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Patients with severe mental illnesses (SMI) were at high risk of infection during Coronavirus Diseases 2019 (COVID-19) pandemic. This study examined hospitalized SMI patients’ attitude and knowledge towards the COVID-19 infection. A cross-sectional survey was conducted in five psychiatric hospitals located in Gansu province, the most economically underdeveloped area in China. Patients’ attitude towards preventive measures and knowledge of COVID-19 were measured by a self-report questionnaire. A total of 925 hospitalized patients with SMI were recruited. Of them, 84.8% (95%CI: 82.4%–87.1%) had positive attitudes towards preventive measures of the COVID-19 outbreak. Being married (OR: 1.55, 95%CI: 1.05–2.30) and a higher educational level (OR: 1.63, 95%CI: 1.12–2.38) were independently associated with positive attitudes towards COVID-19 preventive measures, whereas higher educational level was associated with better knowledge of the COVID-19 outbreak (β: 0.231, P

Objective In this case report, we describe our experience with a patient who was treated for rectal adenocarcinoma complicated with primary cholangiocarcinoma of the liver and highlight the problems in the diagnosis and treatment of these potentially fatal lesions. Methods In the clinical setting, we often use the concept of “monism” for diagnosis and treatment. In this report, we review the diagnosis and treatment of rectal adenocarcinoma complicated with primary cholangiocarcinoma of the liver. Results Four months after surgery, the patient’s carbohydrate antigen 19-9 level was elevated, and positron emission tomography/computed tomography showed multiple liver metastases. The patient underwent three rounds of transarterial chemoembolisation and two rounds of radiofrequency ablation at our hospital for recurrent hepatocellular carcinoma. The clinical response was poor and indicative of progression of intrahepatic lesions. Conclusion A preoperative multidisciplinary team, rapid intraoperative pathological examination, and active comprehensive postoperative treatment are necessary to improve the prognosis of multiple primary tumours.

This study sought to determine whether chronic hepatitis B or C would modify the association between insulin analogues and hepatocellular carcinoma (HCC) risks. We conducted a nationwide nested case-control study for HCC cases and matched controls from 2003 to 2013 among newly diagnosed type 2 diabetes patients on any antidiabetic agents in Taiwan before and after exclusion of chronic viral hepatitis, respectively. A total of 5832 and 1237 HCC cases were identified before and after exclusion of chronic viral hepatitis, respectively. Incident HCC risks were positively associated with any use of premixed insulin analogues (adjusted odds ratio (OR), 1.27, 95% CI 1.04 to 1.55) among total participants, especially among current users (adjusted OR, 1.45, 95% CI 1.12 to 1.89). However, the association between HCC occurrence and premixed insulin analogues diminished among participants without chronic viral hepatitis (adjusted OR, 1.35, 95% CI 0.92 to 1.98). We also observed a significant multiplicative interaction between chronic viral hepatitis and premixed insulin analogues on HCC risks (P = 0.010). Conclusions: Chronic viral hepatitis signifies the role of premixed insulin analogues in HCC oncogenesis. We recommend a closer liver surveillance among patients prescribed premixed insulin analogues with concomitant chronic viral hepatitis.

