Triptolide protects against 1-methyl-4-phenyl pyridinium-induced dopaminergic neurotoxicity in rats:Implication for immunosuppressive therapy in Parkinson’s disease

Objective Neuroinflammation with microglial activation has been implicated to have a strong association with the progressive dopaminergic neuronal loss in Parkinson＇s disease （PD）. The present study was undertaken to evaluate the activation profile of microglia in 1-methyl-4-phenyl pyridinium （MPP^＋）-induced hemiparkinsonian rats. Triptolide, a potent immunosuppressant and microglia inhibitor, was then examined for its efficacy in protecting dopaminergic neurons from injury and ameliorating behavioral disabilities induced by MPP^＋. Methods The rat model of PD was established by intranigral microinjection of MPP^＋. At baseline and on day 1, 3, 7, 14, 21 following MPP^＋ injection, the degree of microglial activation was examined by detecting the immunodensity of OX-42 （microglia marker） in the substantia nigra （SN）. The number of viable dopaminergic neurons was determined by measuring tyrosine hydroxylase （TH） positive neurons in the SN. Behavioral performances were evaluated by counting the number of rotations induced by apomorphine, calculating scores of forelimb akinesia and vibrissae-elicited forelimb placing asymmetry. Results Intranigral injection of MPP^＋ resulted in robust activa- tion of microglia, progressive depletion of dopaminergic neurons, and ongoing aggravation of behavioral disabilities in rats. Triptolide significantly inhibited microglial activation, partially prevented dopaminergic cells from death and improved behavioral performances. Conclusion These data demonstrated for the first time a neuroprotective effect of triptolide on dopaminergic neurons in MPP^＋ induced hemiparkinsonian rats. The protective effect of triptolide may, at least partially, be related to the inhibition of MPP^＋-induced microglial activation. Our results lend strong support to the use of immunosuppressive agents in the management of PD.

Changes in Levels of Endogenous Plant Hormones During Floret Development in Wheat Genotypes of Different Spike Sizes

The levels of endogenous plant hormones regulate floret development and degeneration, and thus grain set in flower crops. This study was undertaken to characterize the changes of endogenous hormone levels during floret development in three wheat ( Triticum aestivum L.) genotypes: “97J1' with the highest grain set and fertile florets per spike, “H8679' with the lowest grain set and fertile florets per spike, and a medium, “YM158'. The results showed that the peak level of ABA appeared between stamen and pistil differentiation and antherlobe formation of floret development, and the timing delayed with the size of spike (earliest in “H8679” and latest in “97J1”). From antherlobe formation to meiosis, the levels of ABA and GA 1+3 decreased sharply in the ears of “97J1”, while in the ears of “H8679” there was only a slight decrease in ABA, and even an increase in GA 1+3 . The ratio of isopentenyladenosine (iPA)/ABA and IAA/ABA in the ears of “97J1” increased sharply from antherlobe formation to meiosis, but changed only slightly in the ears of “H8679”. At antherlobe formation, IAA and GA 1+3 levels were higher in the ears of “97J1”, but lower in the ears of “H8679” than in the leaves. At meiosis, ABA, GA 1+3 and IAA levels in the “97J1” ears were much lower than in the leaves, but similar in “H8679”. These results indicated that the sharp decreases of ABA and GA 1+3 in ears from antherlobe formation to meiosis and the lowest maintenance at meiosis may be favorable for development of fertile florets and enhancement of grain set in wheat.

Relationship Between Endopeptidase and H_2O_2 During the Aging of Wheat Leaf

The relationship between hydrogen peroxide (H 2O 2) and endopeptidase(EP) in wheat ( Triticum aestivum L. cv. Yanmai 158) leaves was studied during natural and artificial aging. Rapid accumulation of endogenous H 2O 2 and marked increase of EP activity were observed during the later phase of aging. A new EP isozyme with higher activity was detected by electrophoresis on polyacrylamide gels containing denatured heamoglobin. With the increase of exogenous H 2O 2, the activity of EP increased at first and then decreased.

