With the continuous rise of the elderly population in China,the aging phenomenon is becoming more and more severe,and it has become a major problem for social development.As a result,the demand for aging services is growing rapidly,but the supply of aging service management professionals is lagging behind and the gap between the two is deepening.This paper aims to provide a valuable reference and inspiration for China's education reform and practice in this field through a thorough study and comparative analysis of the training models of aging service management programs in United States colleges.This paper synchronized and analyzed similarities and differences in the aging service management programs between China and the United States in training objectives,admission requirements,and graduation requirements.This paper also reported the successful experience and unique advantages of the United States in the training of aging service management professionals.Based on the in-depth analysis of the talent training model of the colleges that offer aging service management educational programs in the United States,the aim of the systematic reform and innovation is to provide a solid supply guarantee and intellectual support for the healthy and harmonious development of China's aging society.Meanwhile,it will also effectively promote the smooth implementation of the national aging development strategy.

Objective To explore the expression of myelin transcription factor 1 (MyT1) and its significance in the brain of epileptic rats induced by lithium chloride-pilocarpine. Methods Models of epilepsy of SD rats were established by intraperitoneal injection with lithium chloride and pilocarpine. MyT1-positive cells in the cortex and hippocampal field CA 1 of epileptic rats were determined by immunofluorescence histochemistry.Results Compared with the control group, the number of MyT1-positive cells within the cortex and hippocampal field CA 1 of epileptic rats decreased significantly at 1 day after seizure ( P

Objective To investigate the protective effect of topiramate(TPM) on neuronal apoptosis in rats with acute seizures.Methods We treated the PTZ-induced seizure rats with TPM at 80mg/(kg?d)(high-dose group) and 40mg/(kg?d)(middle-dose group) or physiological saline(control group) for 2 weeks.Neuronal apoptosis in CA_1 and CA_3 regions in hippocampus was identified by terminal deoxynucletidyl transferase-mediated dUTP-biotin in situ nick end labeling(TUNEL) assay.Results Two weeks following seizures,TUNEL-positive neurons were detected in CA_1 and CA_3 regions each group.The numbers of TUNEL-positive neurons in CA_1 and CA_3 of control group were(35.83?)4.58 and(36.83?)3.83,(23.50?)2.81 and(25.50?)3.72 of high-dose TPM group,(31.52?)3.43 and(32.35?)4.69 of middle-dose TPM group.There was a very significant difference between high-dose TPM group and control group(all(P)0.05).Conclusion High dose administration of TPM after experimental status epilepticus may attenuate seizure-induced hippocampal neuronal injury.

Objective To investigate the association of PPAR gamma Pro12Ala polymorphisms with conroy heart disease(CHD). Methods One hundred eighty impatients were recruited in the study. Venous blood samples were collected after 12 h of fasting from all patients. DNA was extracted and Pro2Ala polymorphism in the PPAR gamma 2 genes was genotyped through the PCR-RFLP. The frequency and distribution of Pro2Ala polymorphism in Chinese Han population with CHD were analyzed. Gensini Score based on coronarography were used to grade the coronary. Results There were a total of 135 CHD patients,of which 52 were affected with single coronary lesion,43 with multi-coronary lesion,and 45 were normal. The frequency of P12/P12, A12/P12 in the coronary lesion group were 92.6% (125/135) and 7.4% (10/135) which were similar to that of 93.3% (42/45) and 6.7% (3/45)(P =0. 548). In the single coronary lesion group, the frequencies of P12/P12 and A12/P12 were 94.0% (42/52)and 9.6% (5/52) ,and 90.0% (36/40) and 10.0% (4/40) in the bi-coronary lesion group,97.7% (42/43) and 2.3% (1/43) in the multi-coronary lesion group,with no significant difference among the three groups( P ＞0.05).There were no significant difference on the frequency of P12/P12 and A12/P12 between various subgroups defined according to Gensini score (P = 0. 246). Compared to the frequency in non-obese, the frequency of A12/P12 were significantly higher in the obese ( P = 0.028 ). In PPAR gamma 2 genes B the Exton BstuI enzyme restriction site genes, BMI,waist-hip ratio and total cholesterol in the carriers of P12A genotype were significantly higher than those in the P12P genotype carriers ( P ＜ 0. 05 ). Conclusions PPAR gamma Pro12Ala polymorphisms might not be associated with CHD in Chinese Han population. The frequency of A12/P12 in obese is significantly higher than that in non-obese. PPAR gamma Pro12Ala polymorphisms might be associated with adiposity and lipid metabolism.