Supplemental Digital Content is available in the text, Background: Liver cirrhosis is a risk factor for the loss of muscle mass, which is associated with numerous adverse health outcomes. This meta-analysis aimed to examine whether loss of muscle mass was a predictor of increased mortality in cirrhotic patients without or before liver transplantation. Methods: Without language restriction, PubMed and Embase were searched for articles published from the earliest records to December 2018 investigating the influence of loss of muscle mass on survival of cirrhotic patients. Those who had undergone liver transplantation and had hepatocellular carcinoma were excluded. The main outcome was the hazard ratio (HR) for the association of mortality with loss of muscle mass, and the secondary outcome was the association of loss of muscle mass with Child-Pugh class and death caused by severe infection. Results: The meta-analysis included 16 observational studies, comprising 4070 participants. The pooled crude and adjusted HRs for the association of mortality with loss of muscle mass were 2.05 (95% confidence interval [CI], 1.51–2.78) and 2.36 (95% CI, 1.61–3.46). Using Child-Pugh Class A as reference, the odds ratios (ORs) for the association of loss of muscle mass with Child-Pugh Class B and Class C were 1.68 (95% CI, 0.96–2.92) and 1.94 (95% CI, 0.66–5.65). Patients with loss of muscle mass were likely to have infection-related mortality (OR = 3.38, 95% CI, 0.61–18.88) but the association did not reach statistical significance. Conclusions: Loss of muscle mass is associated with mortality in cirrhotic patients without or before liver transplantation. Future studies should be conducted to explore whether exercise and nutritional supplementation can reverse muscle mass loss and improve long-term survival.

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease related to metabolic syndrome. This study applied an integrated analysis based on texture, backscattering, and attenuation features in ultrasound imaging with the aim of assessing the severity of NAFLD. Ultrasound radiofrequency data obtained from 394 clinical cases were analyzed to extract three texture features (autocorrelation, sum average, and sum variance), the signal-to-noise ratio (SNR), and the slope of the center-frequency downshift (CFDS slope). The texture, SNR, and CFDS slope were combined to produce a quantitative diagnostic index (QDI) that ranged from 0 to 6. We trained the QDI using training data and then applied it to test data to assess its utility. In training data, the areas (AUCs) under the receiver operating characteristic curves for NAFLD and severe NAFLD were 0.81 and 0.84, respectively. In test data, the AUCs were 0.73 and 0.81 for NAFLD and severe NAFLD, respectively. The QDI was able to distinguish severe NAFLD and a normal liver from mild NAFLD, and it was significantly correlated with metabolic factors. This study explored the potential of using the QDI to supply information on different physical characteristics of liver tissues for advancing the ability to grade NAFLD.

Resection of the cephalic or middle portion of lateral crura of alar cartilages is a method for correcting bulbous nose in which the resected cartilages usually are discarded, resulting in a waste of autologous tissues. A silastic implant usually is used to correct saddle nose in Asian countries, but implant extrusion, a severe complication, sometimes occurs. Cartilage flaps were first reported by Jose to increase the projection of the nasal tip. In this study, the authors used cartilaginous flaps of the lateral crura to wrap the tip of the nasal implant for patients with bulbous and saddle noses. This study aimed to investigate the application of cartilaginous flaps of lateral crura. A flap was created from the cephalic portion of the lateral crus of the alar cartilage, leaving the caudal portion intact. The cartilage flap remained attached at the level of the original domal segment of the middle crura. It was rotated over to wrap the tip of the silastic implant, then sutured to the other side flap. From March 2003, 19 patients were treated with this technique. The results were satisfactory without implant extrusion or any other complications except for nonobvious scars. The cartilage flap can reduce the incidence of implant extrusion and help to reduce the size of the bulbous tip.

Glyceryl trinitrate (GTN), also known as nitroglycerin, has been used to treat angina and heart failure for more than 130 years. Recently, it was shown that mitochondrial aldehyde dehydrogenase-2 (ALDH2) is responsible for formation of NO, the metabolite needed for GTN efficacy. In the present study, we show that the common G-to-A polymorphism in exon 12 of ALDH2 — resulting in a Glu504Lys replacement that virtually eliminates ALDH2 activity in both heterozygotes and homozygotes — is associated with a lack of efficacy of sublingual GTN in Chinese subjects. We also show that the catalytic efficiency (Vmax/Km) of GTN metabolism of the Glu504 protein is approximately 10-fold higher than that of the Lys504 enzyme. We conclude that the presence of the Lys504 allele contributes in large part to the lack of an efficacious clinical response to nitroglycerin; we recommend that this genetic factor be considered when administering nitroglycerin to patients, especially Asians, 30–50% of whom possess the inactive ALDH2*2 mutant allele.

