Mediating effect of self-efficacy on self-management ability and self-management behavior in patients with type 2 diabetes mellitus / 北京大学学报(医学版)

OBJECTIVE@#To investigate the mechanism of self-efficacy between self-management ability and self-management behavior and its differences among patients with different disease courses through mediation tests.@*METHODS@#In the study, 489 patients with type 2 diabetes who attended the endocrinology departments of four hospitals in Shanxi Province and Inner Mongolia Autonomous Region from July to September 2022 were enrolled as the study population. They were investigated by General Information Questionnaire, Diabetes Self-Management Scale, Chinese version of Diabetes Empowerment Simplified Scale, and Diabetes Self-Efficacy Scale. Mediation analyses were performed using the linear regression model, Sobel test, and Bootstrap test in the software Stata version 15.0 and divided the patients into different disease course groups for subgroup analysis according to whether the disease course was > 5 years.@*RESULTS@#In this study, the score of self-management behavior in the patients with type 2 diabetes was 6.16±1.41, the score of self-management ability was 3.99±0.74, and the score of self-efficacy was 7.05±1.90. The results of the study showed that self-efficacy was positively correlated with self-management ability (r=0.33) as well as self-management behavior (r=0.47) in the patients with type 2 diabetes (P < 0.01). The mediating effect of self-efficacy accounted for 38.28% of the total effect of self-management ability on self-management behaviors and was higher in the behaviors of blood glucose monitoring (43.45%) and diet control (52.63%). The mediating effect of self-efficacy accounted for approximately 40.99% of the total effect for the patients with disease course ≤ 5 years, while for the patients with disease course > 5 years, the mediating effect accounted for 39.20% of the total effect.@*CONCLUSION@#Self-efficacy enhanced the effect of self-management ability on the behavior of the patients with type 2 diabetes, and this positive effect was more significant for the patients with shorter disease course. Targeted health education should be carried out to enhance patients' self-efficacy and self-management ability according to their disease characteristics, to stimulate their inner action, to promote the development of their self-management behaviors, and to form a more stable and long-term mechanism for disease management.

Advances in dendritic cell-based vaccine delivery / 药学学报

Dendritic cells (DCs) are the most powerful and professional antigen-presenting cells (APCs) known at present. They play vital roles in the initiation and regulation of immune responses in body. Therefore, DC-based vaccine delivery system has gradually become a hotspot of basic scientific research and clinical treatment. DCs can be loaded with whole-cell antigens, nucleic acids, peptides, proteins (such as neoantigens) and nanoparticles to induce specific cellular immune responses and humoral immune responses after antigen processing, presentation and targeting delivery in vivo for the prevention and treatment of various diseases including cancers and microorganism infections. Vaccine-based on this technique is called dendritic cell (DC) vaccines. Great process in DC vaccines has been achieved in recent years. Therefore, we reviewed the characteristics of DC, types of DC vaccines and their clinical research progress in this paper.

One-stop strategy for treatment of atrial fibrillation: feasibility and safety of combining catheter ablation and left atrial appendage closure in a single procedure / 中华医学杂志(英文版)

BACKGROUND@#Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure.@*METHODS@#Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively.@*RESULTS@#A total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA2DS2-VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed.@*CONCLUSION@#Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population.

Progress of mechanical power in the intensive care unit / 中华医学杂志(英文版)

Mechanical power of ventilation, currently defined as the energy delivered from the ventilator to the respiratory system over a period of time, has been recognized as a promising indicator to evaluate ventilator-induced lung injury and predict the prognosis of ventilated critically ill patients. Mechanical power can be accurately measured by the geometric method, while simplified equations allow an easy estimation of mechanical power at the bedside. There may exist a safety threshold of mechanical power above which lung injury is inevitable, and the assessment of mechanical power might be helpful to determine whether the extracorporeal respiratory support is needed in patients with acute respiratory distress syndrome. It should be noted that relatively low mechanical power does not exclude the possibility of lung injury. Lung size and inhomogeneity should also be taken into consideration. Problems regarding the safety limits of mechanical power and contribution of each component to lung injury have not been determined yet. Whether mechanical power-directed lung-protective ventilation strategy could improve clinical outcomes also needs further investigation. Therefore, this review discusses the algorithms, clinical relevance, optimization, and future directions of mechanical power in critically ill patients.

