Moreover, the urine formation process could be acting to concentrate MCYST in the tubular fluid. In this sublethal dose experiment the analyses of free MCYST in tissues and samples of excreta showed the presence of the toxin (mean ± SD) in liver (data not shown), kidney (113.5 ± 21.3 ng/g), serum (0.46 ± 0.20 ng/ml), urine (2348 ± 354 ng – total amount) and feces (663 ± 331 ng – total amount). Despite the fact that the ELISA method only detects the non-protein conjugated amount of toxin (a minor percentage of the total), the data show that MCYST was circulating

in the organism and was partially eliminated through feces and urine in a period of 24 h. It was also observed that MCYST and/or its

GSH conjugates (MCYST-GSH, MCYST-Cys; also detectable by ELISA antibodies; Metcalf et al., 2000) were detected in the urine at a concentration that indicates find more a process of secretion, since FEMCYST is about 138% (see Table 1). This secretion of the toxin probably occurs along the renal Selumetinib solubility dmso tubules and confirms the active role of kidney in the elimination of MCYST from the organism. Ito et al. (2002) have already detected the toxin in this organ, and not only MCYST itself, but also its conjugates. These ones result from the main route of MCYST detoxication which is through the activity of GST. That conjugation makes the toxin more hydrophilic and less toxic (Wiegand et al., 2002; Gehringer Interleukin-2 receptor et al., 2004). However, despite being less toxic, these conjugates can still induce damage in renal tissue (Kondo et al., 1992). The generation of reactive oxygen species (ROS) in the MCYST group is shown by increased formation of MDA, a known lipid peroxidation indicator (Fig. 2A) and also by a significant decrease in catalase enzyme activity (Fig. 2B). The observed oxidative damage verified by the lipid peroxidation process indicates a higher production

of ROS by renal cells exposed to MCYST. An excessive amount of ROS could reduce some antioxidant enzyme activities. If superoxide dismutase is affected, the consequent excess of superoxide anion radical can inhibit catalase activity (Kono and Fridovich, 1982), consistent with the reduced catalase activity observed after MCYST-LR exposure. Moreover, according to Ding et al. (2000), MCYST-LR induces damage to mitochondria by altering its membrane potential and permeability transition (MPT). The toxin may disrupt the mitochondrial electron transport chain, followed by ROS production and then change in MPT. This presence of ROS in renal tissue could also contribute to the formation of collagen in the interstitial space observed in cortex and medulla regions (Fig. 1D and F). In a recent study, using a skeletal muscle cell model, Cabello-Verrugio et al.

, 2011). Similarly, the critical role of other mediators from arachidonic acid including endogenous epoxygenated fatty acids ( Wagner et al., 2011) and leukotrienes ( Noguchi and Okubo, 2011) in different form of inflammatory pain including check details nerve injury-induced neuropathic pain is also elucidated. However, the role of these arachidonic acid derived mediators in the development of anticancer agents-induced neuropathic pain is not described. Instead, a study has shown that administration of a PGE1 analog i.e., limaprost

attenuates paclitaxel and oxaliplatin (but not that of vincristine)-induced mechanical allodynia possibly due to normalization of chemotherapeutic agents-induced decrease in blood flow ( Gauchan et al., 2009a, Gauchan et al., 2009b and Gauchan et al., 2009c). Administration of antioxidants such as acetyl-l-carnitine, alpha-lipoic acid or vitamin C attenuates oxaliplatin-induced hyperalgesia Selleck Pirfenidone suggesting the critical role of oxidative stress in oxaliplatin-induced neuropathic pain. Furthermore, intrathecal administration of the neurotoxin for IB4-positive nociceptors, IB4-saporin, markedly

attenuates IB4 staining in the dorsal horn of the spinal cord and prevent oxaliplatin-induced hyperalgesia suggesting that oxaliplatin acts on IB4 (+)-nociceptors to induce oxidative stress-dependent acute peripheral sensory neuropathy (Joseph et al., 2008). Recently, administration of phenyl N-tert-butylnitrone, a free radical scavenger, has been shown to reduce mechanical allodynia in paclitaxel-induced neuropathic pain in rats (Kim SPTLC1 et al., 2010). A very recent study has demonstrated an increase in reactive oxygen species in DRG neurons treated with bortezomib (Wang et al., 2011).