Characterization of Endopeptidases in Wheat Leaves During Dark-induced Senescence

The characterization of senescence-associated endopeptidase (EP) isoenzymes in wheat (Triticum aestivum L. cv. Yangmai 158) leaves during dark-induced senescence was performed. It was found that there was much higher endoproteolytic activity in dark-induced wheat leaves than in control. Six endopeptidase isoenzymes (EP1-EP6) were identified by natural gradient-polyacrylamide gel electrophoresis (PAGE) co-polymerized gelatin in the gel, five of which (EP1, EP2, EP4, EP5 and EP6) were only detected in senescing leaves. Treatment with 6-benzyl aminopurine (6-BA) delayed the expression of these EP isoenzymes and abscisic acid (ABA) accelerated it. The activity of EP3 could be detected at a wider range of pH and temperature levels while EP4, EP5 and EP 6 could be only detected at pH 4-5 and 30 -45 degreesC, EP1 and EP2 at pH 3-5 and 30-45 degreesC. All of the EP isoenzymes showed high thermal stability, especially EP3, EP5 and EP6 which still had activitiy even by incubation at 55 degreesC for 1 h. By using different class-specific inhibitors, EP1 and EP2 were characterized as metal-dependent cysteine-proteases, EP4 as a serine-protease.

Effect of Echinacea Polysaccharide on Secretion of TNF-α mRNA by IEC-6 Injured by LPS

Objective] This study was conducted to investigate Echinacea polysaccha-ride （EPS） on expression of tumor necrosis factor （TNF） under injury of intestinal epithelial cel s （lEC-6） by lipopolysaccharide （LPS）, so as to discuss the action mechanism of EPS to injured cel s. [Method] Total DNA was extracted with TRlzon reagent, TNF-α mRNA was amplified, and the amplification products were subjected to agarose gel electrophoresis and imaging. [Result] 50 μg/ml EPS could partial y in-hibited the production of TNF-α mRNA by lEC-6 under the stimulation of LPS, while the inhibition of 200 and 500 μg/ml EPS on the level of TNF-α mRNA gradual y in-creased with the concentration increasing; and lEC-6 cel s pretreated with 50, 100, 200 and 500 μg/ml EPS for 24 h and then stimulated by 10 μg/ml LPS for 1 and 4 h were analyzed by RT-PCR method, and it was found that the expression of TNF-α mRNA induced by LPS could be effectively inhibited by EPS, and the inhibition rate at 4 h was higher than that at 1 h. [Conclusion] EPS could play its role of protecting intestinal mucosa by inhibiting the secretion of TNF-α mRNA by cel s un-der the stimulation of LPS, and such inhibition effects of EPS had concentration dependency and time dependency.

Isolation and Characterization of Platelet-Activating Factor (PAF) Inhibitors from Zanthoxylum schinifolium

Two new compounds,schinifolin Ⅰ and acetoxyschinifolin Ⅱ,along with five known compounds(auraptenⅢ,dictamnine Ⅳ,scoparone Ⅴ,skimmianine Ⅵ,and β-sitosterol Ⅶ)were isolated from the roots of Zanthoxylum schinifolium Sieb.et Zucc.col- lected in Yixing County,Jiangsu Province.The structure determination was based upon spectroscopic analysis(UV,IR,MS,PMR,CMR,2D NMR).The structures of schinifolin Ⅰ and acetoxyschinifolin Ⅱ were elucidated as 7[(3′,7′-dimethyl-2′,6′-octadienyl)] oxy-8-methoxy-2H-1-benzopyran-2-one,and 7[(3′,7′-dimethyl-5′-acetoxy-2′, 6′-octadienyl)]oxy-8-methoxy-2H-1-benzopyran-2-one,respectively. In the test of platelet aggregation caused by PAF,compounds Ⅰ,Ⅱ,Ⅲ and Ⅴ showed inhibitory activity.

