted from the novel "In the Dark" by writer Jin Shichai, which mainly tells the story of undercover policeman Xie Lanshan and portrait expert Shen Liufei fighting criminals together.

Xie Lanshan, played by Peng Guanying, and Shen Liufei, played by Zhang Yujian, met at the police academy. They established a strong affection and vowed to become excellent anti-drug policemen.

Among the posters issued at present, this group of quasi-anti-drug policemen are determined, and they are willing to hide in the dark to protect the light.

Perhaps the audience is still immersed in the vicious villain in Under the Sun, but Peng Guanying has turned over and become a policeman. With his acting skills, he is bound to perform a completely different image from Feng Xiaosheng and look forward to his new works. Wen/Hua Su

Burst! Get married early for playing ball! This is the role model of the players!

We’ve seen many ways to take a break in the NBA over the years.

In order not to play ball, various operations are endless.

Of course, if it is expanded to the level of the national team,

The reasons are even more strange, and reasonable ones include:

The previous season was too tired and needed time to rest.

Of course, it also includes the life event of "getting married"

"No, do you mean me?"

Some people cringe, others walk with their heads held high.

At the beginning of recruiting players for the World Cup, the United States team

Big names are refusing, so that the stars are dim.

People say that the dream team is not as good as Canada next door.

However, brunson announced his joining early.

He was the first to sign up and also the first to report.

It is also the first batch to invest in training camps.

What’s more, in order to concentrate on the national team competition,

Don’t let your personal life affect the whole.

He was originally scheduled to marry his fiancee on September 2.

Shengsheng finished the wedding one month in advance!

He also invited university teammates and national team teammates to witness together.

After the teammates witnessed it, the bottle was thrown and the suit was taken off.

Go directly to the national team training camp without neglect.

No honeymoon! I just want to play basketball!

People say: Life is bigger than basketball. Come to him

Everything is just a derivative of basketball.

At the end of the season, everyone else was busy on vacation.

Brunson has begun to complain that the season hasn’t started yet.

He can’t wait to hit another level.

All kinds of wild game bureaus and training bureaus in the middle have not fallen behind.

Although we stand in brunson’s wife’s point of view.

The husband is eager to serve the country and is absorbed in his work.

It must have affected the sweetness of the couple’s daily life.

But if you look at it from the perspective of the American men’s basketball team.

In the absence of big names, there is such a person.

So focused, so crazy, so serious

Others will be infected more or less, so strengthen your enthusiasm.

But then again, this year’s US team lineup

It is indeed the most embarrassing dream team in the past years.

Do you think the American team can make it into the top four this time?

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Manchester city wants to win the championship? The Premier League champion is overwhelming.

Manchester City beat Real Madrid 5-1 in UEFA Champions League (UCL) this season and entered the final.

After the 2020-21 season, Manchester City entered the Champions League final again after two years. At that time, due to the 0-1 loss to Chelsea, the champion suffered setbacks, but finally got revenge.

Whether Manchester City can win UCL, Premier League (EPL) and FA Cup at the same time has attracted much attention.

The competition of EPL championship made Arsenal feel a favorable atmosphere. He hasn’t reached the top of the league since the 2003/04 season.

However, in the case of Arsenal’s decline, Manchester City launched a fierce pursuit. If one more champion is added, the EPL championship trophy will be won.

Manchester City also reached the final in the FA Cup. Compete with local rival Manchester United for the championship.

If Manchester City wins three games, UCL, EPL and FA Cup will all win the championship.

In this case, the football statistics website "Live Ball" uses the information of the gambling company "FiveThirtyEight" to determine the probability that Manchester City will win every game.

The EPL champion of Manchester City has a probability of 99% if only one victory is added.

Failing to win the championship in the "Star Wars", UCL, with a strong frog image in the well, won 74% of the championship probability.

The probability of Manchester City winning the FA Cup is 75%.

Jeffers: It is debatable for Tashuai to give up this season. Odegard needs to pay attention to physical fitness.

Arsenal lost to Nottingham Forest, Manchester City won the Premier League title ahead of schedule, and the Gunners’ performance at the end of this season was disappointing. Artta admitted at the press conference that the team gave up the championship competition this season and the coaching staff was responsible. Francis jeffers, a former English star, was annoyed by the mentality of his old club. He thought that the Arsenal had lost its spiritual system. Jeffers said: It is debatable that Tarzan gave up this season. Arsenal’s strength is not as good as Manchester City’s, and the thickness of Tarzan’s lineup is not good. However, these conditions are not the reasons for Arteta to give up this season. Even if the team’s hope of winning the championship is getting smaller and smaller, Tashuai should let the players cheer up in the rest of the game, instead of letting everyone "prepare for next season’s work in advance". This young marshal’s behavior is debatable.

Odegard, Saca and others have performed well this season, and jeffers also said "Monday morning quarterback" that Odegard is basically the MVP of this season if the Gunners can win the Premier League title with all their might. It’s a pity that the players and coaches were slack at the end of this season. jeffers reminded the Norwegian star, Odegard, that he needed to pay attention to physical problems. He obviously encountered physical problems in these games. Since Arsenal’s exit from the Europa League, jeffers said that the schedule of this club is not intensive. Even if these young players can’t rotate throughout the season and the gunners’ lineup is thin, their physical fitness should recover in the later stage of the schedule. Odegard is only a young man in his twenties, at least his physical fitness is far from the Premier League standard, which is a problem that Norwegian stars need to pay attention to.

