Transnasal endoscopic retrograde chalangiopancreatography using an ultrathin endoscope: A prospective comparison with a routine oral procedure

AIM: To investigate if transnasal endoscopic retrograde cholangiopancreatography (n-ERCP) using an ultrathin forward-viewing scope may overcome the disadvantages of conventional oral ERCP (o-ERCP) related to the large- caliber side-viewing duodenoscope. METHODS: The study involved 50 patients in whom 25 cases each were assigned to the o-ERCP and n-ERCP groups. We compared the requirements of esophagogastroduodenoscopy (EGD) prior to ERCP, rates and times required for successful cannulation into the pancreatobiliary ducts, incidence of post-procedure hyperamylasemia, cardiovascular parameters during the procedure, the dose of a sedative drug, and successful rates of endoscopic naso-biliary drainage (ENBD). RESULTS: Screening gastrointestinal observations were easily performed by the forward-viewing scope and thus no prior EGD was required in the n-ERCP group. There was no significant difference in the rates or times for cannulation, or incidence of hyperamylasemia between the groups. However, the cannulation was relatively difficult in n-ERCP when the scope appeared U-shape under fluoroscopy. Increments of blood pressure and the amount of a sedative drug were significantly lower in the n-ERCP group. ENBD was successfully performed succeeding to the n-ERCP in which mouth-to-nose transfer of the drainage tube was not required. CONCLUSION: n-ERCP is likely a well-tolerable methodwith less cardiovascular stress and no need of prior EGD or mouth-to-nose transfer of the ENBD tube. However, a deliberate application is needed since its performance is difficult in some cases and is not feasible for some endoscopic treatments such as stenting.

A specific gene-expression signature quantifies the degree of hepatic fibrosis in patients with chronic liver disease

AIM： To study a more accurate quantification of hepatic fibrosis which would provide dinically useful information for monitoring the progression of chronic liver disease. METHODS： Using a cDNA microarray containing over 22000 clones, we analyzed the gene-expression profiles of non-cancerous liver in 74 patients who underwent hepatic resection. We calculated the ratio of azanstained： total area, and determined the morphologic fibrosis index （MFI）, as a mean of 9 section-images. We used the MFI as a reference standard to evaluate our method for assessing liver fibrosis. RESULTS： We identified 39 genes that collectively showed a good correlation （r 〉 0.50） between geneexpression and the severity of liver fibrosis. Many of the identified genes were involved in immune responses and cell signaling. To quantify the extent of liver fibrosis, we developed a new genetic fibrosis index （GFI） based on gene-expression profiling of 4 clones using a linear support vector regression analysis. This technique, based on a supervised learning analysis, correctly quantified the various degrees of fibrosis in both 74 training samples （r = 0.76, 2.2% vs 2.8%, P 〈 0.0001） and 12 independent additional test samples （r = 0.75, 9.8% vs 8.6%, P 〈 0.005）. It was far better in assessing liver fibrosis than blood markers such as prothrombin time （r = -0.53）, type IV collagen 7s （r = 0.48）, hyaluronic acid （r = 0.41）, and aspartate aminotransferase to platelets ratio index （APRI） （r = 0.38）. CONCLUSION： Our cDNA microarray-based strategy may help clinicians to precisely and objectively monitor the severity of liver fibrosis.

A Case of Relapsing Polychondritis Successfully Treated with Combination of a Glucocorticoid and Cyclosporine

Relapsing polychondritis is a rare cartilaginous inflammatory disease affecting the external ear, nose, peripheral joints and tracheobronchial tree. It is characterized by recurrent inflammation and degeneration of cartilage and connective tissue. A 72-year-old man complained of dyspnea, cough and wheezing for 2 months. Diffuse wall thickening and narrowing from the trachea to segmental bronchus were seen on chest CT. Tracheostomy was performed in order to avoid as-phyxia, and he was diagnosed as relapsing polychondritis on the basis of pathology evaluation of a tracheal biopsy specimen. He was treated with high doses of a glucocorticoid, with which his symptoms improved. However, the cough and wheezing recurred after tapering of the glucocorticoid. His symptoms thereafter were improved by combination of the glucocorticoid with cyclosporine. The immunosuppressive agent provided effective treatment for glucocorticoid-resistant relapsing polychondritis.

Rhodium Nanoparticle-Loaded Carbon Black Electrocatalyst for the Glycerol Oxidation Reaction in Alkaline Medium

Rhodium nanoparticle-loaded carbon black (Rh/CB) was prepared by a wet method, and its activity and durability for glycerol oxidation reaction (GOR) in alkaline medium were compared with Pt, Pd and Au nanoparticle-loaded CB (Pt/CB, Pd/CB and Au/CB). In the cyclic voltammogram of the Rh/CB electrode, the redox waves due to hydrogen adsorption/desorption and the surface OH monolayer formation/reduction were observed at more negative potentials than the Pt/CB and Pd/CB electrodes. The onset and peak potentials of the GOR current densities for the Rh/CB electrode were ca. –0.55 and –0.30 V vs. Hg/HgO, respectively, which were 0.10 and 0.20 V more negative than the Pt/CB electrode whose GOR activity was the best, indicating that Rh was a fascinating metal for reducing the overpotential for GOR. In the electrostatic electrolysis with the Rh/CB and Pt/CB electrodes, the decrease in the GOR current density in the former with time was suppressed compared to that in the latter, suggesting that the tolerance to poisoning for the Rh/CB electrode was superior to that for the Pt/CB electrode.

PtAg Nanoparticle Electrocatalysts for the Glycerol Oxidation Reaction in Alkaline Medium

To improve the activity for glycerol oxidation reaction (GOR) of Pt, PtAg (mole ratio of Pt/Ag = 3 and 1) alloy nanoparticle-loaded carbon black (Pt/CB, PtAg(3:1)/CB, PtAg(1:1)/CB) catalysts were prepared by a wet method. The resultant catalysts, moreover, were heat-treated in a N2 atmosphere at 200°C. The alloying of Pt with Ag for each PtAg/CB was confirmed by X-ray diffractometry and electron dispersive X-ray spectrometry. The heat-treatment did not change the crystal structure of the PtAg alloys and increased their particle size. X-ray photoelectron spectroscopy exhibited that stabilizers were completely removed from the PtAg alloy surface, and the Pt4f and Ag3d doublets due to metallic Pt and Ag, respectively, shifted to lower binding energies, supporting the alloying of Pt with Ag. Both PtAg/CB electrodes had two oxidation waves of glycerol irrespective of heat-treatment, which was different from the Pt/CB electrode. The onset potential of the first oxidation wave was -0.60 V, which was 0.20 V less positive than that for the Pt/CB electrode, indicating the alloying of Pt with Ag greatly improved the GOR activity of Pt. The heat-treated PtAg(3:1)/ CB electrode improved the GOR current density of the second oxidation peak. In the potentiostatic electrolysis at -0.1 and 0 V for both PtAg/CB electrodes, the ratio of oxidation current density at 60 min to that at 5 min (j60/j5), an indicator of the catalyst deterioration, at 0 V was higher than that at -0.1 V, because the adsorbed oxidation intermediates were greatly consumed at the larger overpotential. The heat-treatment of the PtAg(3:1)/CB electrode increased the j60/j5 value at -0.1 V but decreased that at 0 V. This could be attributed to the formation of high-order oxidation intermediates which might have stronger poisoning effect.