Lipopolysaccharide-induced cerebral inflammatory damage and the therapeutic effect of platelet activating factor receptor antoganist

Objective To investigate lipopolysaccharide （LPS） induced acute cerebral inflammatory damage and the therapeutic effect of ginkgolide B （BN52021）. Methods Thirty Sprague-Dawley rats were randomly divided into 3 groups （n = 10 for each group）： Control group, Model group and Treatment group （treated with BN52021）. LPS were injected into the fourth ventricle of rat to make a neuroinflammatory murine model. Morris water maze was used to detect the learning and memory ability of rats; changes of synapse number and subcellular ultrastructures were observed under a transmission electron microscope; OX-42 positive microglia in the brain was detected by immunohistochemical method. Results The average escape latency in the Treatment group were significantly shortened than that in the Model group; and the percentage of swimming distance traveled in platform quadrant accounting for total distance increased markedly. The rough endoplasmic reticulum and polyribosomes in the Treatment group were more than that in the Model group, but the number of synapses seemed to have no obvious change. The number of OX-42 positive microglia in the Treatment group decreased markedly than that in the Model group, and the grey density of OX-42-positive cells increased significantly. Conclusion LPS can induce inflammatory damages to the brain, but the damage could be antagonized by BN52021. Platelet activating factor receptor antagonist may offer an effective therapy for neurodegeneration diseases.

A New High Performance FM Transmitter

A new FM transmitter is reported. It adopts a fractional-N PLL synthesizer to realize the FM modulator. An extra offset current has also been applied to eliminate the effects of the mismatch in CP. The chip is fabricated with CSMC 0.5μm DPTM CMOS technology. Experiments show that it achieves THD≤0.08% and SNR≤ 82dB,and the maximum outband emission energy ≤ 90dBc/Hz. Furthermore,it also uses an auto frequency adjusting method to avoid tuning up the external inductances. All these merits are very suitable for FM transmission.

Effect of Platelet Activation and Endothelial Cell Injury on Malignant Cancer

Objective: To study the effects of platelet activation and endothelial cell injury on the patients with malignant tumor and their prognoses.Methods: Radioimmunity and ELISA methods were employed to detect the TXB2, GMP-140, vWF, cGMP and FN in 78 cases of malignant tumor and 40 healthy control persons.Results: The levels of TXB2, MP-140 and cGMP were increased in intestinal cancer group, lung cancer group and hepatic cancer group, while FN decreased in intestinal cancer and lung cancer group. cGMP was positively related to TXB2, GMP-140, vWF in malignant tumor group. FN was decreased in the group complicated with infection and the group with metastasis, while the other indexes increased. GMP-140, vWF and cGMP was decreased after operation except for the increasing of FN.Conclusion: Activations of platelet and injury of endothelial cells developed in patients with malignant tumor, and both of them affected the metastasis and prognosis of malignant tumor. Key words platelet activation - epithelium injury - malignant tumor - metastasis This work was supported by grants from Guangdong Medical Science foundation (A2000633).

Decompression of the small bowel by endoscopic long-tube placement

AIM:To investigate and compare the decompression effect on small bowel obstruction of a long tube inserted using either endoscopic or fluoroscopic placement.METHODS:Seventy-eight patients with small bowel obstruction requiring decompression were enrolled in the study and divided into two groups.Intubation of a long tube was guided by fluoroscopy in one group and by endoscopy in the other.The duration of the procedure and the success rate for each group were evaluated.RESULTS:A statistically significant difference in the mean duration of the procedure was found between the fluoroscopic group(32.6±14.6 min)and the endoscopic group(16.5±7.8 min)among the cases classified as successful(P<0.05).The success rate was significantly different between the groups:88.6%in the fluoroscopic group and 100%in the endoscopic group(P <0.05).CONCLUSION:For patients with adhesive small bowel obstruction,long-tube decompression is recommended and long-tube insertion by endoscopy was superior to fluoroscopic placement.

Capsule endoscopy

Capsule endoscopy(CE) is a simple,safe,non-invasive,reliable technique,well accepted and tolerated by the patients,which allows complete exploration of the small intestine.The advent of CE in 2000 has dramatically changed the diagnosis and management of many diseases of the small intestine,such as obscure gastrointestinal bleeding,Crohn's disease,small bowel tumors,polyposis syndromes,etc.CE has become the gold standard for the diagnosis of most diseases of the small bowel.Lately this technique has also been used for esophageal and colonic diseases.

