Blood samples were drawn and analysed in the Society reference la

Blood samples were drawn and analysed in the Society reference laboratory for the following screening tests: prothrombin time (PT), APTT and coagulation factor assays. Inhibitor detection and VWF RiCof were performed depending on the result of the screening tests. HBs Ag, anti-HCV, anti-HIV 1 + 2 and syphilis tests were also performed to detect transfusion transmitted agents (TTA). Diagnosis of the bleeding disorder type was confirmed for 760 of these cases. Among the 760 confirmed patients, 82.5% had haemophilia. Among these, 89.6%were haemophilia

HM781-36B mw A; 10.4% were haemophilia B; 8.3% had VWD; 9.2% had other rare bleeding disorders as follows: 1.2% FVII deficiency, 0.7% FV deficiency, 1.8% F1 deficiency, 0.4% FX deficiency, 1.4% platelets dysfunctions (mainly Glanzmann Thrombasthenia) and 3.7% had combined FVIII and FV deficiency. Eighty (21.3%) cases of 375 screened for transfusion transmitted agents were positive for at least one infection: 0.5% were HBsAg positive, 19.7% were anti-HCV positive, 0.8% had combined HBsAg and anti-HCV positivity and 0.3% was anti-Syphilis positive. All patients were negative for HIV1 and HIV2. The preliminary data presented here follow known data on haemophilia A, haemophilia B and VWD disease. This registry will certainly help in improving haemophilia care in Syria. “

Linsitinib mouse The possibility of alloimmunization in patients receiving protein replacement therapy depends on (at least) three risk factors, which are necessary concomitantly

but insufficient MCE公司 alone. The first is the degree of structural difference between the therapeutic protein and the patient’s own endogenous protein, if expressed. Such differences depend on the nature of the disease mutation and the pre-mutation endogenous protein structure as well as on post-translational changes and sequence-engineered alterations in the therapeutic protein. Genetic variations in the recipients’ immune systems comprise the second set of risk determinants for deleterious immune responses. For example, the limited repertoire of MHC class II isomers encoded by a given person’s collection of HLA genes may or may not be able to present a ‘foreign’ peptide(s) produced from the therapeutic protein – following its internalization and proteolytic processing – on the surface of their antigen-presenting cells (APCs). The third (and least characterized) variable is the presence or absence of immunologic ‘danger signals’ during the display of foreign-peptide/MHC-complexes on APCs. A choice between existing therapeutic products or the manufacture of new proteins, which may be less immunogenic in some patients or patient populations, may require prior definition of the first two of these variables. This leads then to the possibility of developing personalized therapies for disorders due to genetic deficiencies in endogenous proteins, such as haemophilia A and B.

Because antibodies to CagA remain positive longer than H pylori

Because antibodies to CagA remain positive longer than H. pylori IgG surface antibodies, relying on H. pylori IgG antibodies alone might misclassify a significant proportion of patients who once had the infection [10]. In our study population,

the frequency of active and past infection with strains carrying CagA was very high—more than 70%. The results of other studies in Mexican population are consistent with ours [5, 40]. Longitudinal studies are required to understand the meaning of high prevalence of the virulence factor in these populations. Most of the epidemiological studies in adults have found an association between peptic learn more ulcers and gastric cancer, with H. pylori carrying CagA-positive strains [39, 41]. However, other factors may affect these associations. A study was carried out in two villages of the same country with high prevalence of CagA-positive strain but different gastric cancer risks. The study demonstrated that in subjects with CagA-positive and vacA s1 m1 strains, the ancestral origin of H. pylori strains was a strong predictor for gastric cancer risk. The European but not the African phylogeographic origin of the H. pylori strains was strongly associated with more advanced histological lesions and increased Cetuximab chemical structure DNA damage in gastric epithelial

cells [3]. Another study concluded that iron depletion, in conjunction with the presence of H. pylori CagA-positive strains, should be considered a risk factor for the progression of gastric cancer because iron deficiency enhances H. pylori virulence and could represent a measurable biomarker to identify infected populations at higher risk for gastric cancer [11]. Clinically, the UBT is useful to monitor the eradication of bacteria after receiving therapy because this test identified active infection. At the public health level, serological tests give a more complete representation of the percentage of individuals who have been exposed to H. pylori infection and of the prevalence of virulence factors. If the prevalence of H. pylori infection obtained using serological tests is compared to the prevalence by UBT, serological tests overestimate the prevalence

