Familial hypercholesterolemia(FH) is a common autosomal dominant dyslipidemia,which is caused by mutations of the low-density lipoprotein receptor(LDLR) gene producing defect or deficiency in LDLR.The characters of FH are elevated level of total and LDL cholesterol.FH is considered to be a complex polygenic disease.Recently,more findings indicate that proprotein convertase subtilisin/kexin type 9(PCSK9) gene play an important role in serum cholesterol metabolism.Some mutated PCSK9 proteins decrease LDLR,which cause FH in affected families.Some other mutated PCSK9 proteins decrease self-affinity,which cause hypocholesterolemia.We review the newest researches about the structure,function ofPCSK9 gene and the relation of its mutations with plasma cholesterol metabolism.

Transducer,which acts as both ultrasound emitter and echo receiver,is the most important acoustics part in medical ultrasonic imaging system.The development of ultrasonic imaging technology makes ultrasound image clearer and more intuitionistic.This paper mainly introduces the technical development and the prospects of piezocomposite transducer,piezoelectric single crystal transducer,wide-band transducer,3D imaging transducer and capacitive micromachined ultrasonic transducer(cMUT).

After an analysis of the matching for library and teaching model of MOOC, MOOC-related problems were pointed out, such as insufficient supplementary resources, no soft environment for attending MOOC, limita-tions of traditional service model, and how to construct a MOOC-based service model for medical teaching in library was elaborated with suggestions proposed for changing the traditional service model in library, such as bringing into full play of the advantages of intensive information and the supplementary role of library in medical teaching , and providing new types of service.

Objective To investigte the possibility of interventional mechanical thrombectomy dealing with chronic vascular thrombus, and assessing its curative effects. Methods Twenty three cases included 17 males 6 females, and aged from 46 to 80 year with a mean of 64.8. All patients were coinsided with MRA, vascular ultrasound and angiography, in which 12 patients with chronic heart and vascular disease, and 11 patients with serious diabetes. Thrombi were located in iliac artery ( n=9,L=4,R=3 , bilaterals=2), femoral artery( n =2), populiteus artery ( n =2), popliteus artery( n =3), iliac vein ( n =7, L=5,R=2), portal vein ( n =1). The length of thrombi varied from 3 to 8 cm, and the diameter from 5 to 10mm.Filter should be placed in inferior cava vein before venous thrombus treatment ( n =7). Mechanical thrombectomy was undertaken as following: ATD ( n=9, Vein=7), PTD( n =2), and Oasis( n =1). After guide wire passing through thrombus segment, Oasis was inserted for remove thrombus. Urokinase (500 000U) was usually administered for catheter directed thombolysis before/during mechanical thrombectomy. Stent should be placed in the segment if stenosis was confirmed after thrombectomy angiography. Drugs were used after thrombectomy including thromboyltic drug, heparinzed anticoagulation and changing microcirculation. Vascular ultrasound, reconstruction CTA and clinical follow up had all been carried out. Results 12 cases (85.7) were undergone successfully thrombectomy. One case failured with portal vein thrombus formation, the other with multiple segments involvement in femoral artery was treated by combined ATD and Oasis. Sy mptoms of 15 cases were either released or disappared, including ischemia, swelling and motion limitations. The patency shown by vascular ultrasound follow up were 100% in three months, 85.4% in six months, 73.2% in twelve months, with simultaneously blood flow improvement to normal and obviously corrected 76.5%,65.4% 60.1% in 3,6,12 month respectively.Conclusions Interventional mechanical thrombectomy is a new choice of treating chronic vascular thrombus with its direct curative effects, but still needs long term follow up.

Objective To evaluate and analyze the effect of treatment on fractures of the clavicle with reconstruction plate or with Kirschner wire.Methods Of 56 clavicular fracture cases for treatment with surgical procedures,22 cases were fixated with reconstruction plate.34 cases were fixated with Kirschner wire.Results All 56 cases were followed up for 10~48 months,on average 21 months.Reconstruction plate fixation group:2 cases concomitant with delayed fracture healing were multiple trauma patients.The mean union time in this group was 3.6 months(range from 3 to 5 months).Kirschner wire fixation group:3 cases with wires migration.The mean union time in this group was 2.3 months(range from 2 to 3 months).According to Kalarsson's shoulder function evaluating criteria,all cases were excellent.Conclusion Surgical technique with Kirschner wire is simple and credible treatment for clavicular uncomminuted fractures.,it complys with the conception of minimally invasive technique and is a recommendable way.

Objective To describe the current status of adult overweight and obesity in urban and suburb areas of Tianjin.Methods 2 283 adult people including 1 131 from urban and 1 152 from suburb were selected by multi-stage cluster random sampling.The waist circumference,weight and height of the subjects were measured.Then the BMI was calculated.Results The mean BMI of adult people in Tianjin was 25.05?5.02 kg/m2,the overweight rate was 36.9%,the obesity rate was 20.0% and the abdominal obesity rate was 63.9%.The prevalent rates of overweight,obesity and abdominal obesity in different age groups showed significant differences.The rates of overweight,obesity and abdominal obesity increased with ages in urban area.The overweight rate in 40～49 yrs and the obesity rate in 50～59 yrs reached their peak values in suburb.Besides the overweight rate in urban was significantly higher,the obesity rate and abdominal obesity rate were no significant differences between urban and suburb.The prevalent rates of overweight,obesity and abdominal obesity showed no significant differences between the adult male and female in Tianjin,but the prevalent rates of obesity and abdominal obesity in female were significantly higher than those in male in the suburb.The prevalence of obesity in the middle-ages showed significant differences between different occupational population,the retired taking the highest while the workers taking the lowest value.The prevalence of obesity showed no significant differences between population with different education background and different income situation.Conclusion The rates of adult overweight and obesity in Tianjin were higher than those of all over the country in 2002,and the abdomen obesity reached to 63.9%.Intervention should be taken to change this situation as soon as possible.