The prescribing cascade and medication therapy management between cholinesterase inhibitors and anticholinergic drugs / 中国药学杂志

OBJECTIVE: To discuss about one patient with Alzheimer′s disease and urinary incontinence and to investigate the prescribing cascade between cholinesterase inhibitors and anticholinergic drugs further more. METHODS: Clinical pharmacists participated in a medication therapy management program aiming at one patient with Alzheimer′s disease and urinary incontinence. By doing this they successfully identified and interrupted a prescribing cascade. Then some constructive advices were provided to doctors and patients on the rational administration of drugs. RESULTS: The drug treatment plan was adjusted by clinical pharmacists and doctors after evaluating the benefits and risks about the use of cholinesterase inhibitors and anticholinergic drugs in the elderly patient with chronic disease. And this change directly led to a significant relief of urinary incontinence in the patient. CONCLUSION: The use of cholinesterase inhibitors in Alzheimer′s patients increases the risk of urinary incontinence, and at the same time additional use of anticholinergic drugs in the treatment of urinary incontinence can further damage the cognition.Therefore, clinical pharmacists and doctors should pay great attention to the prescribing cascade of cholinesterase inhibitors and anticholinergic drugs. To identify and interrupt prescribing cascades is important when clinical pharmacists and doctors are prescribing prescriptions for elderly patients with chronic diseases. They must work closely for the optimization of prescriptions and the improvement of medication safety in elderly patients.

Effect of procyanidine on the function and expression of miR-221 in human umbilical vein endothelial cells / 解放军医学杂志

Objective To study the effect ofprocyanidine (PC) on the proliferation and migration of human umbilical vein endothelial cells (HUVECs),determine the expression changes of miR-221,and to investigate the mechanism involved.Methods HUVECs were cultured in vitro and treated with PC (5,25,50,75,100μg/ml) for 24 hours,and a PC concentration of 50μg/ml was screened by CCK-8 assay for the follow up experiment,then the cell proliferation activity was detected by the wound healing assay.The expression of miR-221 in HUVECs was detected by real-time quantitative PCR;MiR-221 target genes were predicted in miRWalk database,and the target genes were analyzed by GO and KEGG pathway.Results Compared with the control group,the HUVECs treated with PC for 24h,their proliferation activity in PC 5μg/ml group did not change obviously (P＞0.05),and in PC 25,50,75 and 100μg/ml groups decreased in a concentration dependent manner (P＜0.01).Compared with the control group,the migration ability of PC 50μg/ml group decreased markedly (P＜0.01).Compared with the control group,the expression of miR-221 increased after treatment with PC 50μg/ml (P＜0.01).Go analysis indicated that the target genes of miR-221 were mainly related to cell proliferation,migration,gene translation and so on.The target genes related to cell proliferation and migration were ADAM17,KIT,PDGFD and so on.KEGG pathway analysis showed that the target genes of miR-221 enriched 5 signal pathways,such as FoxO,PI3K-Akt and so on.Conclusions Low concentration of PC has no effect on the proliferation activity of HUVECs.A certain concentration of PC can inhibit the proliferation and migration of HUVECs,of which the mechanism may be involved with the up-regulation of miR-221 and FoxO,PI3K-Akt and other signaling pathways.

Speculating the Conditions and Characteristics of Morbidity of "Warm Haze" Based on Pathogenic Properties of Haze and SARS / 中国中医药信息杂志

Although haze and severe acute respiratory syndrome (SARS) are different, they are not only both closely related to climate, but also take respiratory symptom as their main clinical manifestation when they play pathogenetic roles. Based on the comparative analysis of the pathogenic properties of haze and SARS, this article speculated the conditions and characteristics of the morbidity of "warm haze", a newly serious infectious disease which consists of haze combines abnormally warm climate that potentially occurs, as well as proposes related early warnings and measures in order to provide reference for TCM in preventing newly infectious diseases and inspire a new thinking of TCM in preventing diseases which consist of both climatic and environmental factors.