Indole phytoalexin derivatives induce mitochondrialmediated apoptosis in human colorectal carcinoma cells

To investigate the mechanism of the antiproliferative effect of synthetic indole phytoalexin derivatives on human colorectal cancer cell lines. METHODSChanges in cell proliferation and the cytotoxic effect of the tested compounds on human colorectal cancer cell lines and human fibroblasts were evaluated using MTS and BrdU assay, allowing us to choose the most potent substance. Cell cycle alterations were analyzed using flow cytometric analysis. The apoptosis-inducing effect of compound K-453 on the HCT116 cell line was examined with annexin V/PI double staining using flow cytometry, as well as acridine orange/propidium iodide (AO/PI) staining. The flow cytometry method also allowed us to measure changes in levels or activation states of other factors associated with apoptosis, such as poly (ADP-ribose) polymerase (PARP), caspase-3 and -9, cytochrome c, Bcl-2 family proteins, and also the integrity of the mitochondrial membrane. To evaluate activity of the transcription factors and proteins involved in signaling pathways we used Western blot analysis together with flow cytometry. RESULTSAmong the ten tested compounds, compound K-453 {(±)-trans-1,2-dimethoxy-2’-(3,5-bis-trifluoromethylphenylamino)spiro{indoline-3,5’[4’,5’]dihydrothiazol} exhibited the most potent activity with IC50 = 32.22 ± 1.14 μmol/L in human colorectal HCT116 cells and was thus selected for further studies. Flow cytometric analysis revealed a K-453-induced increase in the population of cells with sub-G1 DNA content, which is considered as a marker of apoptotic cell death. The apoptosis-inducing effect of compound K453 was also confirmed by annexin V/PI double staining and AO/PI staining. The apoptosis was associated with the loss of mitochondrial membrane potential, PARP cleavage, caspase-3 and caspase-9 activation, release of cytochrome c, as well as changes in the levels of Bcl-2 family members. Moreover, flow cytometry showed that compound K-453 stimulates phosphorylation of p38 MAPK but decreases phosphorylation of Akt and Erk 1/2. Activation of p38 MAPK was also confirmed using Western blot analysis. This analysis also revealed down-regulation of NF-κB1 (p50) and RelA (p65) proteins and the loss of their anti-apoptotic activity. CONCLUSIONIn our study compound K-453 exhibited an antiproliferative effect by induction of intrinsic apoptosis as well as modulation of several signaling pathways.

Different distributions of interstitial cells of Cajal and platelet-derived growth factor receptor-α positive cells in colonic smooth muscle cell/interstitial cell of Cajal/plateletderived growth factor receptor-α positive cell syncytium in mice

AIM To investigate the distribution and function of interstitialcells of Cajal(ICCs) and platelet-derived growth factor receptor-α positive(PDGFRα+) cells in the proximal and distal colon.METHODS The comparison of colonic transit in the proximal and distal ends was performed by colonic migrating motor complexes(CMMCs). The tension of the colonic smooth muscle was examined by smooth muscle spontaneous contractile experiments with both ends of the smooth muscle strip tied with a silk thread. Intracellular recordings were used to assess electrical field stimulation(EFS)-induced inhibitory junction potentials(IJP) on the colonic smooth muscle. Western blot analysis was used to examine the expression levels of ICCs and PDGFRα in the colonic smooth muscle.RESULTS Treatment with NG-nitro-L-arginine methyl ester hydrochloride(L-NAME) significantly increased the CMMC frequency and spontaneous contractions, especially in the proximal colon, while treatment with MRS2500 increased only distal CMMC activity and smooth muscle contractions. Both CMMCs and spontaneous contractions were markedly inhibited by NPPB, especially in the proximal colon. Accordingly, CyPPA sharply inhibited the distal contraction of both CMMCs and spontaneous contractions. Additionally, the amplitude of stimulationinduced nitric oxide(NO)/ICC-dependent slow IJPs(sIJPs) by intracellular recordings from the smooth muscles in the proximal colon was larger than that in the distal colon, while the amplitude of electric field stimulationinduced purinergic/PDGFRα-dependent fast IJPs(fIJPs) in the distal colon was larger than that in the proximal colon. Consistently, protein expression levels of c-Kit and anoctamin-1(ANO1) in the proximal colon were much higher, while protein expression levels of PDGFRα and small conductance calcium-activated potassium channel 3(SK3) in the distal colon were much higher.CONCLUSION The ICCs are mainly distributed in the proximal colon and there are more PDGFRα+ cells are in the distal colon, which generates a pressure gradient between the two ends of the colon to propel the feces to the anus.