Very recently, administration of vitamin C and N-acetyl-l-cysteine has been shown to alleviate the cytotoxicity in Schwann cells but not myeloma cells treated with bortezomib suggesting the neuroprotection with out altering the anti-tumor activation (Nakano et al., 2011). Our own studies have shown the important role of oxidative stress in development of neuropathic pain in different models including vincristine-induced neuropathic pain (Muthuraman et al., 2008, Kaur et al., 2010 and Muthuraman and Singh, 2011). Paclitaxel-induced peripheral neuropathy is characterized by activation of calcium-activated proteases such as calpains and caspases (Joseph and Levine, 2004 and Wang et al., 2004). Boehmerle et al. (2007) also demonstrated an increase in calpain activity in primary rat DRGs and human neuroblastoma cells on prolonged exposure of paclitaxel. Furthermore, an increase in calpain activity causes degradation of neuronal Ca2+ sensor-1 which in-turn is responsible for reduction in inositol trisphosphate-mediated Ca2+ signaling.

Table 1 shows that C12 presented the highest free EE content, statistically differing from the other trials (p < 0.05), possibly because this trial had the highest concentration of core material tested. Trials C1, C2, C5, C6 and C11 presented the lowest values for free EE content, and the highest values for the ratio of wall material to core material. Lamprecht et al. (2001) obtained different results for free EE after reticulation with different chemical agents and by spray drying, varying from 4.3 to 28.2 g/100 g Davidov-Pardo et al. (2008), working with soy protein isolate by the enzyme gelation process obtained

values above 5 g/100 g for free fish oil. The analyses of the effects of the concentration of the wall materials (SPI:GA), the wall Selleckchem GSK3 inhibitor material to core material ratio (wall:core) and the TG concentration on the mean particle size, failed to present acceptable regression coefficients (R2 < 75%) for obtaining mathematical models considering the independent variables under study, even though

the repeatability of the results was proven by the central point trials (C15, C16, C17 and C18–1.5:1.0 SPI:GA; 2.0:1.0 wall:core; 6.0 UA of TG/g), which did not present statistical differences between them (p > 0.05). The values obtained for the mean particle size can be seen in Table 1. The size of microparticles produced by complex coacervation using the polymer pair of gelatin and gum Arabic is affected by selleck inhibitor many parameters, such as the stirring rate, solution viscosity, core/polymer ratio, amount of water, etc (Inoue, Kawai, Kanbe, Saeki, & Shimoda, 2002). According to Mascarenhas (2010), p. 167, a reduced relative dispersion of the particle size can be noted when the microcapsules are produced under controlled conditions, when compared to those produced in the ice bath, that is,

controlling the cooling rate resulted in particles with greater uniformity of size amongst them. However, according to Mukai-Correa et al. (2003), the particles produced by complex coacervation can vary from Farnesyltransferase 1 to 500 μm. The variation in mean particle size obtained in this study could possibly be explained by small differences in the cooling temperature during the production process, and by variations in the concentrations of the polymers and core material used, altering the viscosity of the dispersions. Lamprecht et al. (2001) obtained results of about 40 μm for microcapsules of fish oil encapsulated in a matrix of gelatin:GA by complex coacervation. On the other hand, Jun-xia et al. (2011) obtained a mean result of 7.569 μm for microcapsules produced with SPI:GA by coacervation.

Among the genes identified were an angiotensin-converting enzyme and a regulator of this enzyme (calmodulin). Interestingly, in tick (Bophilus microplus), Bm9, an

angiotensin-converting enzyme which is expected to act as a vasoconstrictor has been used in a protective vaccine ( Jarmey et al., 1995). The gut is, unsurprisingly, Selleckchem Bcl-2 inhibitor characterized by expression of genes associated with the primary function of the intestine: digestion. Accordingly a large number of proteases are extremely upregulated in accordance with previous findings (Kvamme et al., 2004). In line with these findings an oligopeptide transporter (solute carrier family 15) is also extremely upregulated. Both adenlyat cyclase and Ca2 + transporting ATPase were also Selleck Obeticholic Acid highly upregulated, as expected based on their role in controlling secretion in exocrine protease secretion (Scott and Baum, 1985). A number of lysosomal genes were also upregulated further attesting to the active digestive function of the intestine. Metabolic processes generally appear to be upregulated in the subcuticular tissues compared to the other tissues. This is not surprising

given that the extremely highly expressed vitellogenins (LsVit1 and LsVit2) and yolk associated protein (LsYAP) production have been identified as subcuticular tissue products in female lice (Dalvin et al., 2011 and Dalvin et al., 2009). The previously reported localization and expression pattern of vitellogenin and yolk associated protein (LsYAP) were confirmed by the present results. In the subcuticular tissue several amino acid degrading pathways are among the highly upregulated pathways, with most involved genes upregulated 2–10 fold. This indicates that nutritional amino acids are transported directly to the subcuticular tissues and utilized there. The elevated peroxidase expression in the subcuticular tissue has several candidate explanations. The elevated peroxidases may play a role in anti-thrombosis in the saliva of blood feeding insects