of H. pylori up to 30%. But serological tests based on immunoglobin G antibodies underestimate the percentage of infection that corresponds to active and acute infection in subjects MCE without detectable immune response to H. pylori whole-cell or Cag A-specific antigens but with positive UBT. In this study the percentage of underestimation was 4.9%. The results of our study confirm the association between factors related to low socioeconomic level and poor health conditions as iron deficiency and low height for age with H. pylori infection [4, 9, 21, 23], even in this low-income homogeneous population. H. pylori infection has been associated with ID or IDA in children in multiple studies. In clinical trials, higher response to iron supplementation has been observed with H.

Urine was collected for 24 hours Patients were subsequently tran

Urine was collected for 24 hours. Patients were subsequently transferred to the Hepatic Hemodynamics Unit, and hemodynamics measurements were obtained. Subsequent to 2 hours after hemodynamics measurements, all study subjects underwent transthoracic echocardiography (TTE) to assess cardiac structure and systolic and diastolic function. Patients Caspase inhibition were discharged from the hospital with diuretics, norfloxacin, lactulose, or band ligation to prevent recurrence of ascites, SBP, hepatic encephalopathy (HE), and variceal bleeding, respectively. After discharge from the hospital, patients were followed up for at least 1 year in the outpatient clinic.

During follow-up, we performed an evaluation of all bacterial infections, variceal bleeding, HE, and type 1 HRS[19] occurring in the patients included in the study. These patients were managed with standard therapy (Supporting Materials). FDA-approved Drug Library Patients transplanted during follow-up were considered as censored at the time of transplantation. Under fluoroscopic control, a Swan-Ganz catheter (Abbott Labs, Abbott Park, IL) was advanced into the pulmonary artery for measurement of cardiopulmonary pressures (right atrial pressure

[RAP], pulmonary artery pressure [PAP], and pulmonary capillary wedged pressure [PCWP]) and cardiac output (CO). A 7-F balloon-tipped catheter (MediTech Cooper Scientific Corp., Watertown, MA) was advanced into the main right hepatic vein to measure wedged and free hepatic venous pressures (WHVP and FHVP, respectively). Hepatic venous pressure gradient (HVPG) was calculated as the difference between WHVP and FHVP. All measurements 上海皓元医药股份有限公司 were performed in triplicate and the average taken.[20] Heart rate and mean arterial pressure (MAP) were measured with an automatic sphygmomanometer. Systemic vascular resistance was calculated as follows: MAP (mmHg) − RAP (mmHg)/CO (L/min−1) × 80. Left ventricular stroke work was calculated as

follows: (stroke volume × [MAP − PCWP] × 0.0136) (g m-m). PRA, ALDO, NE, and ANF were determined as previously described.[20] BNP was measured using a chemiluminometric immunoassay run on the ADVIA Centaur Immunochemistry analyzer (Siemens Healthcare Diagnostics, Tarrytown, NY). Values in healthy subjects on a low-sodium diet were as follows: 1.35 ± 0.94 ng/mL/hour, 24.2 ± 11.3 ng/dL, 253 ± 114 pg/mL, 6 ± 0.5 fmol/mL, and 25 ± 10 pg/mL, respectively. TTE was performed using commercially available instruments operating in a 2.5-5.0 MHz transducer in standard parasternal and apical views according to the recommendations of the American Society of Echocardiography (ASE).[21] Calculations of different cardiac dimension and volumes were assessed by M-mode cursor. Left ventricular ejection fraction (LVEF) was obtained by a modified version of Simpson’s method.

When mouse primary hepatocytes were exposed to sorafenib, transfo

When mouse primary hepatocytes were exposed to sorafenib, transforming growth factor-β signaling was decreased, and this diminished EMT.[30] In another study, Nagai et al. introduced hepatocyte growth factor (HGF) to induce EMT morphology and migration in HepG2 and Huh7 cells.[31] These cells showed increased SNAI1 and N-cadherin expression and decreased E-cadherin

expression, all indicators of EMT. Sorafenib inhibited these changes and even stopped the HGF-mediated cell migration. Thus, sorafenib can restrain EMT transition in most HCC cells, but cells resistant to sorafenib continue to transition. AUTOPHAGY IS A process by which cells recycle material by enclosing an organelle within a vesicle and fusing it with a lysosome to degrade it. This mechanism may promote cancer growth because it enables the cells to survive nutrient deprivation. A study completed Selleck KU-60019 by Shimizu et al.

