This paper analyzed the necessity of due diligence in hospital mergers and acquisitions from the perspective of two trading parties,and summarized such roadblocks in hospital due diligence,as lack of awareness,information asymmetry and lack of co-ordination of the investigated.Going through the five main aspects of due diligence in hospital mergers and acquisitions,including business due diligence,financial due diligence,human resource due diligence,legal due diligence and hospital environmental and occupational safety due diligence,the authors put forward pertinent suggestions and countermeasures on efficient due diligence work.

The adenocarcinoma of the esophagogastric junction (EGJA) is located in a unique anatomical position and at the junction of the squamous epithelium and the columnar epithelium. The biological characteristics of this disease are different from those of esophageal or gastric cancer. The diagnostic classification of EGJA has been subject to controversies, and no gold standard therapeu-tic regimens have been established, especially in the choice of treatment of locally advanced EGJA. Results from large-scale clinical tri-als and imaging technology development showed that the treatment of EGJA has been individualized. Furthermore, this problem high-lights the importance of multidisciplinary collaboration. This article focuses on current progress in studies on EGJA.

Based on the theory of Donabedian quality theory,namely structure-process-outcome theory,the evaluation and maintenance of nursing environment is analyzed.Through related websites,retrieval of patient safety case and literature and combined with the relationship with three layers,the high quality nursing environment and patient safety is analyzed,to study its localization and reference,and to put forward the corresponding suggestions in order to help ensure the safety of patients.

Objective To explore and summarize the heart-shape anastomosis for hirschsprung′s disease .Methods Before the operation,the colon was cleaned thoroughly ,31 cases of this group (8 month-6 years old)underwent colonic pull-through and the dilated segment of colon was pulled out and resected.Normal colon and lower segment of rectum′s stomosis were stomosed as heart-shape (higher anterior and lower posterior).After replacing the colon and stomosis ,close the abdomen layer by layer.Results All 31 cases anus sphincter muscle were retained at most degree,so that retained their function of normal defecation .All 31 cases were healed and discharged, without one case with early complications as stomosis fistila,et al.No stomosis stenosis or other late period complication were found in 24 cases with long period follow-up.Conclusions Heart-shape stomosis is a good method for hirschsprung′s disease,especially fitful to the common type and short-segment type and long-segment type with diseased part in sigmoid colon .This method is easy,convenient,no special equipment was needed,easy to be publicized.

The origin and development of umbilical therapy in traditional Chinese medicine is explored from related literature in the history. As a result, the Shang period is regarded as initial period of umbilical therapy, while periods from Han Dynasty, Jin Dynasty and Southern-Northern Dynasties to Sui Dynasty and Tang Dynasty could be taken as stage of primary development. Time from Song Dynasty, Jin Dynasty and Yuan Dynasty to Ming and Qing Dynasties is believed as mature stage. Also the manipulation, application principle, indications and contraindications of umbilical therapy are explained. A brief overview of modern development of umbilical therapy is also described.
China ; History, 15th Century ; History, 16th Century ; History, 17th Century ; History, 18th Century ; History, 19th Century ; History, 20th Century ; History, Ancient ; History, Medieval ; Humans ; Medicine in Literature ; Medicine, Chinese Traditional ; history ; methods ; Umbilicus ; physiology

Objective To explore the necessity of inferior vena cava(IVC) filter implantation during catheter directed thrombolysis (CDT) for acute deep vein thrombosis (DVT). Method Ninety-three patients with acute DVT were reviewed from Nov. 2006 to Dec. 2008. There were 35 men and 58 women, age averaging at (60 ±29) year old, treated with CDT followed by percutaneous transluminal angioplasty ( PTA). The course of DVT was from 5 h ～ 15 d (6. 28 ±7.08) d with 80 left lower limbs and 13 right lower limbs involved. Results There were 30 patients with prior IVC filter implanted compared with 63 patients without filters (67. 7% ,63/93). Among the patients without filter, there were 93. 6% (59/63) left lower limbs. DSA was redone after thrombolysis. Seventy-seven iliacfemoral thrombosis was resolved completely and stenosis or occlusion of the iliac vein were found in 90. 9% (70/77) cases. Endovascular treatment was performed in 57 patients. There was no patients suffering from symptomatic pulmonary embolism (PE). PE was found in 3 cases with a filter and 1 case without filter was suspected of PE on pulmonary CTA after treatment. Conclusion It is not necessary to routinely place an IVC filter during CDT for treating DVT on left lower limb when the thrombosis is not involing the IVC.