(Ma et al., 2009), and peroxidase enzymes may be produced by the subcuticular tissue and exported through the intestinal cells into the gut. O-methylated flavonoid Peroxidases are indicated to be involved in cuticle scelerotization and elevated expression in the subcuticular tissue may be related to cuticle generation and maintenance (Soares et al., 2011). The elevated peroxidase may be involved in production of thyroid hormone with uncharacterized functions (Heyland and Moroz, 2005). We report the first transcriptomic analysis of tissues in salmon louse. Four of the five different tissues display a clear expression profile. The exception is that, the frontal tissue is hard to untangle due to the heterogeneity of these samples comprising both neuronal, glandular tissues as well as other cell types including intestine contamination. Still the results show that this region does indeed display the expected neural factors.

Unlike procedural memory deficits, Cyclopamine price which the PDH considers to be core deficits, impairments of other functions that depend on the same brain structures might or might not be observed, depending on the extent and nature of the underlying brain abnormalities (e.g., since different but parallel and anatomically proximate frontal/basal-ganglia circuits may underlie procedural and working memory) (Ullman, 2006a and Ullman and Pierpont, 2005). In contrast, the medial temporal lobe structures that underlie learning

and consolidation in declarative memory are posited to remain largely normal, and thus declarative memory functioning should be essentially intact in SLI. Moreover, declarative memory is predicted to compensate, at least to some extent, for functions such as rule-governed aspects of grammar that are normally

largely subserved by procedural memory, but that declarative memory can at least partly underlie. Ullman and Pierpont (2005) accompanied their theoretical proposal with an in-depth review of the neural substrates of SLI, as well as of the status of language, this website memory, and other cognitive capacities in the disorder. Additionally, since the publication of their paper, a number of empirical studies examining these issues have been published. Overall, the data appear to largely support the pattern of predictions of the PDH. Here we briefly review those studies that are most relevant here. All studies that have examined learning in procedural memory

in SLI have observed deficits. These have been found both in the verbal domain in tasks that depend on procedural memory structures (Evans et al., 2009 and Plante et al., 2002), and in non-verbal domains. Non-verbal procedural memory deficits, which we focus on in the present paper, have been observed both in probabilistic category learning (Kemény and Lukács, 2010) and implicit sequence learning (Lum et al., 2010 and Tomblin et al., 2007). The sequence learning deficits have been examined with implicit visuo-spatial Serial Reaction Niclosamide Time (SRT) tasks, which have been independently shown to depend on procedural memory (Knopman and Nissen, 1991, Nissen and Bullemer, 1987, Siegert et al., 2006 and Thomas et al., 2004). In a study by Tomblin et al. (2007), adolescents with SLI had slower learning rates of the sequence as compared to TD children. Lum et al. (2010) reported that children with SLI showed no sequence learning, whereas TD children did. Specifically, after repeated exposure to a visuo-spatial sequence, the response times of the TD children decreased, but then significantly increased when the visual stimulus was presented randomly (rather than as the sequence). This indicates the TD group learned aspects of the sequence. In contrast, no significant increase between sequenced and random blocks was observed for the SLI group.