discovered that sorafenib increases autophagy in Huh7, HLF and PLC/PRF/5 cells, which leads to resistance.[32] Chloroquine, an inhibitor of autophagic flux, can be added in combination with sorafenib to significantly increase the suppression of tumor growth in vivo.[32] In another study, markers of autophagy, including LC3-11, Atg5 Aloxistatin datasheet and autophagosomes, increased when cells were exposed to sorafenib.[33] This autophagy was induced by endoplasmic reticulum stress. When autophagy was inhibited by 3-MA, chloroquine or Atg5 siRNA knockdown, sorafenib-induced cell death increased. However, another study has shown that excess autophagy can promote apoptosis and decrease tumor size. When sorafenib was combined with pemetrexed, a folate anti-metabolite that stimulates autophagy, the treatment increased autophagy and cell death

in vitro and suppressed tumor growth in vivo.[34] The interaction was 上海皓元 not merely additive, but synergistic. Thus, autophagy can either enable cell survival or promote cell death, and further investigations may elucidate the different circumstances under which each occurs. MANY RECENT STUDIES have tested the efficacy of sorafenib in combination with another therapy to investigate if the effects of the multikinase inhibitor can be improved. Because overactive EGFR expression potentially leads to sorafenib resistance,[35] Yang et al. tested sorafenib with CH12, a monoclonal antibody against EGFRvIII in Huh7 cells, SMMC-7721 cells, and Huh7 cells overexpressing EGFRvIII (Huh7-EGFRvIII) in vitro and in vivo.[36] They found that the combination was indeed more effective than sorafenib alone in Huh7-EGFRvIII and SMMC-7721 cells. The MEK/ERK, phosphoinositide 3-kinase/AKT, and STAT3 pathways all showed increased inhibition with the addition of CH12. Because erlotinib is a drug that also inhibits EGFR, Sieghart et al. endeavored to discover if it also could be combined with sorafenib to produce additive effects.

46(95%CI 006-085) CONCLUSIONS: Fibroscan® and CAP™ were feasib

46(95%CI 0.06-0.85). CONCLUSIONS: Fibroscan® and CAP™ were feasible

in most of NAFLD patients studied. However, the agreement Small Molecule Compound Library of these noninvasive methods when compared to liver histology was unsatisfactory. Besides the prevalence of high BMI, perhaps the heterogeneous fibrosis and steatosis of NAFLD liver histology were to blame. Disclosures: The following people have nothing to disclose: Denise S. Vanni, Claudia P. Oliveira, Daniel F. Mazo, Fabiola Rabelo, José Tadeu Stefano, Flair J. Carrilho Introduction: Nonalcoholic steatohepatitis (NASH) has been associated with low levels of hepatic polyunsaturated fatty acids (PUFA), particularly omega-3 PUFA. There is no data on whether omega-3 PUFA modulate microRNA (miRNA) expression in liver. Some studies have reported altered miRNA expression in obese patients with NASH but there are no studies on whether there is an association with PUFA. The aim of this study was 1) to compare miRNA expression between patients with simple steatosis (SS), NASH, and healthy controls (HC), and 2) to examine correlations between

hepatic miRNA expression and omega-3 PUFA. Methods: miRNA expression was measured by NanoString technology in liver tissue from 24 living liver donors as healthy controls (HC; n= 24) and patients with biopsy proven SS (n= 25) or NASH (n= 22). Groups were compared by t-test ( p<0.001). Polyunsaturated fatty acids in hepatic total lipids were measured by gas chromatography. Results are given in % of total fatty acids. Spearman correlations were used to identify potential associations. Results: Twenty-six miRNAs were differentially expressed between HC, SS and NASH, including

miR1 0b which was upregulated in HC vs NASH (p=0.00001). Total omega-3 PUFA were lower in NASH (mean± SD) (2.35±0.65 %) and SS (3.28±1.23 %) compared with HC (4.44±1.61 %) (p<0.05). Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), the biologically active long-chain omega-3 PUFA, were also lower in NASH and SS than in HC (p<0.05). Twenty of the differentially expressed miRNAs were significantly correlated with at least one omega-3 PUFA, including miR1 0b which was positively correlated with DHA (r=0.417, p=0.001) and total omega-3 PUFA (r=0.343, p=0.008). Conclusion: The 上海皓元医药股份有限公司 expression of miR1 0b was higher in HC than NASH and positively correlated with hepatic omega-3 PUFA. A potential target of miR1 0b is peroxisome proliferator-activated receptor-α, which can contribute to steatogenesis and inflammation in NAFLD. These results support the concept of associations between PUFA, epi-genetic mechanisms, and NAFLD-related gene expression. Further studies are required to establish cause-effect relationships and examine the potential of omega-3 PUFA supplementation to regulate miRNA in NAFLD. Disclosures: David W.