Human hepatic sinusoidal endothelial cells can be distinguished by expression of phenotypic markers related to their specialised functions in vivo

The hepatic sinusoids are lined by a unique population of hepatic sinusoidal endothelial cells (HSEC), which is one of the first hepatic cell populations to come into contact with blood components. However, HSEC are not simply barrier cells that restrict the access of blood- borne compounds to the parenchyma. They are func- tionally specialised endothelial cells that have complex roles, including not only receptor-mediated clearance of endotoxin, bacteria and other compounds, but also the regulation of inflammation, leukocyte recruitment and host immune responses to pathogens. Thus understand- ing the differentiation and function of HSEC is critical for the elucidation of liver biology and pathophysiology. This article reviews methods for isolating and studying human hepatic endothelial cell populations using in vitro models. We also discuss the expression and functions of phe- notypic markers, such as the presence of fenestrations and expression of VAP-1, Stabilin-1, L-SIGN, which can be used to identify sinusoidal endothelium and to permit discrimination from vascular and lymphatic endothelial cells.

Acute small bowel obstruction caused by endometriosis:A case report and review of the literature

Gastrointestinal involvement of endometriosis has been found in 3%-37% of menstruating women and exclusive localization on the ileum is very rare(1%-7%).Endometriosis of the distal ileum is an infrequent cause of intestinal obstruction,ranging from 7% to 23% of all cases with intestinal involvement.We report a case in which endometrial infiltration of the small bowel caused acute obstruction requiring emergency surgery,in a woman whose symptoms were not related to menses.Histology of the resected specimen showed that endometriosis was mainly prevalent in the muscularis propria and submucosa and that the mucosa was not ulcerated but had inflammation and glandular alteration.Endometrial lymph node involvement,with a cystic glandular pattern was also detected.

Prospective controlled study on the effects of polyethylene glycol in capsule endoscopy

AIM:To prospectively confirm whether a small amount of polyethylene glycol(PEG)ingested after swallowing endoscopy capsule improves image quality and completion rate.METHODS:Forty-four consecutive patients referred to us for capsule endoscopy(CE)were randomized to two groups.All patients were restricted to clear fluids for 12 h before the examination.Patients in group A(22 cases)received no additional preparation,while those in group B(20 cases)ingested 500 mL of PEG within a 2 h period starting 30 min after swallowing the capsule.Clear fluids and meals were allowed 2 h and 4 h after capsule ingestion,respectively.Image quality was assessed as the percentage of visualized bowel surface area as follows:1:<25%;2:25%-49%;3:50%-74%;4:75%-89%;5:>90%.The small bowel record was divided into five segments by time,and the score for each segment was evaluated.All CE examinations were performed with the Pillcam SB capsule endoscopy sys-tem(Given Imaging Co.Ltd.,Yoqnem).RESULTS:This study ended in December 2009,because sample size was considered large enough.A total of 44 patients were enrolled.Two patients in group B were excluded from the analysis because small bowel images could not be obtained from these patients;one had a full stomach,while the other presented with a massive gastric bleed.Thus,22 patients from group A and 20 patients from group B completed the study.There was no significant difference in age(P=0.22),sex(P=0.31),and indication for CE.No significant adverse events occurred in any of the study patients.In group A,image quality deteriorated as the capsule progressed distally.However,in group B,image quality was maintained to the distal small bowel.In each of the five segments,the visibility score was significantly higher in group B than in group A(segment 1:4.3± 0.7vs 4.7±0.5,P=0.03;segment 2:4.2±0.9vs 4.8 ±0.4,P=0.01;segment 3:4.0±1.0 vs 4.6±0.7,P =0.04;segment 4:3.6±1.1 vs 4.5±0.6,P=0.003;segment 5:2.7±1.0vs 4.4±0.8,P=0.00004).Thus,the use of PEG during CE examination significantly improved image quality in all time segments,and this effect was more pronounced in the distal ileum.The completion rate to the cecum was not significantly different between groups A and B(81.8%vs 85.0%,P =0.89).There was no difference in the gastric transit time between groups(36.2±35.0 min vs 54.0±56.6 min,P=0.23),but the small bowel transit time was significantly longer in group A than in group B(246.0± 107.0 minvs 171.0±104.0 min,P=0.04).CONCLUSION:The ingestion of a small amount of PEG after the swallowing of an endoscopy capsule significantly improved CE image quality,but did not enhance the completion rate to the cecum.