Is Bladder Training by Clamping Before Removal Necessary for Short-Term Indwelling Urinary Catheter Inpatient? A Systematic Review and Meta-analysis

PURPOSE: Urinary catheterization is a common technique in clinical practice. There is, however, no consensus on management prior to removal of the indwelling catheter for short-term patients. This systematic review examined the necessity of clamping before removal of an indwelling urinary catheter in short-term patients. METHODS: A systematic literature review was conducted using eight databases and predetermined keywords-guided searches. Some 2,515 studies were evaluated. Ten studies that met the inclusion criteria were selected. RESULTS: The quality of the studies was assessed using the Jadad scoring system. Only 40.0% of studies were rated as high quality. This review found that catheter clamping prior to removal was not necessary for the short-term patient. When made a comparison with the unclamping group, there was no significant difference in recatheterization risk, risk of urine retention, patients' subjective perceptions and rate of urinary tract infection. CONCLUSIONS: This review indicated that bladder training by clamping prior to removal of urinary catheters is not necessary in short-term catheter patients. In addition, clamping carries the risk of complications such as prolonging urinary catheter retention and urinary tract injury. Further investigation requires higher quality methodologies and more diverse study designs.

Application of Electrochemically Active Bacteria as Anodic Biocatalyst in Microbial Fuel Cells / 分析化学

Microbial fuel cell ( MFC ) is a novel device with the function to produce energy and degrade organic materials. The characteristics of anodic electrochemically active bacteria and catalytic activity are one of key factors to affect MFC performance. This review summarized the enrichment, source, taxonomy, physiological and biochemical characteristics and electricity production ability of electrochemically active bacteria.

Study on identification of Sarcandra glabra and Chloranthus spicatus's leaves by PCR amplification of specific alleles / 中国中药杂志

The paper is aimed to identify SNP in Sarcandra glabra and Chloranthus spicatus, and authenticate S. glabra from Ch. spicatus and the mixture by using PCR amplification of specific alleles. SNPs in the ITS sequences of S. glabra and Ch. spicatus were found by ClustulX 2. 1 program and Bioedit software. Primers for authentic S. glabra and Ch. spicatus was designed according to the SNP site, and ITS sequence universal primers plus to the authentic primer to construct a multi-PCR reaction system, and then optimized the PCR reaction system. Five hundred and eighty band special for S. glabra and 470 bp band special for Ch. spicatus were found by using multi-PCR reaction. The multi-PCR reaction system could be applied to identify S. glabra and Ch. spicatus's leaves.

Genetic relationship and parent selection of some Sarcandra glabra resources based on ISSR / 中国中药杂志

The study is aimed to assess the genetic diversity and genetic relationship of 18 Sarcandra glabra resources from different populations,and guide parent selection of cross breeding between these resources. The molecular marker technique ISSR was used to investigate the genetic diversity of the 18 resources. Data was analyzed by POPGEN 32, and a cluster diagram was presented by UPGMA. One hundred and ninety-eight amplified fragments were obtained using 23 ISSR primers. One hundred and eighty-four polymorphic loci were identified. Nei's genetic diversity index (h) was 0.32, Shannon diversity index (I) was 0.485 4. The genetic similarity coefficient among the resources ranged from 0.383 8 to 0.878 8 in an average of 0.661 2. The genetic distance between sample S2 and sample S18 was the farthest, so as between sample S3 and sample S18 both Nei's genetic distance was 0.957 5, The genetic distance between sample S4 and sample S5 was the closest, the Nei's genetic distance was 0.129 2,and the sample S1, S2, S3, S7, S10 were significantly different from the others based on the clustering analysis, the three groups S2 vs S3, S2 vs S6, S2 vs S18 were the best parent group selection. There was a middle level of genetic differentiation in the resources. The genetic distance between resources gives useful information to guide parent selection of cross breeding.

