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

Systemic sclerosis is an autoimmune disease characterized by skin thickening and tightness.Digestive system is the most commonly damaged system secondary to skin,and as to unspecific clinical manifestations,this complication is often ignored in the early,the prognosis and quality of life of patients will be affected.This article overviews the recent research developments on pathology,clinical features,management of systemic sclerosis with digestive system involvement,to draw attention to early diagnosis and treatment of this condition for the improvement of the prognosis.

Objective To assess the feasibility and accuracy of transesophageal echocardiography (TEE) in screening patients,intraoperative guidance of occluder releasing and efficacy assessment in the patients of percutaneous left atrial appendage (LAA) occlusion with Watchman.Methods Ultrasonic instrument Philips iE33(proble model X7-3t) were used to measure the maximum diameter and the depth of LAA ostium in enrolled patients by TEE,and intraoperative guided puncture of interatial septum,positioning Watchman transmission system and instruction closure release under TEE,immediate evaluate the postoperative therapeutic effect and record the complications by TEE.At 45 days after implantation,patients should repeat TEE to assess the efficacy.Results Eighteen patients underwent device implantation.Seventeen patients implant successfully,except one patient can't implant device beacuse of the LAA morphologe was not suitable.There was one patient showing thrombus formation on the surface of device,one patient of LAA and the device axial angulation was 90 °.At 45 days after implantaion,16 patients were fullowed up,there were no major stroke at all.Conclusions TEE has important application value in screening of preoperative patients,intraoperative guidance of occluder releasing and efficacy assessment in the patients of percutaneous left atrial appendage occlusion with Watchman.

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 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.

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 investigate the clinical treatment efficacy of mutabilis coated nasal ointment to postoperative nasal septal reconstruction.Methods After surgical reconstruction,116 cases were divided into the treatment group and control group ac-cording to random method,58 cases in each group.The treatment group was given mutabilis coated nasal ointment combine with physiological seawater nasal care device;the control group was only given physiological seawater nasal care device in the same time. The effects were observed for 6 months.Results The total effective rate of treatment group was higher than the control group (98.28%),the two groups had significant difference(P <0.05).Postoperative follow-up,the bleeding rate in the treatment group have no significant difference compared with the control group(P >0.05);the incidence of infection and cavity stricture in the treat-ment group were significantly lower than the control group(P <0.05).Conclusion The application of mutabilis coated nasal oint-ment can promote the wound healing of nasal cavity,but also can prevent the operation adhesion,and shorten repair time,so as to improve the clinical effect of operation.