BACKGROUND: A good many researches believe that the gene polymorphism of vascular endothelia nitric oxide synthase(eNOS) correlate with diseases of heart, brain and kidney. However, it is still not clear whether eNOS Glu298Asp correlates with myocardial infarction in the elderly Chinese.OBJECTIVE: To investigate the distribution of Glu298Asp polymorphism of vascular eNOS in the elderly as well as correlation between Glu298Asp polymorphism of eNOS and myocardial infarction in the elderly Chinese.DESIGN: A case-controled study based on diagnosis.SETTING, PARTICIPANTS and METHODS: A total of 37 patients with myocardial infarction were selected into case group, which all of them were patients from either outpatient department or inpatient department of the First Affiliated Hospital of Nanjing Medical University. Thereinto, 20 cases without hypertensive history were allocated into case subgroup. Totally 172 subjects selected from the re-testees of physical checkup of our hospital were assigned into control group, of which 92 cases without hypertensive history were allocated into control subgroup. Indices like height, body mass and fasting blood sugar were detected respectively in all participants of all groups. The polymorphism of Glu298Asp of eNOS gene was assayed by polymerase chain reaction(PCR), and restriction fragment length polymorphism (RELP).MAIN OUTCOME MEASURES: The polymorphism of Glu298Asp of eNOS gene as well as the allelic frequency of 298Asp in the elderly of four groups.RESULTS: Genotype of Glu/Asp of the case group was higher than that of the control group(32.43% and 18.02% respectively) . The genotype composition of Glu298Asp polymorphism had significant difference between the case group and the control group(x2 = 3.87, P < 0. 05) . Between normotensive subgroups, Genotype Glu/Asp of the case subgroup was higher than that of the control subgroup(35.00% and 10. 87% respectively) . The genotype composition of Glu298Asp polymorphism of the eNOS gene also had significant difference between the case subgroup and the control subgroup (x2 = 7.43, P < 0.01) . The allelic frequency of 298Asp of the case group was higher than that of the control group without statistical significance (16. 22% and 9.01% respectively, P > 0. 05) . Between normotensive subgroups, the allelic frequency of 298Asp of the case subgroup was significantly higher than that of the control subgroup(17.50% and 5.43% respectively, x2 = 6.82, P < 0.01 ) ).CONCLUSION: Glu298.Asp polymorphism of the eNOS gene exists in the elderly Chinese. The genotype of Glu/Asp and allelic frequency of 298Asp might be a genetic susceptible marker of myocardial infarction in the elderly Chinese.

Objective To explore the association of Glu298Asp polymorphism of the endothelial nitric oxide synthase gene (eNOS) with myocardial infarction in Chinese aged people based on a case-control study. Methods Thirty-seven patients with myocardial infarction and 172 sex- and age-matched healthy control subjects were enrolled. Their height, weight and blood pressure were measured and the fasting plasma lipid concentrations were examined. Glu298Asp polymorphisms of the eNOS gene were examined using PCR and RFLP methods. Results Genotype Glu/Asp in the patient group was higher than that in the control group (32.4% vs 18.0%). The genotype composition of Glu298Asp polymorphism showed significant difference between the patient group and the control group ( =3.87, P 0.05). Among the normotensive subgroup, the allelic frequencies of 298Asp in the patient subgroup was higher than that in the control subgroup (17.5% vs 5.4%). The allelic frequencies of 298Asp had significant difference between the patient subgroup and the control subgroup ( =6.82, P

Objective To analyze the distribution characteristics and influencing factors of brachial-ankle pulse wave velocity (baPWV) in elderly population in order to direct the early diagnosis and prevention of arteriosclerosis in the elderly.Methods A total of 927 cases of elderly residents were randomly selected from 19 villages in Shengze area,Jiangsu Province.The indexes such as age,gender,height,weight,waist circumference,hip circumference and blood pressure were collected through standardized questionnaire and physical examination.The biochemical indicators including serum bilirubin,creatinine,uric acid,fasting blood glucose and blood lipids were measured,and baPWV was tested by automatic arteriosclerosis measurement system.Results The differences in age,systolic blood pressure,heart rate,serum bilirubin,creatinine,uric acid,triglycerides levels and baPWV were statistically significant between the male and female (all P＜0.05).BaPWV rised with the increase of age.Overall,baPWV was faster in the female than in male (P＜0.01).Blood pressure (r=0.36,0.59,P＜0.001),age (r=0.26,0.30,P＜0.001) and heart rate (r=0.30,0.33,P＜ 0.001) were correlated with baPWV,while uric acid had a correlation with baPWV (r=0.12,0.21,P＜0.01).A correlation was found between total cholesterol and baPWV (r=0.09,0.11,P＜0.05) Multi-variable linear stepwise regression analysis showed that systolic blood pressure,heart rate and age were the influencing factors for baPWV,of which systolic blood pressure had the greatest influence on baPWV (β＞0.5,P＜0.001).Conclusions With the increase of age,the baPWV shows rising trend.The monitor of baPWV may be useful in the elderly,especially in females.Blood pressure control,especially the control of systolic blood pressure can slow the progression of atherosclerosis.