Proliferation and differentiation of neural stem cells co-cultured with cerebral microvascular endothelial cells after oxygen-glucose deprivation / 华中科技大学学报（医学）（英德文版）

Various stem cells, including neural stem cells (NSCs), have been extensively studied in stroke models, but how to increase neuronal differentiation rate of NSCs remains unresolved, particularly in a damaged environment. The purpose of this study was to investigate the effects of cerebral microvascular endothelial cells (CMECs) on the neurogenesis of NSCs with or without oxygen-glucose deprivation (OGD). The NSCs acquired from primary culture were immunostained to prove cell purity. Survival and proliferation of NSCs were determined after the co-culture with CMECs for 7 days. After removing the CMECs, NSCs were randomly divided into two groups as follows: OGD and non-OGD groups. Both groups were maintained in differentiation culture for 4 days to evaluate the differentiation rate. Mouse embryo fibroblast (MEF) cells co-cultured with NSCs served as control group. NSCs co-cultured with CMECs had an increase in size (on the 7th day: 89.80±26.12 μm vs. 73.08±15.01 μm, P<0.001) (n=12) and number [on the 7th day: 6.33±5.61/high power objective (HP) vs. 2.23±1.61/HP, P<0.001] (n=12) as compared with those co-cultured with MEF cells. After further differentiation culture for 4 days, NSCs co-cultured with CMECs had an increase in neuronal differentiation rate in OGD and non-OGD groups, but not in the control group (15.16% and 16.07% vs. 8.81%; both P<0.001) (n=6). This study provided evidence that OGD could not alter the effects of CMECs in promoting the neuronal differentiation potential of NSCs. These findings may have important implications for the development of new cell therapies for cerebral vascular diseases.

HPLC characteristic chromatographic profile of Sarcandra glabra / 中国中药杂志

<p><b>OBJECTIVE</b>To develop the characteristic chromatographic profile of Sarcandra glabra by HPLC for its quality control.</p><p><b>METHOD</b>The HPLC analysis was performed on an Agilent Zorbax Eclipse XDB-C18 column (4. 6 mm x 250 mm, 5 microm) with column temperature at 40 degree C. The mobile phase was consisted of water containing 0. 5% formic acid and acetonitrile to methanol (1:9) in gradient mode, and the detection wavelength was set at 344 nm.</p><p><b>RESULT</b>A common mode of the HPLC characteristic chromatographic profile has been establised. There were 20 common peaks , seven of which were identified, and 46 samples from different habitats were classified into five groups based on principal component cluster analysis.</p><p><b>CONCLUSION</b>The method was time-saving and can represent the chemical information and provide a scientific basis for quality control of S. glabra.</p>

Proliferation and differentiation of neural stem cells co-cultured with cerebral microvascular endothelial cells after oxygen-glucose deprivation / 华中科技大学学报（医学）（英德文版）

Various stem cells, including neural stem cells (NSCs), have been extensively studied in stroke models, but how to increase neuronal differentiation rate of NSCs remains unresolved, particularly in a damaged environment. The purpose of this study was to investigate the effects of cerebral microvascular endothelial cells (CMECs) on the neurogenesis of NSCs with or without oxygen-glucose deprivation (OGD). The NSCs acquired from primary culture were immunostained to prove cell purity. Survival and proliferation of NSCs were determined after the co-culture with CMECs for 7 days. After removing the CMECs, NSCs were randomly divided into two groups as follows: OGD and non-OGD groups. Both groups were maintained in differentiation culture for 4 days to evaluate the differentiation rate. Mouse embryo fibroblast (MEF) cells co-cultured with NSCs served as control group. NSCs co-cultured with CMECs had an increase in size (on the 7th day: 89.80±26.12 μm vs. 73.08±15.01 μm, P<0.001) (n=12) and number [on the 7th day: 6.33±5.61/high power objective (HP) vs. 2.23±1.61/HP, P<0.001] (n=12) as compared with those co-cultured with MEF cells. After further differentiation culture for 4 days, NSCs co-cultured with CMECs had an increase in neuronal differentiation rate in OGD and non-OGD groups, but not in the control group (15.16% and 16.07% vs. 8.81%; both P<0.001) (n=6). This study provided evidence that OGD could not alter the effects of CMECs in promoting the neuronal differentiation potential of NSCs. These findings may have important implications for the development of new cell therapies for cerebral vascular diseases.