OBJECTIVETo observe the effect of postoperative analgesia with dexmedetomidine on the survival rate of amputated finger replantation.

METHODS91 cases, who was going to receive amputated finger replantation, were randomly divided into group A (n = 48) and B (n = 43). PCIA (patient-controlled intravenous analgesia) was set immediately after operation in group A (fentanyl 1.0 mg + tropisetron 4.0 mg + 10 mg + dexmedetomidine 200 microg + saline 100 ml) and group B (same as group A except dexmedetomidine). Background infusion is 2 ml/h with a bolous of 0.5 ml and lockout time is 15 min. postoperative VAS score, Ramsay score, condition of replanted fingers and other adverse events at the 0-6 h, 6-12 h, 12-24 h and 24-48 h were recorded and analyzed.

RESULTSThe age, sex, height, weight, amputated time (Ts), revascularized time (Tt) in the two groups were not statistically different (P > 0.05). Postoperative VAS score in the two groups was significantly different at the 0-6 h, 6-12 h, 12-24 h and 24-48 h (P < 0.05), but Ramsay score was not (P > 0.05). The highest and lowest postoperative VAS score and Ramsay score were markedly different between two groups (P < 0.05). 3 of the 60 fingers in group A experienced vascular crisis and 2 underwent vascular explore surgery. 13 of 56 fingers in group B occurred vascular crisis, and 10 underwent vascular explore surgery, showing significant difference between the two groups (P < 0.05). PCIA adverse reactions showed no difference between the two groups (P > 0.05). Bradycardia and hypotension didn't happen in any patients in the two groups. 4 weeks after surgery, the survival rate was 96.7% (58/60) in group A, and 83.9% (47/56) in group B (P < 0.05).

CONCLUSIONPostoperative analgesia with dexmedetomidine as an adjuvant can increase the survival rate of replantation fingers with high safety.

Adolescent ; Adult ; Analgesia ; Dexmedetomidine ; therapeutic use ; Double-Blind Method ; Female ; Finger Injuries ; surgery ; Humans ; Male ; Postoperative Care ; Replantation ; Young Adult

Objective To evaluate therapeutic effects of radiofrequency ablation for thyroid benign nodules . Methods By using the radiofrequency electrode (18G ×7 cm, working segment length =1 cm), a total of 61 patients with 87 thyroid benign nodules underwent ultrasound-guided radiofrequency ablation in our department from February 2013 to May 2014.The maximum diameter , volume, and volume-reduction ratio (VRR) were measured by ultrasound at 1, 3, 6, and 12 months after operation. Results The 61 patients with 87 thyroid benign nodules were successfully treated with radiofrequency ablation , including 3 cases receiving secondary ablation after 1 month.The maximum diameter of thyroid nodules was (2.24 ±0.63) cm preoperatively, and (1.82 ±0.81) cm, (1.52 ±0.72) cm, (1.03 ±0.43) cm, and (0.56 ±0.36) cm at 1, 3, 6, and 12 months after ablation, respectively.The maximun volume was (5.37 ±1.85) ml preoperatively, and (4.41 ±2.16) ml, (3.19 ±1.92) ml, (1.34 ±0.61) ml, and (0.69 ±0.41) ml at 1, 3, 6, and 12 months after ablation, respectively.The VRR were (20.7 ±13.2)%, (48.6 ±16.1)%, (77.3 ±4.7)%and (88.7 ±5.6)%, respectively at 1,3,6, and 12 months after ablation.At the final follow-up, 51 (58.6%) nodules disappeared completely. Conclusion Ultrasound guided radiofrequency ablation for thyroid benign nodules is safe and effective .

Objective To investigate the effect of Dicer knockdown on the proliferation,migration and invasion of cholangiocarcinoma cell line TFK-1.Methods The study used liposome-mediated method to transfect Dicer-siRNA into TFK-1 cells.The mRNA and protein expressions of Dicer after transfection were detected by real-time PCR and western blot.CCK8 assay,scratch test and transwell assays were performed to analyze the influence on the proliferation,migration and invasion of cells,respectively.Results Compared with the control,Dicer mRNA level at 48 h and Dicer protein level at 96 h were both significantly reduced after transfection with Dicer-siRNA (P ＜ 0.01).CCK8 assay revealed that the absorbance value significantly increased at 72 h,96 h and 120 h after transfection (P ＜0.01).Scratch test and transwell assay showed that the migration ability and the number of invasive cells significantly increased (P ＜ 0.05).Conclusion Dicer knockdown enhanced the proliferation,migration and invasion of cholangiocarcinoma cell line TFK-1.

Objective To utilize the expert resource in central hospital for helping doctors in community hospital to make suitable diagnosis and treatment,improve the technical level of community medical care. Methods The Telemedicine Diagnosis System is developed based on B/S mode and Microsoft Visual Studio.net C#2005 in Windows platform. Results The Telemedicine Diagnosis System has been developed, and realized the function of interface display, information management, medical image transmission and telemedicine diagnosis. Conclusion The system has friendly interface, simple operation, more reliability and quick data transmission, and it can accurately realize the experts' telemedicine diagnosis in time.