Policy background and stakeholder theory were elaborated.It could be concluded that the key stakeholders of the policy were residents,training hospitals,healthcare administrators,primary healthcare institutions and patients of such institutions.Through analysis of these stakeholders,effects on the interests of all parties were investigated and strategies to improve feasibility of the policy were put forward.Two key points were suggested for such policy goals.First,top-level policies should be designed and be effectively implemented.Second,conversion of the residents from permanent hospital employees to “contractors”or“ freelancers”.

Objective To analyze the feasibility of the policy that “Residents service or employment at primary care institutions after standardized training”.Methods Analyzing the feasibility of this policy by using questionnaire survey and in-depth interview.Results Constituent ratios of overall feasibility were 58.3％ (532/912)and 66.1％(603/912)for specialist and general practitioner respectively; percentage of feasibility of in-depth interview was 46.7％ (7/15).Conclusion The policy has feasibility,if government formulates and implements perfect complement policies effectively,and makes this policy to be impassable stage to resident.

Objective To investigate the prevalence of anxiety and depression in elderly patients with metabolic syndrome (MS) and its related factors.Methods A total of 672 subjects aged 60 or over undergoing health check-up in two Nanjing community health service centers from November 2015 to October 2016 were enrolled in the study.The basic information and the history of hyperlipidemia,hypertension and diabetes were collected by questionnaire survey;the results of physical examination and biochemical testing were documented.The prevalence of anxiety and depression were investigated by the Hospital Anxiety and Depression Scale (HADS).According to MS diagnostic criteria,the subjects were divided into MS group (n=181) and non-MS group (n=491).The HADS scores of two groups were compared and the influencing factors related to anxiety and depression were analyzed.Results The levels of systolic blood pressure (SBP),diastolic blood pressure (DBP),body mass index(BMI),levels of fasting blood glucose (FBG),triglyceride (TG),low density lipoprotein cholesterol (LDL-C) were higher and high density lipoprotein cholesterol (HDL-C) was lower in MS group than those in non-MS group (all P<0.05).The prevalence rates of anxiety and depression in MS group (30.9% and 34.8%) were significantly higher than those in non-MS group (20.2% vs.25.1%,χ2=8.655,6.288,P=0.003,0.012).Multivariate logistic regression analysis showed that obesity (BMI≥28 kg/m2),high FBG (≥7.0 mmol/L),hypertension [blood Pressure≥140/90 mmHg (1 mmHg=0.133 kPa)] were the independent risk factors for anxiety in MS patients (OR=3.987,2.827,2.375,respectively,all P<0.05);obesity (BMI≥28 kg/m2),high FBG(≥7.0 mmol/L),smoke,high TC (≥5.2 mmol/L),hypertension (≥140/90 mmHg) were the independent risk factors for depression in MS patients (OR=7.718,3.233,2.071,1.932,1.910,respectively,all P<0.05).Conclusion Elderly patients with metabolic syndrome are prone to anxiety and depression,and obesity,high FBG,hypertension and other factors are the risk factors for anxiety and depression.

