A picture of great market potential and mismatch of supply and demand in Anhui was drawn in the paper,with five challenges analyzed for the industry in general.The authors proposed to integrate medical resources and aging care resources,to build a diversified and tiered health care and aging care supply system,an integrated administrative coordination mechanism,and enhance fiscal support among other policy suggestions.These proposals were designed to encourage the development of the aging care industry featuring a combination of medical resources and aging care.

Objective To study the echocardiographic characteristics and its diagnosis value on congenital supravalvular aortic stenosis (SVAS) in children. Methods Thirty-one patients with SVAS diagnosed by multiplane echocardiography were enrolled in the study. Their echocardiographic characteristics were compared with cardiac catheterization, operation, and gene detection results. Echocardiographic changes were mainly observed in aortic valve, supravalve, descending aortic arch, pulmonary artery valve, main pulmonary artery and its branches,and coronary artery. Results Of the 31 patients,26 had hourglass type SVAS,4 hypoplastic type,and 1 membranous type; 2 patients had extremely mild stenosis (defined as a Doppler gradient <25 mm Hg) ,20 mild (25～49 mm Hg) ,5 moderate (50～75 mm Hg) ,and 4 severe C>75 mm Hg) ones. Nineteen patients were diagnosed with Williams syndrome by gene detection. Three patients were associated with aortic valve stenosis including one missed at the initial diagnosis; 10(32.26%) patients with pulmonary stenosis, including pulmonary valve stenosis in 6, left and right pulmonary artery stenosis in 3 ,and branch stenosis in 1:6 patients with coronary stenosis. Conclusions The sternal border and five chamber apical views are the best to detect SVAS. Williams syndrome patients are prone to SVAS.Pulmonary stenosis echocardiography forms a great proportion of the SVAS patients. Routine examination is necessary for coronary stenosis in cases of SVAS.

0 05). However, the scores at all the 4 time points of 1 week, 1 month, 3 month and 6 month follow up after surgery, were higher than the scores before surgery( P

Objective To compare the efficacy of supraclavicular approach and infraclavicular approach in ultrasound-guided brachial plexus block(BPB).Methods One hundred and twenty patients,ASA Ⅰ-Ⅲ,aged 18-80 yr,scheduled for upper extremity surgeries of both gender,were randomized into two groups(n =60):supraclavicular group(group SCB)and infraclavicular group(group ICB).The anesthetic mixture consisted of ropivacaine 0.375％ and lidocaine 1％ in equal volumes with epinephrine 1∶200 000,the total dose was 0.5 ml/kg.The block performance time,duration of anesthesia and success of anesthesia(surgery was accomplished without supplementary block)were recorded.A blinded observer assessed pinprick sensory block in the seven distal nerve territories(axillary,radial,musculocutaneous,median,ulnar,medial antebrachial and medial brachial cutaneous nerves)every 5 min up to 30 min after injection.Success of nerve block,side effects and complications were recorded during and after operalion.Results Group ICB was superior in success rate of anesthesia and nerve block of ulnar,medial antebrachial and medial brachial cutaneous nerves,the rate of parasthesia was lower and the block performance time was longer compared with group SCB(P ＜ 0.05).No major complications occurred in both groups.Conclusion Under ultrasound guidance,infraclavicular BPB is superior to supraclavicular approach.

Objective To compare the various surgical procedures commonly used to treat ampullary neoplasms.Methods The clinical data of 238 patients with ampullary tumor who were admitted to the Peking Union Hospital from January 1995 to June 2012 were retrospectively analyzed.There were 51 patients with benign ampullary adenomas (34 patients treated with local tumor resection,17 patients treated with pancreaticoduodenectomy) and 187 patients with ampullary cancer (25 patients treated with ampulla local excision,162 patients treated with pancreaticoduodenectomy).Results For both ampullary cancer and benign tumor,the group of patients who received local excision was superior to the group of patients who received pancreaticoduodenectomy in operative time,blood loss,hospital stay,and incidence of postoperative complications (all P＜0.05).For benign ampullary adenomas,there were no significant differences in postoperative median survival time between local resection and pancreaticoduodenectomy (P=0.071,x2 =2.003).For stage T1 or T2 ampullary cancer,there was also no significant difference in the postoperative median survival time (P=0.054,x2=3.163).However,the postoperative median survival time of the pancreaticoduodenectomy group was significantly longer than that of the local resection group for patients with stage T3 or T4 ampullary cancer (P=0.041,x2 =6.309).Conclusions Ampullary tumors are characterized by relatively good response to treatment.The results suggested that for patients with benign ampullary adenomas and stage T1 or T2 of ampullary cancer,local resection is a good surgical procedure.For patients with ampullary cancer at more advanced stages (T3 or T4),pancreaticoduodenectomy is the first choice of therapy.