Complete sequence of the M segment of Amur virus in rodent from China / 中华流行病学杂志

Objective To study the complete sequence of M segment of Amur virus in rodents and to explore their molecular characteristics. Methods Complete M segment of Amur virus in rodent from China was amplified by RT-PCR. The purified PCR product was cloned into pGEM-T Easy vector and then sequenced. Phylogenetic analysis on multiple nucleotide sequences was performed with the Tree PUZZLE and DNAStar software. Results The full-length of its M gene comprised of 3615 nucleotides with one open reading frame (ORF) including 3408 nucleotides and encoding a protein which comprised 1135 amino acids. The ORF was located at bases 41 to 3448. The phylogenetic analysis of JilinAP06 with other hantaviruses revealed that the complete sequence of M segment of JilinAP06 strain was closely related to those Amur viruses such as B78 strain, Liu strain and H5 strain were all from the patients. The complete sequence of M segment of JilinAP06 had only 79.5% identities with the nucleotide sequence of HTNV strain 76-118. Conclusion The complete sequence on M segment of Amur virus in rodent was first time identified in this country.

Clinical experiences of surgical manipulations for hepatic masses in difficult sites / 中国医学科学院学报

<p><b>OBJECTIVE</b>To summarize the surgical experiences, risks, complications, and managements for hepatic masses in difficult sites.</p><p><b>METHODS</b>Totally 47 patients were divided into three groups based on the liver tumor sites: primary porta hepatis group, secondary porta hepatis group, and caudate lobe group. All patients underwent different portion of hepatectomy.</p><p><b>RESULTS</b>The surgery duration was (289.6 +/- 62.2) ml-nutes, intra-operative blood loss was (602.3 +/- 256.4) ml, and intra-operative blood transfusion was (524.0 +/- 325.9) ml. Incidence of surgical complications in each group was 61.5%, 26.9%, and 25%, respectively. Serious complications observed were biliary leakage (27.7%), bleeding (6.4%), and post-operative liver failure (2.1%). Three perioperative deaths were reported: two patients died of bleeding, and one patient died from liver failure.</p><p><b>CONCLUSIONS</b>Dissection of the liver and exposure of major blood vessels and biliary ducts are of critical importance in the surgeries for hepatic masses in difficult sites, and post-operative complications may be remarkably reduced through delicate manipulations of the small intra-hepatic vessels and biliary ducts during resection. A thorough pre-operative evaluation plays a key role in predicting the feasibility and risks of the surgery. Damage to the major blood vessels adjacent to the tumor, in addition to bleeding, may result in in-flow or outflow obstruction and cause necrosis of the corresponding hepatic lobe. Compared with damage to the primary portal area, vascular damage to the secondary porta is generally associated with higher fatality.</p>

Preoperative evaluation of liver function using 99mTc-diethyl iminodiacetic acid based on single photon emission computed tomography / 中国医学科学院学报

<p><b>OBJECTIVE</b>To establish a three-dimentional liver function evaluation system using 99mTc-diethyl iminodiacetic acid (99mTc-EHIDA) scintigraphy based on single photon emission computed tomography (SPECT).</p><p><b>METHODS</b>Totally 16 patients with liver lesions were divided into cirrhosis group and non-cirrhosis group. SPECT was performed 2 days before operation and 5 days after operation. Serum liver functions were examined on the same day of scintigraphy. SPECT images of areas of interest of heart and liver were aquired. Time of the peak of EHIDA density in liver (Tpeak), five-minutes heart liver index (HLI5), blood clearance index (HH15), receptor index (LHL15), and the predictive values were calculated.</p><p><b>RESULTS</b>Tpeak was not significantly different between two groups, while HLI5, HH15, and LHL15 were significantly different (P = 0.033, P = 0.001, and P = 0.005). HLI, and LHL15 were significantly correlated with preoperative total protein and prealbumin levels (P = 0.003, P = 0.015, P = 0.022, P = 0.038) and post-operative prealbumin (P = 0.037, P = 0.042). The predictive values of HLI5 and LHL15 correlated well with postoperative HLI5 and LHL15 (r = 0.675, P = 0.016; r = 0.629, P = 0.028).</p><p><b>CONCLUSION</b>The three-dimentional liver function evaluation system using 99mTc-EHIDA based on liver SPECT may facilitate the further studies of risks of liver surgery.</p>