Objective To clarify the relation between the expression of Foxp3 in peripheral blood and plasma transforming growth factor betal (TGF-β1) and the activity of systemic lupus erythematosus (SLE). Methods Foxp3 mRNA expression of 28 active SLE patients, 13 inactive SLE patients and 16 healthy controls was determined by polymerase chain reaction. Active SLE patients were followed up; Foxp3 mRNA expression of 20 active patients was measured in the stable status and the plasma TGF-β1 was measured by ELISA in the active and stable status. Results The active SLE patients showed reduced levels of Foxp3 mRNA than the inactive SLE patients (P<0.01) and the healthy controls(P<0.01). Expression of Foxp3 mRNA and the plasma level of TGF-β1 in 20 SLE patients were both higher in stable status than in active status, Conclusion The expressions of Foxp3 mRNA in peripheral blood and TGF-β1 in plasma has significant inverse corelation with disease activity, which suggests that regulatory T cells may play an important role in the pathogenesis of SLE.

Taking global minimum essential requirements(GMER)as standard,school of basic medical science in Wuhan University paid more attention to the cultivation of students' professional skills, innovation ability and communication ability. ‘Response to injury’integrated course was carried out. Based on the immunology,this course involves pathology and pathophysiology and explores the mecha-nism of the diseases' diagnosis and treatment. It took small classes,bilingual education,literature read-ing ,experiments and discussions in various forms . This reform aimed to improve the immunology , pathology and pathophysiology teaching and make our medical education meet the process of globalization.

Objective To compare cost-effectiveness between endoscopical esophageal variceal ligation (EVL) combined non-selective beta-receptor blocker strategies and covered-stents transjugular intrahepatic portosystemic shunt (cTIPS) in preventing esophageal variceal rebleeding in liver cirrhosis with portal hypertension.And to explore the threshold of cost-effectiveness in stents in China.Methods According to clinical practice and associated guidelines,a six state Markov-based decision analytic model was established with TreeAge Pro Suite 2014 to compare the cost-effectiveness between two interfering strategies after followed up for seven years.The parameters such as costs,life years (LY),quality-adjusted life-years (QALY) and incremental costeffectiveness ratio (ICER) were directed.Results The results of baseline research in the seven-year follow-up period indicated that the cost of endoscopical EVL combined non-selective beta-receptor blocker B was 7 444.25 United States dollar (USD)/each,and yielded 1.98 QALY.The expected cost of cTIPS was 13 151.69 USD/ each and could have 2.34 QALY.In the 7th year,ICER was 16 001.74 USD.Based on willingness-to-pay (WTP) threshold of China (19 887.00 USD),cTIPS had better cost-effectiveness than endoscopical EVL combined non-selective beta-receptor blocker B.The price of covered stents less than 5 401.52 USD had cost-effectiveness.The results of single factor sensitivity analysis indicated that rebleeding probability of endoscopical EVL combined non-selective beta-receptor blocker B group was the most influential factor in the result of model.The second important factor was the cost of cTIPS.The probabilistic sensitivity analysis reported cTIPS to be the optimal strategy at WTP of 19 887.00 USD in 83％ of the iterations.Conclusions Seven-year follow-up indicates that cTIPS may be a more cost-effective strategy than endoscopical EVL combined non-selective beta-receptor blocker B in preventing esophageal variceal rebleeding.The price of covered stents less than 5 401.52 USD which have cost-effectiveness in China.