Regarding the "collapse" of Arsenal in these games, jeffers said bluntly that Tashuai gave up this season after knowing that the team could not compete with Manchester City. The coaching staff began to give up, and the players’ nerves will naturally relax. Nottingham Forest itself will be relegated through these games, and the mental state of both sides is not at the same level. The reason why Arteta’s action is debatable is that the fans are divided into two factions. Some supporters believe that Arsenal’s goal this season is to enter the top four in the Premier League. Now that they have won the runner-up in the Premier League, Tarzan has overfulfilled the task. The lineup of the club itself is thin. At this time of the season, everyone is either injured or physically weak. It is no problem to give up preparing for next season in advance.

However, some fans who pay attention to the spiritual system don’t buy it. Before two games, the gunners still have the possibility of hitting the league title, but Guardiola leads the team to win the championship with a higher probability. However, there is still a Champions League game in Manchester City, and Arsenal only need to fight on one line. Artta should not give up at this time. Even if the Blue Moon Corps is stronger, it is easy for Gua Shuai to win the league title again, but the Arsenal side can’t lose the mental system, and "slacking off the game" is not desirable. Arsenal’s strategy in these games is debatable. Jeffers agrees with the latter point of view. No matter whether the team has the hope of winning the championship or not, even if the season enters garbage time, Tashuai can’t let the players relax. Because the gunners as a whole are in the recovery period of "post-Wenger era", the team and club must not lose their spiritual strength at this time.

Therefore, jeffers stressed that it is debatable for Tashuai to give up this season. The author thinks that this problem can also reflect Arteta’s lack of experience. He can take the team up, but when the team has setbacks, and this setback "will not be related to the coach crisis, at most, it will lose the championship, and it will not affect the qualification of the Champions League". It can be seen that Arteta needs to learn more from Mourinho and Guardiola in this respect. Regarding Odegard’s physical fitness, some fans don’t agree with jeffers’s point of view-Saka came to the fatigue period earlier than Odegard, and Saka was younger. Why did jeffers say Odegard instead of Saka? Is it because Saka is a native English star?

Jeffers explained this-Saka’s kicking method itself is very exhausting, because his running is mostly high-speed sprint, and if he doesn’t change his kicking method, he will easily accumulate injuries. Odegard is a "master-style" kicking method, and the way of Norwegian stars depends on the overall situation, consciousness and players, with little loss to the body. In this case, Odegard has physical problems, and he is still so young, so he should pay attention to his own problems. Now that Odegard has become the next generation leader of Emirates Stadium, he should demand himself by Premier League standards in all aspects. So jeffers reminded Odegard to pay attention to physical fitness.

7,000 people participated! On the morning of April 28th, Shangzhou City held a half marathon, and the road map was announced!

Shangluo News Network News: The reporter learned from the press conference held in Shangzhou District this morning (April 23) that the 2023 Shangluo Shangzhou Half Marathon will be held in Shangzhou District on the morning of April 28.

The marathon lasted for half a day, and there were two events: half marathon (21.0975km) and mini marathon (5km), with a total of 7,000 participants. The competition routes include Jiangbin Avenue, Shangyang Avenue, Huancheng West Road and Huancheng South Road. While running, runners can enjoy the beautiful natural scenery along the way and feel the unique Shangluo style.

It is understood that the 2023 Shangluo Shangzhou Half Marathon is guided by Shaanxi Provincial Sports Bureau and sponsored by Shangluo Municipal Sports Bureau and Shangzhou District People’s Government. With the theme of "Running a Healthy City and Appreciating the Most Beautiful Shangluo", the organizers will award prizes to the top three male and female half marathon runners respectively, reward the top 30 male and female half marathon runners, and issue finish medals to all the runners who complete the race within the specified time. In addition, from April 28 to May 3, all Japanese contestants can visit the Jiangshan Scenic Area of Qinling Mountain with the number cloth free of charge.

The reporter learned that from 7: 30 am to 12: 00 am on April 28, the traffic management department will conduct traffic control on some roads in Shangzhou City. The specific control sections are as follows. Please choose your travel route in advance.

1. Full-width control from the west of Shangyang Avenue overpass to the intersection of Huancheng West Road;

2. Full-width control at the intersection of Huancheng South Road from the east of Shangluo International Conference Center on Shangyang Avenue;

3. Full-width control of the T-junction of Shangluo North Exit of Shangyang Avenue and Hushan Expressway to Longshan Park and the west section of Shangdan Avenue entrance;

4. Full-width control of the section from Jiangbin Avenue Cross to Shangyang Avenue T-junction at Shangluo North Exit of Shanghai-Shaanxi Expressway;

5. Full-width control from Wangyuan Bridge to Donglongshan section of Jiangbin Avenue;

6. Full-width control of the sections from Chang ‘an Bank to Wangjianglou on Minzhu Road and Tongjiang West Road;

7. Full-width control of the intersection of Huancheng South Road to Lianghekou Park in the east and Guishan Tunnel in the west;

8. Full-width control of the whole section of Huancheng West Road;

9. Full-width control of the section of Xingfu Street from the east to Shangluo intersection and from the west to the intersection of Liuwan Danjiang Bridge. (Reporter: Yang Liyuan)

Editor: Tian Qian Editor: Sun Huangrong