Adolescent ; Adult ; Anemia, Aplastic ; blood ; Case-Control Studies ; Female ; Humans ; Isoenzymes ; metabolism ; Leukocytes, Mononuclear ; metabolism ; Male ; Middle Aged ; Protein Kinase C ; metabolism ; Protein Kinase C-theta ; T-Lymphocytes, Cytotoxic ; cytology ; Th1 Cells ; cytology ; Young Adult

Objective To evaluate the effect of dexmedetomidine on acute kidney injury after cardiac valve replacement with cardiopulmonary bypass (CPB).Methods One hundred patients of both sexes with rheumatic heart disease,aged 32-64 yr,weighing 46-75 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association class Ⅱ or Ⅲ),scheduled for elective cardiac valve replacement with CPB,were divided into 2 groups (n =50 each) using a random number table:control group (group C) and dexmedetomidine group (group D).Dexmedetomidine was intravenously infused in a loading dose of 1 μg/kg over 10 min before induction of anesthesia followed by an infusion of 0.4 μg · kg-1 · h-1 until 24 h after operation in group D,while the equal volume of normal saline was given in group C.The urine output per hour during the postoperative 48 h period was recorded.At 6,12,24,36 and 48 h after operation,blood samples were collected from the median cubital vein for determination of serum creatinine levels.The development and severity of acute kidney injury were determined according to the urine output and serum creatinine level.Results Compared with group C,the incidence and severity of acute kidney injury were significantly decreased in the postoperative 48 h period in group D (P＜0.05).Conclusion Dexmedetomidine infused in a loading dose of 1 μg/kg over 10 min before induction of anesthesia followed by an infusion of 0.4 μg · kg-1 · h-1 until 24 h after operation can reduce the development and severity of acute kidney injury after cardiac valve replacement with CPB in patients.

Objective To assess the incidence,clinic feature,pathological characteristics and prognosis of incidental prostate cancer from specimens via radical cystoprostatectomy (RCP) for muscleinvasive bladder cancer.The postoperative erectile function in patients with NVB operation are also to be evaluated.Methods Between Jan 2002 and Jan 2015,150 male patients with bladder cancer who underwent radical cystoprostatectomy in our center were included in this study.133 patients underwent open surgery and 17 cases underwent laparoscopic operation (13 patients underwent NVB operation).The average age of 150 patients was 63 years (ranging 41 to 83 years).The average tPSA was 3 ng/ml(ranging 0.2 to 7.8 ng/ml).The digital rectal examination was negative,CT results didnt exhibit the evident of abnormality in prostate.Results Overall,incidental prostate cancer was diagnosed in 11 male patients (7.3％).The pathological diagnosis are all prostatic adenocarcinoma.In those patients,the mean age was 65.5 years (ranging 42 to 82 years).The mean tPSA at the time of surgery was 2.6 ng/ml (0.3-4.0 ng/ml).There was no statistical significance of tPSA values in the incidental prostate cancer group and non risk group (2.6vs.3.2ng/ml)(P ＞ 0.05).The preoperative enhanced CT imaging showed normal prostate in 7 cases,prostate hyperplasia in 2 cases,prostate calcification in 1 cases and bladder cancer invasion into the prostate in 1 cases.9 cases of incidental prostate cancer are low risk grade (Gleason score ≤ 6,the clinical stage ≤T2).Among 11 cases,bladder cancer histologic type in 10 cases was transitional cell carcinoma and small cell carcinoma in 1 case.According to the TNM classification,4 cases were less than pT2 stage and 7 cases were more than pT3 stage.11 patients were followed up between 6 to 24 months (mean 10 months).All patient survived at the end of study without the treatment of castration.Among 13 cases accepted NVB operation,8 cases achieve the preoperative level of erectile function to achieve.Conclusions The rate of incidental prostate cancer from RCP specimens is low,Most patients have low risk level,and there was no statistical significance of tPSA values between the incidental prostate cancer group and non risk group.

A new method was developed for the separation and determination of inosine monophosphate (IMP) by ion chromatography (IC) with suppressed conductivity detection. Separation was achieved on an anion-exchange column Ionpac AS11-HC of high capacity within a short time. 30 mmol/L KOH produced by an EGC-KOH eluent generator was used for isocratic elution. No interferences existed between the seven common inorganic anions and IMP. Under the optimum conditions, the linear range of the calibration curve for IMP was 1. 0-200 mg/L, with correlation coefficient ( R2 ) of 0. 999. The relative standard deviations (RSDs) for retention time, peak height and peak area of IMP were 0. 16%, 0. 94% and 0. 86%, respectively, indicating good reproducibility of the method. The method was successfully applied to the determination of IMP in meat products, with spiked recovery ranging from 86. 0% to 110. 0%. This simple, accurate and reliable method could be served as a rapid and effective analytical tool for meat flavoring research.