Objective To identify risk factors of lymph node metastasis in superficial esophageal squamous cell carcinoma (ESCC),and to provide evidence for treatment choice under endoscope.Methods From January 2007 to December 2011,285 patients with pathologically diagnosed ESCC who received surgery and had clear record of lymph nodes resection were enrolled.The clinical pathological data of these patients were analyzed,including age,gender,smoking and drinking history,history of cancer,family history of cancer,location,tumor size,presence of esophageal,depth of infiltration,differentiation,and vascular cancer embolus.Univariate analysis (chi square test or Fisher exact probability method) and multivariate Logistic regression analysis were performed for risk factors of lymph node metastasis assessment.According to the rates of lymph node metastasis,patients were divided into three groups as follows:low risk,high risk and extremely high risk of lymph node metastasis.KaplanMeier method was used to calculate the average survival time and cumulative five years survival rate.Results Among the 285 patients with ESCC,40 (14.0 ％) patients with lymph node metastasis.The results of univariate analysis showed that location (x2 =9.333),tumor length (Fisher exact probability method),depth of infiltration (x2 =9.327),differentiation degree (Fisher exact probability method) vascular cancer embolus (Fisher exact probability method) were significantly associated with lymph node metastasis (all P＜0.05).The results of multivariate analysis indicated that tumor length over 5 cm,invasion to submucosal layer and vascular cancer embolus were independent risk factors of lymph node metastasis,and the odd ratio was 17.408(95％ confidence interval (CI) 1.557 to 194.686),3.471(95％CI 1.440 to 8.365) and 6.256(95％CI 1.787 to 21.910),respectively.The lymph node metastasis rates of patients in low risk,high risk and extremely high risk group were 5.2％(6/115),15.8％ (24/152) and 10/18,respectively;the average survival times were (69.9 ± 2.4),(63.8 ± 2.1) and (51.7 ± 1.7) months,respectively.The cumulative five years survival rates were 59 ％,51 ％ and 31％,respectively,and the difference was statistically significant (x2 6.816,P=0.033).Conclusions The risk of lymph node metastasis is high in ESCC patients with tumor length over 5 cm,invasion to submucosal layer and vascular cancer embolus,and the prognosis is poor.Lymph node metastasis should be considered when endoscopic therapy is chosen.

Objective To observe the risk factors for portal vein thrombosis (PVT) in cirrhotic patients prior to receiving endoscopic treatment to prevent gastroesophageal varices rebleeding.Methods A retrospective analysis was conducted on cirrhotic patients admitted to Zhongshan Hospital,Fudan University from 2008 to 2013 for secondary prevention of gastroesophageal varices bleeding via endoscopic treatment.Relevant information and data were collected,followed by an univariate analysis and multiple Logistic regression analysis in attempt to identify potential factors affecting the formation of PVT.Results Totally 591 patients were enrolled in the present study and were classified as present-PVT group (n =122,20.64 ％) and absent-PVT group (n =469,79.36 ％).Univariate analysis showed that MELD score,hemoglobin,platelet count,total bilirubin,alanine aminotransferase,blood urea nitrogen,splenectomy ratio all achieved statistical significance between the two groups (P＜0.05).The multiple Logistic regression showed that MELD score,lowered blood urea nitrogen,elevated D-dimer and history of splenectomy were independent factors associated with the formation of PVT (P values were separately 0.016,0.026,0.014 and ＜0.001).Conclusions Cirrhotic patients should receive regular surveillance for MELD score,liver function,D-dimer and portal vein ultrasonography,especially in patients received with a previous history of splenectomy.

Objective To analyze the possibility of assessing portal hypertension in patients with decompensated liver cirrhosis via contrast-enhanced ultrasonography and common serum markers.Methods Fifty-four patients with decompensated liver cirrhosis were divided into two groups according to hepatic venous pressure gradient (HVPG):HVPG＜12 mmHg (1 mmHg=0.133 kPa) and HVPG ≥12 mmHg.The non-invasive index of routine blood test,liver function,coagulation function,Child-pugh score (CPS) and the results of contrast-enhanced ultrasound such as hepatic artery arrival time (HAAT),hepatic vein arrival time (HVAT)、portal vein arrival time (PVAT),hepatic artery to henatic vein arrive transmit time (HA-HVTT) and portal vein to hepatic vein arrive transmit time (PV-HVTT) were assessed by univariate analysis and multivariate Logistic regression analysis,and then were used to generate a diagnostic model.The receiver operating characteristic curve was also used for analysis.Results The non-invasive model is Y =-0.217 × PV-HVTT + 1.526 × CPS-7.097.When the area under ROC curve (AUROC) was ≥0.857 and the best cutoff value was ≥0.631,and the sensitivity and specificity in judging HVPG≥ 12 mmHg were 87.5 ％ and 78.6％,respectively.Conclusions The model composed of PV-HVTT and CPS could be used to assess portal hypertension.