, 2012 and Kusahara and Hasumi, 2013 suggest that Panobinostat future circulation changes may increase basal melting on decadal time scales also in this region. Here, we use a regional high-resolution ice shelf/ocean model, informed by recent sub-ice shelf observations, to investigate basal melting at the Fimbul Ice Shelf (FIS). The oceanographic configuration of the FIS, illustrated by the schematic cross-section in Fig. 1, is typical for the ice shelves along the coast of Dronning Maud Land (40°W–20°E), where ice shelves cover large parts of the

narrow continental shelf. Basal melting in this region is believed to be largely determined by the dynamics of the Antarctic Slope Front (ASF), which circulates westward along the steep continental Docetaxel slope (Chavanne et al., 2010 and Heywood et al., 1998) and separates the Warm Deep Water (WDW) in the deep ocean off-shore from the colder and fresher Eastern Shelf Water (ESW) on the continental shelf (Nicholls et al., 2009). Previous coarse-resolution models have suggested the direct inflow of WDW and high melt rates in the order of several meters per year at the FIS

(Timmermann et al., 2012, Smedsrud et al., 2006 and Hellmer, 2004). Meanwhile, observations indicate much less access of WDW (Nicholls et al., 2006, Price et al., 2008 and Walkden et al., 2009), showing that the ice shelf cavity is mainly filled with cold water closely matching the properties of the ESW (Hattermann et al., 2012). Nøst et al. (2011) argue, based on the analysis of hydrographic SPTLC1 data collected by instrumented seals in combination with idealized numerical modeling, that baroclinic eddies play an important role for the WDW transport

towards the coast. Nøst et al. (2011) find that the coastal thermocline depth is controlled by the balance between a wind-driven Ekman overturning circulation that accumulates ESW near the coast (Heywood et al., 2004 and Sverdrup, 1953), and an eddy-driven overturning circulation, which counteracts the deepening of isopycnals across the ASF. Thus, one hypothesis motivating our study is that previous coarse resolution models were not able to realistically simulate basal melting at the FIS because they did not properly represent eddy processes. In addition, the recent sub-ice shelf observations of Hattermann et al. (2012) showed that fresh and solar-heated Antarctic Surface Water (ASW) has access to the cavity beneath the FIS. This buoyant water mass forms within a thin layer at the ocean surface during the sea ice melt season. The subduction of ASW near the ice front is a typical feature observed along the Eastern Weddell Sea coast (Ohshima et al., 1996, Årthun et al., 2012 and Graham et al., 2013). Our work explores the role of ASW and upper ocean processes in basal melting, which has received little attention in the literature to date.

Uczucie dyskomfortu w jamie brzusznej (nieprzyjemne uczucie nieopisywane jako ból) lub ból spełniający co najmniej 2 z poniżej wymienionych warunków przez minimum 25% czasu: – poprawa po defekacji, W porównaniu z II kryteriami rzymskimi skrócono czas niezbędny do rozpoznania zespołu z 3 do 2 miesięcy, co pozwala na szybsze ustalenie rozpoznania i wcześniejsze włączenie leczenia [1]. Zespół jelita nadwrażliwego jest jednym z najczęstszych zaburzeń czynnościowych przewodu pokarmowego. find more W krajach zachodnich jego

występowanie ocenia się na 15–20% populacji młodocianych i dorosłych [2]. Objawy chorobowe najczęściej pojawiają się w okresie od dojrzewania do 30 roku życia [3]. W populacji wieku rozwojowego zespół jelita nadpobudliwego jest rozpoznawany rzadziej niż u dorosłych. Hyams i wsp. [3] stwierdzili występowanie IBS u 8% uczniów klas szkół średnich (średni wiek 12,6 lat) z nawracającymi bólami brzucha w wywiadzie. Statystycznie częściej chorują kobiety (stosunek kobiet do mężczyzn wynosi 2,5:1) [4]. Etiopatogeneza zespołu jelita drażliwego jest złożona i nie została dotychczas dokładnie wyjaśniona. W piśmiennictwie zwraca się uwagę na nieprawidłową motorykę jelit oraz zaburzenia czucia trzewnego (nadwrażliwość trzewna)

[5]. www.selleckchem.com/products/BIRB-796-(Doramapimod).html Zaburzenia motoryki jelit są spowodowane nieprawidłowym uwalnianiem enterohormonów i neuroprzekaźników oraz wadliwą czynnością mięśni gładkich jelita. U pacjentów z rozpoznanym zespołem jelita wrażliwego skurcze odcinkowe jelit występują częściej i są dłuższe niż u osób zdrowych. Czynnikami predysponującymi do rozwoju choroby są uwarunkowania genetyczne oraz silne przeżycia emocjonalne. Zaostrzenie dolegliwości klinicznych obserwuje się pod wpływem stresu, błędu dietetycznego, infekcji, procesów zapalnych, urazu oraz substancji drażniących śluzówkę jelita (laktozy, fruktozy, kwasów żółciowych, alergenów pokarmowych). Do rozpoznania zespołu jelita drażliwego u dzieci konieczne jest spełnienie 3 warunków: 1. Wywiad kliniczny odpowiadającej III kryteriom rzymskim, Zespół jelita nadpobudliwego