Indeed, given that multiple ‘clonal’ strains of extant mangrove k

Indeed, given that multiple ‘clonal’ strains of extant mangrove killifish clearly have escaped the perils of intense inbreeding, at least over the short term, this androdioecious species with a mixed-mating system presumably GSK458 price enjoys some of the best of two worlds: outcrossing’s long-term as well as short-term advantages (continued genetic health and adaptability through recombination), and selfing’s immediate benefits (fertilization assurance and perhaps the intact propagation of locally adapted genotypes). Especially for animals that are sequential

hermaphrodites, the most powerful evolutionary explanations for the ontogeny of sex change have come from a branch of

sex-allocation theory known as the size-advantage hypothesis or SAH (Ghiselin, 1969; Warner, 1975, 1988), which basically predicts that sex change is favored by natural selection when an individual reproduces most effectively as one sex GSK3235025 price when small (and young) but as the other sex when larger (and older). Depending on the biology and ecology of a particular species, males might have a reproductive advantage when small and females when large, in which case protandry would be selectively favored; but in other species, females might reproduce better when small and males when large, in which case protogyny might tend to evolve. The empirical challenge has been to understand what biological conditions generally tip the scales in favor of individuals reproducing as dams versus sires at various size cohorts or age classes. For sequentially hermaphroditic fishes and invertebrates alike, SAH has made predictions about patterns of sex change that seem to be consistent with many observational and experimental tests. Because humans are mammals MCE公司 with sexual reproduction, people are familiar with the concept of pregnancy, that is with the otherwise outlandish notion that one individual carries a genetically different individual inside its body for an extended period of

time before expelling the latter through an orifice. If you are a man, you might feel relieved that this weighty reproductive imposition has been delegated to females in Homo sapiens; and if you are a woman, the thought of becoming pregnant might elicit any of a gamut of emotions ranging from joy to fear or loathing, depending on the circumstances. One day when I was about 8 years old, I had an insight: God had arranged things equitably for men and women. A man could anticipate being drafted into 2 years of military combat whereas a woman might spend on average about 2 years of life in a state of pregnancy (which I imagined to be an equally unpleasant sentence). This childhood revelation is silly, but in some ways it was prescient.

Total nucleic acid was extracted from leaf tissues and subjected

Total nucleic acid was extracted from leaf tissues and subjected to reverse transcription polymerase chain reaction (RT-PCR) using Hop stunt viroid (HSVd) and Citrus exocortis viroid (CEVd)-specific primers, followed by sequencing of PCR products. RT-PCR with HSVd primers amplified a 302- or 305-bp product from affected samples, but none from healthy plants. CEVd was not detected in affected trees. HSVd was also found in graft- and mechanically

inoculated plants. Sequence analyses showed three variants of HSVd in symptomatic mulberries related to plum and peach variants of this viroid with 94.9% identity, but with only 93% identity to Lebanese and Italian mulberry isolates. This is the first report of HSVd associated with vein clearing in mulberry in Iran. “
“Brown eye spot, Small molecule library clinical trial caused by Cercospora coffeicola, Acalabrutinib manufacturer is an important disease of coffee. Both adaxial and abaxial leaf surfaces were inoculated with a conidial suspension of C. coffeicola. Samples were collected from 4 to 168 h after inoculation and then again at 35 days. Germinated conidia showed positive tropism to stomata where attempted penetrations occurred. Appressoria were not observed. After penetration, C. coffeicola colonized the lacunous parenchyma both inter and intracellularly. Sporulation occurred through or

around the stomata. Results from this study provide new insights into the infection process of C. coffeicola on coffee leaf. “
“Alfalfa fields in three western provinces of Iran were surveyed for Peanut stunt virus (PSV) during 2011 and 2012. Forty-seven of 115 samples tested (41%) were infected with PSV. Phylogenetic analysis using coat protein (CP) gene sequences showed that the Iranian isolates belong to the subgroup II of PSV. Pairwise identity analysis revealed four groups representing