Background & Aims : Hepatitis B virus (HBV) genotype C is associated with the development of hepatocellular carcinoma (HCC), compared with genotype B. This study aims to investigate whether HBV genotypes influence the clinicopathologic features and long-term prognosis of patients after curative resection of HCC. Methods : Stored serum samples from 62 patients with HBV-related HCC were tested for HBV genotype using a molecular method. Results : Sixty of 62 patients (96.8%) undergoing curative resection of HCC were infected with genotype B or C. Concomitant cirrhosis was encountered more frequently in patients with genotype C. During a mean follow-up period of 26.3 ± 9.8 months, patients with genotype B had a lower overall tumor recurrence rate than those with genotype C (22% vs. 46%; P = 0.04). Stepwise multiple Cox proportional hazards regression analysis showed that multiplicity of tumor (hazard ratio, 6.84; 95% confidence interval [CI], 1.45–32.2; P = 0.02) was associated with tumor recurrence, whereas genotype C and age were associated with borderline significance (P = 0.06). Stratified analysis showed that genotype C was still associated with tumor recurrence in cirrhotic patients with borderline significance by univariate analysis (hazard ratio, 3.8; 95% CI, 0.84–17.6; P = 0.07). However, cumulative 2-year survival rates were similar between patients with genotype B and C (92% vs. 85%; P = 0.23). Conclusions : Our data suggest that patients with HCC with genotype C have a greater tumor recurrence rate after curative resection of HCC compared with those with genotype B. Prolonged follow-up is needed to clarify the impact of HBV genotype on postoperative outcome.

To study the expression of P-glycoprotein (P-gp) in patients with chronic schistosomiasis and its relationship with gender and age, and to explore its clinical significance.The colonic mucosa specimens of 50 chronic schistosomiasis patients and 4 persons who had a family history of colon cancer but their physical examinations were normal (as a control group) were selected and the expressions of P-gp in the colonic gland of these samples were detected with the immunohistochemical staining method.Compared with the control group, the mean gray value of the positive particles of P-gp of colonic epithelial cells of the chronic schistosomiasis group was significantly reduced (P0.05), but positive unit values were significantly increased (P0.05), which meant the P-gp expression in colonic gland of the patients with chronic schistosomiasis was significantly increased, but this increase had no relationship with sex and age.Chronic schistosomiasis may induce the increase of P-gp expression which may be a compensatory protection mechanism due to the stimulation of schistosome eggs to the colon tissues.

Background Women with elliptical faces are considered to be aesthetically appealing in Asia. Some men prefer this shape for themselves and choose to have their square-shaped face altered to an elliptical shape. To accomplish this, we perform an ostectomy that includes resection of the mandibular angle, splitting of the lateral cortex, and reduction in the width of the chin. Methods Nineteen men with a square face (aged 22-30 years) underwent ostectomy, including resection of the mandibular angle, splitting of the lateral cortex around the mandibular angle, and reduction of the width of the chin by an intraoral approach. Results The results of the ostectomy were satisfactory 3 to 6 months postoperatively. The bigonial distance was effectively reduced and stable chin contours were achieved. The overall shape of the face was elliptical. There was no microgenia, facial asymmetry, hematoma, infection, or permanent mental nerve injury. Conclusion Ostectomy that includes resection of the mandibular angle, splitting of the lateral cortex, and reduction in the width of the chin is a safe and effective method to modify a man's square-shaped face into a more elliptical appearance.