BACKGROUND: Angiotensinogen (AGT) gene is the firstly discovered candidate gene for essential hypertension, both the T174M and M235T polymorphisms locate at the second exons of AGT gene, and there is existence of linkage disequilibrium. The polymorphism at A-6G and G-217A sites in promotor region plays an important role in regulating the gene expression, and the products of keep close correlation with the level of blood pressure. OBJECTIVE: To investigate the association between the polymorphism of AGT gene at A-6G, T174M and G-217A sites and the risk for the attack of essential hypertension in Chinese Han population, DESIGN: A cluster sampling and case-control analysis. SETTINGS: Department of Geriatrics and Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University; Southern Research Center of National Human genome; Department of Cardiology, Dongtai People's Hospital of Jiangsu Province. PARTICIPANTS: The experiment was carried out in the countryside of Dongtai county, Yancheng city, Jiangsu province. All the subjects were selected from the countryside of Dongtai county, Yancheng city, Jiangsu province. Totally 177 patients with essential hypertension who had never accepted any drug treatment, were taken as the essential hypertension group, and hypertension was diagnosed according to the diagnostic standard of hypertension set by WHO/ISH in 1999 (systolic blood pressure ≥ 140 mm Hg and/or diastolic blood pressure ≥ 90 mm Hg); Another 86 normal person were taken as the normal control group. ② Inclusive criteria: The enrolled subjects should be Han nationality; long-term local residents but not from other places; able to answer questions clearly; diagnosed by disease history, clinical symptoms, physical signs and assistant examinations; have complete data of investigation of uniform questionnaires by face-to-face interview (including demographic information, profession history, family history and life styles of smoking, drinking, drinking tea, etc.). ③ Exclusive criteria: The patients with secondary hypertension in the essential hypertension group, subjects having family hisory of hypertension in the normal control group, and those with chronic diseases of liver and kidney, and diabetes mellitus in both groups were excluded. METHODS: Peripheral venous blood samples (3 mL) were collected, and DNA was extracted from human peripheral blood with FlexiGene DNA Kit (250). The Primer3 software was applied to design primers, and the polymorphism sites in the primer sequence were excluded. After multiplex polymerase chain reaction (PCR), 3 μL products were selected to detected the amplified results by agarose gel electrophoresis. The successfully amplified PCR products were purified with the QIAquick PCR Purification Kit, and the purified products were fragmentized with Dnase Ⅰ . The fragmentized products of enzyme digestion were labeled with fluorescein by deoxynucleotide terminal transferase. Two allele specific probes and one mismatched probe were designed respectively for each single nucleotide polymorphism. The chips were prepared with the OmniGridTM 100 TLC samler, each probe was repeated for three times to form three matrix. The hyridization solution was degenerated at 95 ℃ for 10 minutes, and then immediately cut on ice. 10 μL hybridization solution was added onto the chip matrix, hybridized at 50 ℃ for 2 hours, then washed and dried. The chips were scanned with the GenePix 4000B laser confocal scanner (Figure 2),and the intensity of the fluorescent signal for each probe was extracted with GenePix Pro, and the allele score of each single nucleotide polymorphism was calculated to judge the genotype. MAIN OUTCOME MEASURES: ① Comparison of the frequencies of genotype distribution at each polymorphism site of AGT gene in both groups; ② Correlation analysis of the polymorphism of AGT gene at A-6G and T-174M sites with the risk for the attack of essential hypertension; ③ Effects of the polymorphism of AGT gene at A-6G, T-174M and G-217A sites on blood pressure.RESULTS: According to the intention-to-treat analysis,all the 263 subjects were involved in the analysis of results. ① At the A-6G site of AGT gene, the frequencies of AA, AG and GG genotypes (P=0.014) and A and G alleles (P=0.004, OR=0.44) had significant differences between the essential hypertension group and normal control group; At the T174M site, the frequencies of CC, CT and TT genotypes (P=0.031) and A and G alleles (P=0.014, OR=0.55) were significantly different; At the G-217A site, no obvious differences were found in the GG, AG and AA genotypes (P=0.722) and G and A alleles (P=0.403, OR=0.80). ② The risk of essential hypertension in the individuals carrying AA genotype of A-6G polymorphism and CC genotype of T174M polymorphism was reduced by 57% (95%CI= 0.23-0.82, P= 0.010) and 56% (95%CI= 0.25-0.79, P= 0.006) respectively. ③ There were no significant differences in the systolic blood pressure, diastolic blood pressure and mean arterial pressure among different genotypes at the A-6G, T174M sites and G-217A sites (F=0.100- 2.911, P ＞ 0.05). CONCLUSION: The AA genope at A-6G and the CC genotype at T174M site of AGT gene may reduce the risk for the attack of essential hypertension in Chinese Hun population, and no significant correlation was found between the genotype of G-217A polymorphism and the attack of essential hypertension.

Objective To investigate the effect of staging treatment for diabetic leg ulcer by vacuum sealing drainage surgery (VSD) combined with perforator flap.Methods From Aug.2013 to Aug.2015,21 patients (in glycemic stability) with diabetic leg ulcer received the sustained VSD suction after a thorough debridement at the first phase and used perforator flap to repair the wound at second phase.Results After a thorough debridement and the sustained VSD suction,all the wounds were repaired with perforator flaps at the second phase.Postoperative flaps of 19 cases survived completely.Postoperative flaps of 2 cases appeared 1/4-1/5 area necrosis of distal flap and healed well after clear debridement.All patients were followed up in glycemic stability and all the flaps survived well without complications such as osteomyelitis and soft tissue infection.Conclusion Based on glycemic stability,VSD combined perforator flap in treatment of diabetic leg ulcers can control the infection and wound closure,which is worthy of clinical application and promotion.