Promotion of outstanding people to head nurses is key to hospital nursing management.In view of the current shortcomings in the analysis of appraisal data and the interpretation of appraisal results,the analysis of means(ANOM)method is introduced to the process of hospital human resource management.The proposed method aims to solve the problem when the score differences between interviewers are great and the score differences between candidates are small.An example for head nurses' promotion appraisal in a hospital is offered to demonstrate that statistical tools can provide the decision support for hospital personnel selection.Finally,the application differences between ANOM and analysis of variance(ANOVA) in human resources appraisal are compared.

Objective:To explore the application value of transesophageal echocardiography (TEE)in secondum atri-al septal defect (ASD)intervention and minimally invasive occlusion surgery in adult patients.Methods:A total of 134 cases adult patients (>15 years)with pure secondum ASD (including 91 cases undergoing interventional occlu-sion and 43 cases undergoing minimally invasive occlusion surgery),who were screened via transthoracic echocardio-graphy (TTE)and TEE from Jan 2012 to Dec 2012,were selected.Intervention group and minimally invasive sur-gery group received TTE and TEE monitoring respectively during operation.Preoperative TTE and TEE parameters and operation results were compared and analyzed.Results:The parameters of ASD diameter measured by TEE were significantly higher than those measured by TTE in two groups (P <0.01 all).Maximum defect diameter of ASD measured by TEE was significantly higher than that of measured by TTE [(19.8±5.2)mm vs.(18.7±4.9)mm], P <0.01. The correlation between maximum defect diameter measured by TTE and occluder size (intervention group r =0.926,minimally invasive surgery group r =0.215)was all lower than that of TEE (intervention group r=0.965,minimally invasive surgery group r =0.627),P <0.01 both.Conclusion:TEE is better than TTE in as-sessment of ASD size.It should be regarded as a routine preoperative screening method for adult ASD patients.It has important value in real-time monitoring,guidance and immediate evaluation of therapeutic effects during mini-mally invasive ASD occlusion surgery.

Objective To investigate the influence of ursolic acid on vascular endothelial growth factor ( VEGF) , cycloxygen-ase-2 (COX-2), and matrix metalloproteinases-2 (MMP-2) expressed in the mouse retinal ischemic model , and to explore the mecha-nisms of anti-angiogenesis.Methods Sixty 7-day clean-class C57BL/6J mice were divided randomly into 6 groups [ n =10 mice (20 eyes) per group]:blank control, model control (PBS), positive control (triamcinolone), and ursolic acid (UA) intervention (low-dose, medium-dose, and high-dose).Mice in the blank control group were raised in air , and mice in other groups in(75%±2%)O2 high-oxygen environment for 5 consecutive days .Mice in the model control group and breastfeeding mice were put back in air environ-ment (21%O2 ) on the 12th day after the new-born mice to induce the generation of retinal neovascularization .When models were suc-cessful, the drug treatments were applied immediately to the corresponding groups , with injection of 3μl of sterile PBS in model control group, 3 μl of 1.5, 3.00 and 6.0 μg UA in UA intervention group, and 3 μl of triamcinolone (1 ml∶40 mg) in positive control group, respectively.All mice were killed after overdose anesthesia on the 17th day.Their eyeballs were made into samples and retinal tissue pathological sections with H-E dying method.The positive expressions of VEGF , COX-2, and MMP-2 were detected with immu-nohistochemical method .The fresh retinal tissue homogenate was prepared to detect the protein expressions of VEGF , COX-2, and MMP-2 in retinal tissue with western blot method ,and mRNA expressions of VEGF , COX-2, and MMP-2 were detected with real-time fluorescent quantitative polymerase chain reaction ( RT-PCR) .Results According to protein and mRNA expressions of VEGF , COX-2,and MMP-2 in retinal tissue among six groups , protein expressions of VEGF , COX-2, and MMP-2 in model group were significantly higher than those in blank group ( P <0.05 ) .Each protein expression in the high UA intervention group was significantly lower than that in the model group ( P <0.05 ) .Each protein expression in the high UA intervention group was not significantly different from that in the positive group ( P >0.05 ) .Each protein expression in the high UA intervention group was significantly lower than that in the low UA intervention group( P <0.05).Conclusions UA inhibited expressions of VEGF, COX-2, and MMP-2 in retinal ischemia model .UA also played an inhibitory role in the formation of neovascularization , and this role was positively correlated with UA dose .

