Aim:  In spite of numerous studies on the association between diabetes mellitus (DM) and hepatocellular carcinoma (HCC), the results are inconsistent and whether and how the effect of DM on the risk for HCC is modified or synergistically exerted by hepatitis virus infection are still unclear. We aimed to elucidate and quantify the effect modification and synergism between hepatitis B and C virus (HBV and HCV, respectively) and DM leading to the risk for HCC and also assess the independent contribution of DM to the risk for HCC at population level (population attributable fraction) in a high prevalence area of hepatitis virus infection.

Boerhaave's syndrome is a transmural perforation of the esophagus resulted from a sudden increase in intraesophageal pressure combined with negative intrathoracic pressure. Most common cause is iatrogenic and chest pain is the most common symptom in early presentation. Perforations of the esophagus are associated with a relatively high mortality rate if not promptly managed. The ideal therapeutic strategy continues to be debated but individually tailored therapy offers the best outcome. Here we reported a case of esophageal perforation occurred after endoscopic examination and reviewed treatment modalities.

Objectives: Myostatin, a negative regulator of muscle growth, is increased in hypertrophied and infarcted heart. However, the mechanism of regulation is not known. Mechanical stress is an important regulatory factor for cardiomyocyte growth. The aim of the study was to investigate the effect of cyclic stretch on the expression of myostatin gene in cardiomyocytes.Methods: Neonatal Wistar rat cardiomyocytes grown on a flexible membrane base were stretched by vacuum to 20% of maximum elongation at 60 cycles/min. An in vivo model of aorta-caval shunt in adult rats was used to investigate the myostatin expression.Results: Cyclic stretch significantly increased myostatin protein and mRNA expression after 6 to 18 11 of stretch. Addition of the p38 mitogen-activated protein (MAP) kinase inhibitor SB203580, insulin-like growth factor-1 (IGF-1) monoclonal antibody, and p38 siRNA 30 min before stretch inhibited the induction of myostatin protein. Cyclic stretch increased, while SB203580, IGF-1, and 1GF-1 receptor antibody abolished, the phosphorylated p38 protein. Gel shift assays showed significant increase of DNA-protein binding activity of myocyte enhancer factor 2 (MEF2) after stretch, and transfection with p38 siRNA abolished the DNA-protein binding activity induced by cyclic stretch. Cyclic stretch significantly increased the IGF-1 secretion from myocytes. Both conditioned media from stretched myocytes and exogenous administration of IGF-1 recombinant protein to the non-stretched myocytes increased myostatin protein expression similar to that seen after cyclic stretch. An in vivo model of aorta-caval shunt in adult rats also demonstrated the increased myostatin expression in the myocardium.Conclusions: Cyclic mechanical stretch enhances myostatin expression in cultured rat neonatal cardiomyocytes. The stretch-induced myostatin is mediated by IGF-1 at least in part through a p38 MAP kinase and MEF2 pathway. (c) 2005 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

Pulmonary embolism is an important cause of morbidity and mortality. Some patients develop pulmonary embolism after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma, because the Lipiodol oil embolizes to the pulmonary arterial circulation. We reported one patient with hepatocellular carcinoma complicated by cardio-pulmonary distress secondary to TA CE. The clinical history, laboratory data and image study all supported the diagnosis of pulmonary embolism. Definite diagnosis was confirmed by scintigraphy and pulmonary angiography. This patient fully recovered from the respiratory event after installation of heparin and other supportive care. The clinician must be aware of this potentially fatal complication of TACE. Prompt diagnosis is necessary for optimal management.

Background: The recurrence of duodenal ulcer disease is associated with gastric metaplasia and H. pylori infection.H. pylori-induced inflammatory responses are affected by chemokine in gastroduodenal mucosa.Aim: To evaluate the effect of H. pylori eradication on histological findings and IL-8