Objective To analysis causes of the serious complications after the operation of the lower leg perforator pedicle screw flap, and to explore the corresponding countermeasures. Methods From June, 2012 to Au-gust, 2016, 60 cases of soft tissue defect of ankle and foot were repaired with propeller flaps pedicled with perforator of lower legs. with the area were soft tissue defect ranged from 3.0 cm ×2.0 cm to 19.0 cm ×9.0 cm, and all with bone exposure. Two cases of traumatic tissue defect, 7 cases were chronic osteomyelitis of the distal tibia, 13 cases were in-cision infection and necrosis after the operation of ankle joint fracture and Pilon fracture, 10 cases were simple inci-sion necrosis after calcaneal fracture, 18 cases were calcaneal osteomyelitis, 1 case were soft tissue defect after the ankle tumor operation, 6 cases were soft tissue necrosis after the Achilles tendon rupture, and 3 cases were soft tissue defect of the dorsum with infection. The posterior tibial artery perforator pedicled propeller flap was used in 18 cases. The pedicle of the vascular pedicle was 6.0-18.0 cm from the medial malleolus, the flap rotation was 135 °-180° . There were 42 cases of the perforator pedicle propeller flap of the peroneal artery, 5.0-18.0 cm from the pedicle of the vascular pedicle and 120°-180° rotation in the flap. The area of the flap was 9.0 cm ×3.0 cm-34.0 cm ×18.0 cm. There were 32 cases of direct suture in the donor site and 28 cases of free skin grafting. Results The color, swelling, elasticity, capillary reaction and healing of donor site were observed after operation. There was no flap ischemia occurred in 60 patients. Fourteen cases had venous reflux obstruction, all of which had swelling above II degree, 8 cases had swelling above III degree with obvious purple blood stasis, resulting in partial flap necrosis in 4 cases, all necrosis in 1 case, including 4 cases of free skin grafting, 1 case of flap transplantation and repair. There were 3 cases of necrosis after skin grafting in the flap area, all of which were partial necrosis. There was case of necrosis of the wound surface after di-rect suture of the donor site and 1 case of skin disintegration after disassembly, and all wounds healed after the replace-ment of the wound and the external use of the dried blood powder. All the 60 patients were followed-up for 12 to 30 (mean, 24.5)months. The flaps survived and the donor site scars healed well. The range of motion of the ankle was from-10°to 10°(mean, 5.6 °) and the flexion of the plantar was from 20 °to 50 °(mean, 37.8 °). Fourteen patients with venous reflux disorder were followed up for 15 to 28(mean, 22.3)months. The flap and skin graft survived well. Ankle dorsiflexion ranged from-10° to 10 °(mean, 2.4 °) and plantar flexion from 20° to 45 °(mean, 35.6 °). There was no obvious limp in walking. Conclusion Although the overall effect of the lower leg perforator pedicle propeller flap to repair the soft tissue defect of the foot and ankle is satisfactory, there are still various serious complications, which are mainly due to ia-trogenic. Doctors should strictly follow the basic principles of skin flap surgery from preoperative to postoperative, and during operation and postoperative management, so as to reduce the incidence of complications.

Objective To evaluate the association between vitamin D (VD) and vascular endothelial injury in hypertensive patients.Methods Ninety nine patients with hypertension and 126 healthy subjects (control group) from the same community in Nanjing were recruited in the study.The serum levels of fasting blood glucose (GLU),total cholesterol (TC),low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were measured.Serum 25-hydroxy vitamin D (25-OH-D) and nitric oxide (NO) levels were determined by enzyme-linked immunosorbent assay.The level of plasma endothelial microparticles was measured by flow cytometry.The data were statistically analyzed with SPSS version 19.O.Results The serum 25-(OH)-D [(55.22 ± 11.92) nmol/L vs.(64.17 ± 21.52) nmol/L,t =-3.71],vitamin D binding protein (VDBP) [(257.32 ±141.31) ng/mlvs.(314.21±124.13) ng/ml,t=-3.21],NO levels [(39.35±13.33)μmol/L vs.(43.42 ± 11.83) μmol/L,t =-2.42] in hypertension group were significantly lower than those in control group.And the circulating endothelial cell particles (4.95 ± 1.78 vs.2.84 ± 2.07,t =8.05) in hypertension group was significantly higher than that in control group.In hypertensive patients,the circulating endothelial cell particles in VD deficiency group was significantly higher than that in low VD group and normal VD group [(6.42 ± 1.25)％ vs.(4.6 ± 1.68)％,(3.15 ±0.90)％,F =15.08].And the serum NO level in VD deficiency group was significantly lower than that in other two groups [(36.57 ± 10.52) μmol/L vs.(39.77 ± 13.01) μmol/L,(46.26 ± 25.90) mol/L,F =1.20].Multiple linear regression analysis showed that low serum 25 (OH) D(B =-0.189,SE =0.033,β =0.509,t =-5.72) and gender (B =-0.682,SE =0.351,β =-0.182,t =-2.054) were the risk factors of vascular endothelial injury.Conclusion The serum vitamin D levels in hypertensive patients is decreased,and vitamin D deficiency may be a risk factor for endothelial injury in hypertension.