Effect of early nutrition on intestine development of intrauterine growth retardation in rats and its correlation to leptin

AIM：To investigate the intestine and body development of intrauterine growth retardation（IUGR）rats under early different protein diet and to analyze the correlation between leptin and intestine and body development．METHODS：An IUGR rat model was established by food restriction of pregnant female rats．Fifty-six neonatal IUGR rats and 24 neonatal normal rats were randomly divided into normal control group（Cgroup），IUGR model group （scgroup），low protein diet IUGR group（SL group），and high protein diet IUGR group（SH group）．Eight rats were killed per group at wk 0，4，and 12．Serum leptin，body weight（BW），body length（BL），intestinal weight（IW），intestinal length（IL），andintestinal disaccharidase（including lactase，maltase，and saccharase） were detected．RESULTS：BW（4．50±0．41g），BL（5．96±0．40cm），IW（0．05±0．01g），and IL（15.9±2．8cm）in neonatal IUGR rats were much lower than those in Cgroup（6．01±0．55g，6．26±0．44cm，0．10±0．02g，21.8±2．7cm，P〈0．05），while intestinal lactase and maltase activities were higher than those in Cgroup．SH group showed the fastest catch up growth and their BW，BL，IW，and IL reached the Cgroup level at wk 4．SC group showed relatively slower catch up growth than SH group，and their BW，BL，IW did not reach the Cgroup level at wk 4．SL group did not show intestine and body catch up growth．Intestinal maltase [344±33μmol／（min·q）]and saccharase activities[138±32μmol／（min·g）]in SL group were both markedly lower than nose in C group [751±102，258±271μmol／（min·g），P〈0．05]．There were no significant difierences in lactase activities at wk 4 and disaccharidase activities at wk 12 among all groups（P〈0．05）．The leptin level in SL group（0．58±0．12ng／mL） was the highest in all groups，and much lower in SH group（0．21±0．03ng／mL） than that in any other IUGR groups at wk 4（P〈0．05）．Leptin was negatively related to BW （r=-0．556，P=0．001），IW（r=-0．692，P=0．001） and IL（r=-0．738，P=0．000）at wk 4，while no correlation was found at wk 12．CONCLUSION：High protein diet is a reasonable early nutritional mode to IUGR rats in promoting intestine and body catch up growth．

Double balloon endoscopy associated pancreatitis:A description of six cases

AIM:To perform a single-center analysis of all double balloon endoscopy (DBE) related cases of pancreatitis identified prospectively from a recorded DBE-complication database. METHODS:From November 2003 until January 2007, 603 DBE procedures were performed on 412 patients, with data on complications recorded in a database. The setting was a tertiary care center offering DBE. DBE was performed from the antegrade or retrograde route. Out-come measurements included age, gender, medication, indication, DBE-endoscope type, insertion depth, proce-dure duration, findings, interventions, post-procedural abdominal pain, and post-procedural hospitalization. RESULTS:This is the largest single-center study report-ing on post-DBE pancreatitis prospectively. Six patients (1.0%) developed post-DBE pancreatitis, all after antegrade DBE. There was no association with gender, duration of the procedure or type of endoscope. The mean age was 51.9 years (range 25-78). Four patients had severe pancreatitis. Of these, two had inflammatory signs in the body-tail region, one had pancreatitis in the tail region, and the total pancreas was involved in one. CONCLUSION:The incidence of post-DBE pancreatitis in our series is higher than previously reported. We found no relation with DBE-endoscope type. The inflammatory changes occurred in the body-tail region of the pancreas, suggesting that post-DBE pancreatitis is caused by repetitive mechanical strain on the pancreas.