The risk and the predictors of liver disease progression in carriers of inactive hepatitis B virus (HBV) are unclear.Participants in the Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer-Hepatitis B Virus (REVEAL-HBV) study who were seronegative for hepatitis B e antigen; had serum levels of HBV DNA10,000 copies/mL; and did not have cirrhosis, hepatocellular carcinoma, or increased serum levels of alanine aminotransferase were classified as carriers of inactive HBV (n = 1932). Study participants who were seronegative for HB surface antigen and antibodies against hepatitis C virus, yet had similar clinical liver features, were the controls (n = 18,137). Liver-related death and new cases of hepatocellular carcinoma were ascertained through computerized data linkage with National Cancer Registry and Death Certification profiles. The disease progression rates were estimated. The multivariate-adjusted hazard ratios for risk predictors were derived from Cox regression models.There were 20,069 participants, contributing a total of 262,122 person-years, with a mean follow-up of 13.1 years. Annual incidence rates of hepatocellular carcinoma and liver-related death were 0.06% and 0.04%, respectively, for inactive HBV carriers; rates were 0.02%, and 0.02% for controls, respectively. The multivariate-adjusted hazard ratios for carriers of inactive HBV, compared to controls, were 4.6 (95% confidence interval: 2.5-8.3) for hepatocellular carcinoma and 2.1 (95% confidence interval: 1.1-4.1) for liver-related death. Older age and alcohol drinking habits were independent predictors of risk for carriers of inactive HBV to develop hepatocellular carcinoma.Carriers of inactive HBV have a substantial risk of hepatocellular carcinoma and liver-related death compared with individuals not infected with HBV.

To test the effect of endogenous BDNF on injured nervous system.The left sciatic nerves of the rats were cut off, and then divided into two groups, each with 8 rats. The rats in the experimental group were intraperitoneally injected with anti-BDNF, while the control group was given normal sheep serum (NSS). The dorsal coclums of the rats were cut on the 8th day. The L5 DRG were cut into length wise sections to dye with fluorescent antibody. Positive cells of GAP-43 in the L5 DRG were counted. The second experiment had both sides of sciatic nerves of the rats cut off, followed by the same procedure as the first experiment. The HRP tracing and ABC immunohistochemical staining were performed to analyse the effect of endogenous BDNF on the recovery of injured spinal cords.For the rats with left sciatic nerves cut off, the experimental group had less GAP-43 positive cells in the left L5 DRG than the controls (P0.01). For the rats with both sciatic nerves cut off, the experimental group had less nerves with positive fibers-labeled HRP than the controls at the site of tSCI (P0.01).Endogenous BDNF promote the recovery of injured nervous system.

Background Gastrointestinal graft versus host disease (GI-GVHD) and cytomegalovirus (CMV) enteritis are important complications following allogeneic haematopoietic stem cell transplantation (allo-HSCT). We explored the role of colonoscopy in the diagnosis of GI-GVHD and CMV enteritis following allo-HSCT to identify the endoscopic manifestations of GI-GVHD and CMV enteritis was made. Methods A retrospective analysis of the colonoscopic manifestations of GI-GVHD, CMV enteritis and GI-GVHD with concurrent CMV enteritis (GconC) and their related clinical issues. Results Forty-seven patients underwent 50 colonoscopies with diagnoses of 32 GI-GVHD, 7 CMV enteritis and 11 GconC. Both GI-GVHD and CMV enteritis had colonic mucosal lesions with various manifestations under colonoscopy. Tortoise shell like changes of the mucosa (12 of 32) and deep ulcers (2 of 7) were specific endoscopic manifestations for GI-GVHD and CMV enteritis, respectively, while mucosal oedema, erythema, congestion, erosion and shallow ulcers could not be used to differentiate GI-GVHD from CMV enteritis. GconC patients were prone to have oozing bleeding of the end ileal mucosa and typhlodicliditis. Of the biopsed specimens for GI-GVHD, CMV enteritis and GconC, 64%, 70% and 44% were taken from the rectum and sigmoid colon respectively. Conclusions Following allo-HSCT, tortoise shell like changes and deep ulcers of the colonic mucosa are characteristic changes for GI-GVHD and CMV enteritis, respectively, while the other lesions are not. Most of the GI-GVHDs and CMV enteritis cases can be diagnosed by left colon examination and tissue biopsy, but total colon examination to the terminal ileum is preferred.