Early recurrence after the resection of hepatocellular carcinoma / 中国医学科学院学报

<p><b>OBJECTIVE</b>To observe the precise time of the recurrence after resection of hepatocellular carcinoma (HCC) and to further explore the risk factors associated with postoperative recurrence.</p><p><b>METHODS</b>Totally 94 patients who had undergone resection of HCC were divided into three groups based on the time of recurrence, which was indicated by the digital subtraction angiography (DSA) examination: recurrence between 1 to 6 months, recurrence between 7 to 12 months, and tumor-free after 12 months. Patients with intra-hepatic recurrence were treated with transcatheter arterial chemoembolization and confirmed by CT scans after embolization, contrast-enhanced ultrasound, or magnetic resonance imaging.</p><p><b>RESULTS</b>The recurrence rates of 6 months and 1 year were 30.9% and 36.2%, respectively. No statistically significant difference between 6-month and 1-year recurrence rates was observed. Nine (26.5%) patients with recurrence and five (8.3%) patients free of tumor had previously presented as multifocal HCC, which showed a statistical significance (P = 0.032). The diagnostic accuracy of DSA was 87.2%, which was eventually confirmed by the other investigations.</p><p><b>CONCLUSIONS</b>Most recurrences occure within the first six months postoperatively and multifocal carcinogenesis is one of the risk factors associated with early recurrence after liver resection for advanced HCC. DSA is an important surveillance for early detection of intra-hepatic recurrence after surgery; meanwhile, it also provides information for early management to control the disease progression and for future active therapies.</p>

Diagnosis and treatment of pancreatic metastasis from renal cell carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Pancreatic metastasis from renal cell carcinoma (RCC) is a rare event and has not been reported in our country. We report a series of 3 patients with metastatic RCC to the pancreas after radical nephrectomy at our institution. The published reports in the literature were reviewed, and the diagnosis, treatment as well as prognosis of this rare event were discussed.</p><p><b>METHODS</b>The data of 3 RCC patients with metastasis to the pancreas were reviewed retrospectively, including radical nephrectomy, metastatic interval, the second and third surgical removal. Survival of the three patients was analyzed and the reports in the literature were compared as well.</p><p><b>RESULTS</b>The average interval from radical nephrectectomy to the comfirmed pancreatic metastasis was 6.6 years (range, 1.2 to 12 years). The pathological stage revealed T2N0M0 (n = 2) or T3N0M0 (n = 1), with right-sided tumor in 2 patients and left side in 1. One patient was asymptomatic, while the other two cases were symptomatic at presentation, including upper abdominal pain, weight loss, slight xanthochromia of the skin and titillation, clay stool (n = 1); irregular fever, weight loss and jaundice (n = 1). All pancreatic metastases were hypervascular on arterial stage of CT imaging. One patient had only a solitary pancreatic metastasis (n = 1), the another showed two metastatic lesions (n = 1), the third one had multiple lesions (n = 1). Surgical removal was accomplished in 2 patients: including pylorus-preserving pancreaticoduodenectomy in one, and pylorus-preserving pancreaticoduodenectomy together with partial tail resection in another one. The third one only received interventional therapy due to widespread extrapancreatic metastasis, and died of disseminated disease 11 months after the therapy. One of the above two surgically treated patients underwent the second removal due to local recurrence 2.5 years after the first removal of pancreatic metastasis. These two patients were still alive after follow-up of 8.6 years and 16.1 years, respectively.</p><p><b>CONCLUSION</b>Renal cell carcinoma is an unpredictable tumor that may demonstrate very delayed metastasis even from early-stage of the disease. The pancreas is a rare site of metastasis from renal cell carcinoma. We advocate careful long-term follow-up of patients with a history of RCC. Aggressive surgical management of pancreatic metastatic lesions may provide a chance of long-term survival.</p>

Hereditary angioedema: a Taiwanese family with a novel gene mutation.

Hereditary angioedema (HAE) is an autosomal dominant disorder caused by a deficiency of C1 esterase inhibitor (C1-INH). Affected individuals have attacks of swelling involving almost any part of the body. We studied a family with 15 living members, including a 16-year-old girl who had 3 attacks of angioedema in 2 years. Her paternal uncle had died of asphyxiation during an attack 15 years previously. We analyzed the blood of each family member for C3, C4, and C1-INH levels and sequenced the SERPING1 (formerly C1NH) gene that codes for C1-INH. Six individuals had decreased serum levels of C4 and C1-INH, and they were all found to have a single nucleotide A deletion at codon 210 of the gene, 1210fsX210, a novel mutation that accounts for the HAE in this family.