OMOM capsule endoscopy in diagnosis of small bowel disease

Objective： To assess the diagnostic efficiency of OMOM capsule endoscopy （CE） in a group of patients with different indications. Methods： Data from 89 consecutive patients （49 males, 40 females） with suspected small bowel disease who underwent OMOM CE （Jinshan Science and Technology Company, review. The patients＇ indications of the disease consisted of the Chongqing, China） examination were obtained by retrospective following： obscure gastrointestinal bleeding （OGIB）, abdominal pain or diarrhea, partial intestinal obstruction, suspected inflammatory bowel disease, tumor of unknown origin, hypoproteinemia, constipation, weight loss, and elevated tumor markers. Results： CE failed in one patient. Visualization of the entire small bowel was achieved in 75.0%. Capsules were naturally excreted by all patients. The detection rate of abnormalities was 70.5% for patients with suspected small bowel disease, and the diagnostic yield for patients with OGIB was higher than that for patients with abdominal pain or diarrhea （85.7% vs 53.3%, P〈0.005）. Angiodysplasia was the most common small bowel finding. Active bleeding sites were noted in the small intestine in 11 cases. Conclusion： OMOM CE is a useful diagnostic tool for the diagnosis of variably suspected small bowel disease, whose diagnostic efficiency is similar to that of the Pillcam SB （small bowel） CE （Given Imaging, Yoqneam, Israel）.

Improved techniques for double-balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography

AIM: To investigate the clinical outcome of double balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (DB-ERCP) in patients with altered gastrointestinal anatomy. METHODS: Between September 2006 and April 2011, 47 procedures of DB-ERCP were performed in 28 patients with a Roux-en-Y total gastrectomy (n = 11), Billroth Ⅱ gastrectomy (n = 15), or Roux-en-Y anastomosis with hepaticojejunostomy (n = 2). DB-ERCP was performed using a short-type DBE combined with several technical innovations such as using an endoscope attachment, marking by submucosal tattooing,selectively applying contrast medium, and CO2 insufflations. RESULTS: The papilla of Vater or hepaticojejunostomy site was reached in its entirety with a 96% success rate (45/47 procedures). There were no significant differences in the success rate of reaching the blind end with a DBE among Roux-en-Y total gastrectomy (96%), Billroth Ⅱ reconstruction (94%), or pancreatoduodenectomy (100%), respectively (P = 0.91). The total successful rate of cannulation and contrast enhancement of the target bile duct in patients whom the blind end was reached with a DBE was 40/45 procedures (89%). Again, there were no significant differences in the success rate of cannulation and contrast enhancement of the target bile duct with a DBE among Roux-en-Y total gastrectomy (88 %), Billroth Ⅱ reconstruction (89%), or pancreatoduodenectomy (100%), respectively (P = 0.67). Treatment was achieved in all 40 procedures (100%) in patients whom the contrast enhancement of the bile duct was successful. Common endoscopic treatments were endoscopic biliary drainage (24 procedures) and extraction of stones (14 procedures). Biliary drainage was done by placement of plastic stents. Stones extraction was done by lithotomy with the mechanical lithotripter followed by extraction with a basket or by the balloon pull-through method. Endoscopic sphincterotomy was performed in 14 procedures with a needle precutting knife using a guidewire. The mean total duration of the procedure was 93.6 ± 6.8 min and the mean time required to reach the papilla was 30.5 ± 3.7 min. The mean time required to reach the papilla tended to be shorter in Billroth Ⅱ reconstruction (20.9 ± 5.8 min) than that in Roux-en-Y total gastrectomy (37.1 ± 4.9 min) but there was no significant difference (P = 0.09). A major complication occurred in one patient (3.5%); perforation of the long limb in a patient with Billroth Ⅱ anastomosis.CONCLUSION: Short-type DBE combined with several technical innovations enabled us to perform ERCP in most patients with altered gastrointestinal anatomy.