Background & Aims The efficacy of treatment of Helicobacter pylori infection has decreased steadily because of increasing resistance to clarithromycin, metronidazole, and levofloxacin. Resistance to amoxicillin is generally low, and high intragastric pH increases the efficacy of amoxicillin, so we investigated whether a combination of a high-dose proton pump inhibitor and amoxicillin (dual therapy) was more effective than standard first-line or rescue therapies in eradicating H pylori . Methods We performed a large-scale multihospital trial to compare the efficacy of a high-dose dual therapy (HDDT) with that of standard therapies in treatment-naive (n = 450) or treatment-experienced (n = 168) patients with H pylori infection. Treatment-naive patients were randomly assigned to groups given HDDT (rabeprazole 20 mg and amoxicillin 750 mg, 4 times/day for 14 days, group A1), sequential therapy for 10 days (group B1), or clarithromycin-containing triple therapy for 7 days (group C1). Treatment-experienced patients were randomly assigned to groups given HDDT for 14 days (group A2), sequential therapy for 10 days (B2), or levofloxacin-containing triple therapy for 7 days (C2). H pylori infection was detected by using the 13 C-urea breath test. We evaluated factors associated with treatment outcomes. Results In the intention-to-treat analysis, H pylori was eradicated in 95.3% of patients in group A1 (95% confidence interval [CI], 91.9%−98.8%), 85.3% in B1 (95% CI, 79.6%−91.1%), and 80.7% in group C1 (95% CI, 74.3%−87.1%). Infection was eradicated in 89.3% of patients in group A2 (95% CI, 80.9%−97.6%), 51.8% in group B2 (95% CI, 38.3%−65.3%), and 78.6% (95% CI, 67.5%−89.7%) in group C2. The efficacy of HDDT was significantly higher than that of currently recommended regimens, irrespective of CYP2C19 genotype. Bacterial resistance to drugs was associated with treatment failure. There were no significant differences between groups in adverse events or patient adherence. Conclusions HDDT is superior to standard regimens as empirical first-line or rescue therapy for H pylori infection, with similar safety profiles and tolerability. ClinicalTrials.gov number: NCT01163435.

To explore the relationship between the polymorphism of Interleukin-1 and the pneumoconiosis susceptibility.Eighty patients with silicosis and 45 with coal workers' pneumoconiosis (CWP) were selected while 125 male workers, Han nationality in the same workplace as the patients were selected as the controls. Between the patients and the control, the differences of age and cumulative length of service were less than five years and two years, respectively. The controls were exposed to dusts but did not suffer from pneumoconiosis. Moreover, the patients and the controls were paired by 1:1. DNA was extracted from leucocytes by the hydroxybenzene chloroform method. The polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) techniques and PCR were used to examine polymorphism of IL-1alpha (-889), IL-1beta (-511) and IL-1Ra (+2018) and variable number of tandem repeats (VNTR) of IL-1Ra. After the preliminary experiment, the most adaptive PCR reaction, the restriction enzyme digest and electrophoresis system were used.The difference in IL-1alpha (-889) 1/2 + 2/2 between the pneumoconiosis patients and the controls was significant (P0.01). The result of conditional Logistic regression showed that heterozygote and allele 2 of IL-1a (-889) were risk factors of pneumoconiosis. The difference in the genotype frequencies of IL-1beta (-511) 1/2 + 2/2, IL-1Ra (+2018) 1/2 + 2/2 and IL-Ra VNTR1/2 + 2/2 between the patients and the controls were not statistically significant (P0.05).IL-1alpha (-889) gene polymorphism is related to pneumoconiosis. Workers with IL-1alpha (-889) allele 2 are susceptible to the pneumoconiosis. The relationship between IL-1beta (-511), IL-1Ra (+2018), IL-1Ra VNTR genes polymorphisms and pneumoconiosis are not found.