Objective To explore the value of echocardiography in the diagnosis of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in children.Methods The echocardiographic images of 14 patients with ALCAPA confirmed by operation and 18 patients with endocardial fibroelastosis (EFE) diagnosed by clinical were compared and analyzed.Results Both ALCAPA and EFE exhibited obvious dilated left ventricle,decreased left ventricular systolic function,thick endocardium and mitral regurgitation of different degree.The former additionally showed dilated right coronary artery(RCA) with normal origin,left coronary artery(LCA) emerging from the root or wall of the pulmonary artery(PA),the retrograde flow into PA in LCA and abundant collateral vessels in myocardium.However the later exhibited normal diameter of LCA and RCA and no collateral vessels.Conclusions Color Doppler echocardiography not only demonstrates left ventricular systolic function,endocardium,mitrial regurgitation and collateral vessels in myocardium,but also shows the origination and courses of LCA clearly,which provide exact informations to diagnose ALCAPA.The echocardiography can be used as a powerful tool of ALCAPA diagnosis and preoperative assessment.

Objective To observe the effects of berberine on inflammatory factors, adipokines and fatty acid metabo-lism in 3T3-L1 adipocytes, and to investigate the molecular mechanism underlying berberine’s role of improving insulin re-sistance. Methods mRNA level of inflammatory molecules, adipokines, key enzymes and protein in fatty acid metabolism in 3T3-L1 cells were determined by quantitative real time polymerase chain reaction (qRT-PCR) after cells were treated with different concentrations of berberine (0, 5, 10, 20, 40μmol/L) for 24 hours and with 10μmol/L berberine at different du-rations (0,4,8,24,48 h). These factors mainly included interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α), leptin, adipo-nectin, visfatin, fatty acid synthase (FAS), acetyl-CoA carboxylase (ACC), adipose triglyceride lipase (ATGL) and adipocyte fatty acid binding protein (AFABP). Results In 3T3-L1 adipocytes, transcription level of IL-6, TNF-α, leptin, FAS, AT-GL, AFABP reduced with addition of berberine dosage at 10~40μmol/L(P＜0.05)while visfatin mRNA level increased(P＜0.05)compared with the control group. No significant difference was found in expression of adiponectin(P>0.05). Tran-scription level of IL-6, TNF-α, leptin, AFABP, ATGL, FAS decreased with time after 10μmol/L berberine intervention (8-48 h) compared with the control group(P＜0.05). On the other hand, visfatin mRNA level increased(P＜0.05)compared with the control group. Adiponectin mRNA decreased only after cells were treated with berberine for 48 h(P＜0.05). No sig-nificant difference was found transcription of ACC between each groups treated with berberine(P > 0.05). Conclusion mRNA level of inflammatory factors, adipokines, key enzymes and protein in fatty acid metabolism in 3T3-L1 adipocytes can be affected by berberine and this effect depend on its dose and time . This might be the mechanisms underlying berber- ine to improve insulin resistance.