four 上海皓元医药股份有限公司 phylogenetic subgroups. PSV strains in subgroups III and IV are closely related to each other, as supported by the lowest nucleotide diversity, high pairwise nucleotide identity and high haplotype diversity as evidence of a recent population expansion after a genetic bottleneck. Using the maximum likelihood method, amino acid 86S in the CP gene of the Iranian PSV isolates was found to be under positive selection, although the likelihood ratio test statistics is not significant. This is the first report of the occurrence and phylogenetic relationships of Iranian PSV isolates in west Iran. “
“Gummy stem blight (GSB) is one of the most destructive foliar diseases of cucurbits, worldwide. To identify and characterize the pathogen which causes GSB on watermelon and muskmelon in East China, morphological characteristics, pathogenicity assays as well as sequence characterization of the rDNA internal transcribed spacer (ITS) were performed on 41 isolates collected from Jiangsu, Zhejiang, Anhui and Jiangxi provinces.

After reviewing the title or abstract for evidence of the use of

After reviewing the title or abstract for evidence of the use of US for the diagnosis of musculo-skeletal lesions in haemophilia, we selected 24 of these references. We added data collected from our experience to the most important data found in the references. Our main conclusion is that US is highly valuable for the diagnosis of musculo-skeletal diseases in haemophilia. It is a fast, effective, safe, available, comparative, real-time technique that can help us confirm the clinical examination. It is particularly important in acute haemarthrosis, as it can be used to objectively identify the presence of blood in the joints, measure its

size, pinpoint its location, assess its evolution and 3-MA order confirm its complete disappearance. “
“Children with active selleckchem bleeding or a history of excessive bleeding need a structured evaluation to determine if they suffer from a bleeding disorder and, if so, the etiology of the bleeding disorder. A structured evaluation should

begin with a comprehensive medical history focusing on the child’s history of bleeding. The bleeding history is optimally obtained using validated bleeding questionnaires. This is followed by a thorough family history taking note of abnormal bleeding in close relatives, and any history of parental consanguinity. The physical examination should look for clues to possible underlying bleeding disorders. In general, laboratory testing commences with screening tests. These are able, in most cases, to point toward possible underlying disorders that can be confirmed by specific laboratory tests. Unfortunately,

mild bleeding disorders are often not detected in screening tests and, in children with clinically significant bleeding, additional specific tests are warranted. “
“Summary.  von Willebrand’s disease (VWD) is regarded as the most common congenital bleeding disorder, and although not available in all laboratories von Willebrand factor (VWF) activity is most frequently assessed as ristocetin cofactor (VWF:RCo). This test can be technically challenging, is subject to poor sensitivity (∼20 IU dL−1 VWF:RCo) MCE公司 and has a high degree of inter- and intra-assay imprecision [coefficient of variation (cv) > 25%]. We studied an automated assay using a combined fixed platelet/ristocetin reagent (BC von Willebrand reagent, Siemens Healthcare Diagnostics) on the CS-2000i analyser (Sysmex UK Ltd). Initially inter- and intra-assay imprecision was assessed. The automated method showed good day-to-day reproducibility and linearity of standard curves. This technique, also gave low intra- and inter-assay imprecision using commercial normal (cv < 4.5%) and pathological (cv < 8.1%) control plasmas.

Conclusions— Our preliminary experience suggests that patients s

Conclusions.— Our preliminary experience suggests that patients suffering from TDP, TNP, and PHN may respond favorably to CMJ-S whereas patients with occipital learn more neuralgia/pain are rarely palliated by this neuromodulatory approach. “
“The use of chronic opioid therapy for persistent headache remains controversial because of limited

supporting data and potential risks. In addition to possible individual risks for the patient, society risks associated with diversion and substance abuse are well documented. Few studies directly address risk stratification for opioid therapy where a diagnosis of headache is present, making it necessary to extrapolate from other pain research when developing recommendations for screening and

patient management. Considering the historical framework of opioid prescribing, relevant studies assessing risk stratification of chronic opioid therapy are reviewed. Specific risk factors that may lead to a problematic course with chronic opioid therapy are outlined. Both clinical experience and the limited empirical research underscore the need for multiple assessment tools and ongoing patient monitoring in the evaluation of these risk factors. “
“Migraine associated vertigo” is emerging as a selleck screening library popular diagnosis for patients with recurrent vertigo. However, in view of our current understanding of both migraine and vertigo, “migraine associated vertigo,” in contrast to basilar artery migraine, is neither clinically nor biologically plausible as a migraine variant. (Headache 2010;50:1362-1365)