To explore the relationship between polymorphisms of DNA repair gene XRCC1 and susceptibility to radiation injury.In 1:1 case-control study, 113 abnormal chromosome workers exposed to ionizing radiation were selected as cases and 113 normal chromosome as controls who matched with case for sex, age (+/- 5 years), nation, type of work, the same or more but in 2 years work length and the same similar levels of the cumulative exposure radiation dose. Genotypes were analysed using PCR based restriction fragment length polymorphism techniques.The frequency of XRCC1 26304TT allele in case group (18.58%) was significantly higher than that in control group (7.08%), with OR for radiation damage being 3.47 (95% CI 1.43 - 8.44, P0.05). No association was observed between XRCC1 G27466A and G28152A and susceptibility to radiation injury.The mutation of XRCC1 C26304T is related with the susceptibility to radiation injury. The polymorphisms of XRCC1 G27466A and G28152A are not found to have association with abnormal chromosomes.

To evaluate the relationship of six single nucleotide polymorphisms(SNPs) and their haplotypes of angiotensinogen(AGT) gene to essential hypertension(EH) in Chinese Han population.The genotypes in 185 patients with EH and 185 healthy controls were determined by the method of ABI PRISM SNaPshot Multiplex Kit using six AGT gene polymorphisms at position -217(G/A), -152(G/A), -20(A/C) and -6(G/A) in the promoter region and T174M, M235T in exon 2.The distribution of AGT genotypes and alleles frequencies showed no significant difference between the group of EH and group of controls (P0.05). However, haplotype analysis revealed that H4 haplotype frequency, which included -152A, -20C, -6A and 235T alleles, was significantly increased in the group of EH (P0.05).G-152A, A-20C, G-6A and M235T polymorphisms of AGT gene might play an important role in the occurrence of EH in Chinese Han population.

To bring forward a method to improve the prominence of the forehead contour.16 patients(age 29-53 years, female 11, male 5) were treated through a bicoronal incision. Following the incision, the forehead soft tissues are reflected down to the level of the superior orbital rims with the protection to the supraorbital neurovascular bundles. To adjust the forehead contour, both superior orbital rims and frontal bossing was reduced by burring down the excess bone or removing the anterior wall of the forehead.The operative effect were satisfactory during 3-12 months of follow-up. No recurrence or osteogenesis were found in the cases. Nasofrontal angle and forehead angle were normal. The prominence of the supraorbital ridges disappeared and forehead became nature.Cranioplasty via an osteomy or burring of the outer line of forehead bone are safe, compact and effective way to improve the prominence of the superior orbital rims or frontal bossing.

To discover single nucleotide polymorphisms (SNPs) in the promoter region of angiotensin II type 1 receptor (AT1) gene and evaluate their associations with the occurrence of essential hypertension (EH) and coronary heart disease (CHD) in Chinese Han population.SNPs detection was performed by PCR-sequencing. The genotype was determined by the same method in a total number of 473 unrelated patients including 160 EH cases, 128 CHD cases, and 185 EH combined with CHD cases as well as 160 healthy controls.Six SNPs were discovered in the promoter region of AT1 gene. -810A/T was almost in completely linkage disequilibrium with -713G/T, -214A/C, -213G/C, and -153A/G polymorphisms. No statistically association was found in our population between -810A/T polymorphism and EH, the association of -810A allele and CHD was of borderline significant (chi2=3.649, P=0.056). However, significant differences of genotype distributions were observed in the EH combined with CHD group (TT=126, TA=51, AA=8) compared with the EH patients (TT=127,TA=26, AA=7, chi2=6.410, P=0.041) and the healthy controls (TT=130, TA=24, AA=6, chi2=7.742, P=0.021). The EH combined with CHD patients had a significantly increased A allele frequency than the normal references (0.181 vs 0.106, chi2=7.690, P=0.006) and the EH subjects (0.181 vs 0.125, chi2=4.119, P=0.042). Hypertensive patients carrying TA genotype (OR=1.977, 95 % CI 1.160-3.354, P=0.011) or A allele (OR=1.548, 95 % CI 1.015-2.361, P=0.043) had an increased risk for CHD morbidity.we firstly report that -810A/T polymorphism in the promoter region of AT1 gene might be a genetic risk factor for the pathogenesis of CHD complicated with EH in Chinese Han population.