u dzieci charakteryzuje Alectinib clinical trial się występowaniem nawracających czynnościowych bólów brzucha oraz zmianami w częstości i konsystencji oddawanych stolców. Bóle brzucha mają różną lokalizację, ale typowo umiejscowione są w prawym lub lewym podbrzuszu [6]. Wykazują one różne nasilenie i przerywany charakter. Dzieci skarżą się na dolegliwości bólowe brzucha głównie w dzień, często 60–90 minut po posiłku. Oddanie gazów lub stolca znacznie zmniejsza natężenie bólu. Do objawów klinicznych mogących wskazywać na zespół jelita nadwrażliwego u dzieci należą [7]: – nieprawidłowa częstość oddawania stolców (więcej niż 3 wypróżnienia dziennie lub mniej niż 3 wypróżnienia tygodniowo), Ze względu na charakter oddawanych przez pacjenta stolców wyróżnia się 3 postacie choroby (biegunkową, zaparciową i mieszaną). Zespół jelita nadpobudliwego ma charakter przewlekły i przebiega z okresami zaostrzeń i remisji.

, 2011) or to viewing with appetitive motives under Fasting condition (Yoshikawa et al., 2013). Interestingly, the intensities of the magnetic responses to food pictures showed a wide variability among the participants, and were significantly correlated with the scores of Power of Food Scale (PFS) which was developed to measure individual differences in motivations to eat

beyond physiological need (Lowe et al., 2009). These findings suggest the possible involvement of insular cortex in the neural processes of the motivations to eat immediately after visual exposure of food pictures. Although these findings www.selleckchem.com/products/SP600125.html contributed to clarify the neural basis of the motivation to eat, changes in these instantaneous responses of insular cortex after a meal were not investigated. In addition, insular cortex receives

several lines of sensory signals induced by gustatory and olfactory stimuli and gastric distention as well as visual stimuli during and after the meal. These preoccupied signals on interoceptive platform of insular cortex might affect the response to visual exposure of foods even when the motivation to eat is not completely lost (Damasio, 1996). The aim of the present study was to examine the effect of the ‘Hara-Hachibu’ http://www.selleckchem.com/products/AZD2281(Olaparib).html postprandial condition on neural responses of insular cortex to food pictures. We compared the responses of insular cortex related to appetitive motives immediately after presentation of food images as assessed by MEG in the Fasting state with those in the postprandial state. We designed to set the postprandial state where each participant judged himself to have eaten shortly before reaching satiety (‘Hara-Hachibu’ condition). In order to assess the activities of insular cortex caused by preoccupied signals without visual stimuli of food images, we used Adenosine mosaic images as a control, and we performed the MEG recordings under four conditions (food images in the Fasting condition, mosaic images

in the Fasting condition, food images in the ‘Hara-Hachibu’ condition, and mosaic images in the ‘Hara-Hachibu’ condition). In addition, we performed correlation analysis between the subscale and aggregated scores of PFS and the intensities of the MEG responses. Before the MEG recordings on the day of Fasting condition, all the participants rated their subjective levels of hunger as moderate to excessive (1.7±0.5 on a 5-point Likert-type scale), while they rated as less hunger (4.0±0.0 on a 5-point Likert-type scale) on the day of ‘Hara-Hachibu’ condition. The average length of time spent in consumption of rice balls for the ‘Hara-Hachibu’ condition was around 10 min, and the average amount of rice balls consumed was 365.5±72.0 g. For the subjective levels of appetitive motives during the MEG recordings, they replied “yes” for most of the food pictures presented (17.6±2.