“Background.— New-onset migraine headache attacks (MHAs) can occur after atrial septal device implantation in patients without previous migraine. medchemexpress Plasma calcitonin gene-related peptide (CGRP), which plays a crucial role in migraine pathophysiology, has shown to be released from specific cardiac tissues. Methods and Results.— We prospectively collected patients before and after closure and measured plasma CGRP levels using enzyme-linked immunosorbent assay. Forty atrial septal defect (ASD) patients who had no migraine previously were enrolled. Four (23.5%) of the 17 consecutive patients whose CGRP levels were checked before ASD closure had new-onset MHAs. The patients with MHAs had bigger ASD size (20 ± 0.9 vs 16 ± 1 mm, P = .009) and lower CGRP levels before closure (21.1 ± 3.9 vs 90.1 ± 27.1 pg/mL, P = .042) than those without. Among the 5 patients with blood samplings both during and between attacks, a paired comparison revealed a significantly increased level during attack (257.2 ± 45.5 vs 45.6 ± 25.5 pg/mL, P = .03). Conclusion.— Bigger ASD size and lower plasma CGRP levels before closure can be a potential predictor of new-onset MHAs. Furthermore, a significant increase of CGRP levels during migraine attack implies that the occurrences of new-onset MHAs after ASD closure correlate with the release of CGRP.

Therefore, PCM has two advantages including maintenance of the th

Therefore, PCM has two advantages including maintenance of the thick submucosal layer preventing the leakage of injection solution, and providing good traction thus stretching the submucosal tissue and facilitating the submucosal dissection. Adjusting the approach angle of the knife to be tangential to the muscle layer is easy with this method. The aim of this study is to evaluate the safety and efficacy of PCM compared with conventional ESD. Methods: From August 2008 to July 2013, a total of 37 duodenal neoplasms (cancer VX-809 purchase 20, adenoma 17) in 34 patients

were treated by ESD at Jichi Medical University Hospital. We selected two groups, patients treated by PCM (P-group) or by conventional ESD (C-group). The resection speed (resection area/operating time, mm2/min), en-bloc resection rate, complete resection rate, and perforation rate were analyzed retrospectively. Results: The resection speed was faster in the P-group than the C-group (20.1 vs 15.2 mm2/min, P = 0.15). The en-bloc resection rate and complete resection rate were higher in the P-group than in the C-group (100% and 87.5%, P = 0.17, 85.7% and 71.4%, P = 0.22, respectively). The perforation rate was lower in the P-group than in the C-group (6.7% selleck vs 19.0%, P = 0.27). Conclusion: For each

parameter evaluated, PCM was better than a conventional ESD, trending toward significance, enabling better and safer ESD procedures. These results establish feasibility and support further evaluation of this technique. Key Word(s): 1. endoscopi submucosal dissection pocket-creation method Presenting Author: SHINICHI MORITA

Additional Authors: YASUAKI ARAI, MIYUKI SONE, HIROAKI ISHII, SHUNSUKE SUGAWARA, YASUNARI SAKAMOTO, TAKUJI OKUSAKA, SHIGETAKA YOSHINAGA, YUTAKA SAITO Corresponding medchemexpress Author: SHINICHI MORITA Affiliations: National Cancer Center Hospital, Tokyo, Japan, National Cancer Center Hospital, National Cancer Center Hospital, Tokyo, Japan, National Cancer Center Hospital, National Cancer Center Hospital, National Cancer Center Hospital, National Cancer Center Hospital, National Cancer Center Hospital, Tokyo, Japan Objective: We report our initial experience of antireflux metal stent (ARMS) placement for distal malignant biliary obstruction. Methods: Twenty-six patients with unresectable distal malignant biliary obstruction received endoscopic ARMS placement between February and June 2014 (Male/female = 15/11; Median age = 71 years old [43–87]). Causes of stricture were pancreatic cancer (n = 22), lower biliary tract cancer (n = 2), gallbladder cancer (n = 1) and ampullary cancer (n = 1). Sixteen patients (62%) had duodenal invasion.