To investigate the types of lipid disorder and its relationship with macrovascular diseases and insulin resistance in Chinese diabetic patients.2,430 diabetic patients finished the diabetes complications assessment and were surveyed on their blood lipids, insulin level and macrovascular diseases. The insulin resistance (HOMA-IR) was calculated based on HOMA model.Prevalence of lipids disorder was as high as 63.8% in this group, including 23.9% with both hypercholesterolemia and hypertriglyceridemia (HY-C-T), 16.1% with hypercholesterolemia only (HY-C), 15.0% with hypertriglyceridemia only (HY-T), 5.5% with lower HDL level (L-HDL), 3.3% with hypercholesterolemia, hypertriglyceridemia and lower HDL level together. Compared with the patients with normal lipid level (control group), no duration differences existed among these groups. There were more female patients in HY-C and HY-C-T groups. BMI and WHR were higher in all groups with lipid disorder except in HY-C group. Macrovascular diseases were more common in HY-C-T patients than in control group (33.6% vs 24.0%, P0.001). Average blood pressure and the prevalence of hypertension were significantly higher in HY-C-T, HY-C, HY-T groups than in control group (139/79, 138/76, 134/77 vs. 132/75 mmHg; 53.2%, 50.1%, 46.2% vs. 39.2%). Fasting insulin level was significantly higher in HY-C-T and HY-C-T-L-LDL groups than in controls. Insulin resistance was more severe in all patients with lipid disorder except in L-HDL group, particularly in the HY-C-T-L-HDL group.(1) BMI, WHR increased significantly with the severity of lipid disorder. (2) Nearly two thirds of Chinese diabetic patients have lipid disorder, which is the strong risk factor of macrovascular diseases and aggravates insulin resistance. (3) There was severe insulin resistance in patients with hypertriglyceridemia or with hypertriglyceridemia plus other lipid disorder.

Acinar cell carcinoma is an uncommon malignancy with a reported incidence of 1% among exocrine tumors of the pancreas. The case of a 60-year-old Taiwanese man who presented with obstructive jaundice, abdominal pain, and body weight loss is described here. A mixed clinical picture of islet cell tumor and ductal carcinoma of the pancreas was shown to be a hypervascular tumor at the pancreatic head region with an irregular stricture at the common channel of the common bile and pancreatic ducts. The patient had normal levels of plasma carcinoembryonic antigen, carbohydrate antigen 19-9, alpha-fetoprotein, but an increase in plasma levels of insulin and C-peptide. Immunohistochemical stains and electron microscopic examination of the tumor was consistent with acinar cell carcinoma.

The exons 13, 16, 21 and 23 of cardiac beta-myosin heavy chain (MHC) gene from 32 Chinese patients with hypertrophic cardiomyopathy were analyzed by the polymerase chain reaction and the DNA single strand conformation polymorphism (PCR-SSCP) procedure. The results showed an altered SSCP in exon 13 of one patient. Sequencing analysis revealed that the patient had a G to T transversion in codon 383, resulting in the substitution of Lys by Asn. The missense mutation was also confirmed by Southern blot hybridization with an allele-specific oligonucleotide probe. Because it was found at a residue highly conserved through evolution, this mutation is likely to be the cause of hypertrophic cardiomyopathy in the patient. Because her parents and child were neither clinically nor genetically affected, it was concluded that the mutation in this patient arose de novo and was not passed to her child. This is the first report of a mutant cardiac beta-MHC gene in the Chinese population. Also, it is a novel missense mutation of the cardiac beta-MHC gene.