“
“Dr. J. Nagaraju passed away on the 31st of December 2012. All

those who knew him are devastated by his sudden death. Dr. Nagaraju was a passionate, inspired and imaginative scientist and a beloved friend. He brought a vast contribution to silkworm biology, in many distinct areas. His curiosity was endless, with a permanent attention that scientific progress be useful to society. Dr. J. Nagaraju started his career at the Central Sericultural Research and Training Institute in Mysore (Karnataka), as a Central Silk Board (CSB) employee. In 1989, he came to Lyon (France) for a two-year stay at the CNRS to work on the cellular and molecular genetics of the silkworm. This is when we started to work in collaboration. Back to India, he was invested by the CSB with the mission of running Seribiotech, a brand new research laboratory

in Bangalore in the fast emerging field of biotechnology, aiming at blending fundamental Dasatinib and applied research. After the Seribiotech experience, Dr. Nagaraju moved to Hyderabad in 1998 and joined the Center for Cellular and Molecular Biology (CCMB) and the Center for DNA Footprinting and Diagnostics (CDFD) where he settled down finally. In 1997, he stayed for one year at Harvard University in the laboratory of Daniel Hartl. Dr. Nagaraju first developed fingerprinting of the Bombyx genome by various approaches to assess the genetic diversity of the silkworm in multiple ecotypes and inbred lines. With his little team at Seribiotech, he characterized the first B. mori microsatellites, their type, Selleck E7080 abundance and polymorphism, and their potential for traceability of genetic resources. He maintained interest in repetitive DNA throughout his career

and more recently developed SilkSatDB, a silkworm microsatellite data base and then InSatDb, an interactive interface to query information regarding microsatellite characteristics of fully sequenced insect genomes. As a major silk-producing country, India is home to the mulberry silkworm but also to three other varieties of natural silks: tasar, eri and muga, unique silkworm Dapagliflozin species that feeds on specific host plants. In this field, Nagaraju pioneered the study of the diversity and of the population structure of these rare silkmoths, of dwindling culture. His experience in the study of genome polymorphism and plasticity led him to investigate the genetic diversity of Basmati rice, a high added value product of India agriculture. By using SSR markers, he could develop rapid multiplex microsatellite marker assays for the authentication of traditional Basmati varieties, which awarded him the gratefulness of the Indian Government. In CCMC and CDFD, he also took interest in many fundamental questions. One concerned determination of sex, a fascinating paradigm owing to the myriad of sex determining primary signals among insect species, which he approached with Giuseppe Saccone (Italy).

In addition, this procedure requires an experienced endoscopist who is competent at performing both EUS-FNA and ERCP.29 A recent study30 using endobiliary

radiofrequency ablation followed by self-expandable metallic stent placement showed proven results in the management of malignant biliary strictures. However, the bipolar radiofrequency ablation probe is 8F (2.6 mm) in diameter with a relatively blunt tip that is unlikely to pass through the high-grade strictures described in our series. Another case series31 reported successful percutaneous recanalization of anastomotic biliary strictures with a radiofrequency guidewire, typically used in cardiology. This radiofrequency device is currently unavailable for an endoscopic approach. Although there are studies reporting the use of the Soehendra

stent retriever to dilate tight strictures safely, cases Protein Tyrosine Kinase inhibitor have also been reported Alectinib molecular weight in which this technique was unsuccessful.8, 9, 10 and 32 The current study demonstrates that the wire-guided needle-knife technique is a salvage approach, gaining success in 9 of 10 failed cases when using conventional methods. Most cholangiocarcinomas are adenocarcinomas with abundant fibrous stroma.33 The stricture usually presents as concentric or annular thickening of the tumor tissue (up to 1 cm), which may lead to complete obstruction of the lumen.34 Benign biliary or pancreatic strictures are usually surrounded by rich fibrosis tissue because of hypoxemia secondary to decreased blood supply and thickening of the duct walls causing complete or near-complete obstruction of the lumen. Because of the pathologic features of these strictures, electronic cut of stricture lesions with the needle-knife is potentially reasonable and safe. The needle-knife technique is performed as follows. First, using

the blend current allows the cutting current to cut the thickened wall of the stricture while the coagulation current helps prevent bleeding. Second, the monofilament cut wire is extended to a suitable length about 3 mm beyond the distal tip, which is long enough to cut the thickened wall of stricture along the axis. Third, the Gemcitabine mw needle-knife is pushed through the stricture slowly and with constant pressure. Fourth, firm back-tension is applied to the guidewire to keep it in the right direction. Finally, the direction of the needle-knife should be observed with the use of fluoroscopy to see whether there is free gas under the diaphragm or retroperitoneal air around the extrahepatic bile duct or kidney during needle-knife electrocautery. If any abnormality is detected, the procedure should be terminated immediately because of safety concerns. In our series mild adverse events related to needle-knife technique occurred in two cases: one was self-limited bleeding and another was bile duct perforation.