Any small bowel polyp ≥ 1 cm in size on radiological imaging Barasertib was referred for DBE-assisted polypectomy. Antegrade and retrograde DBE were successful in reaching and resecting targeted polyps in 90% (18/20) and 71.4% (10/14) of procedures, respectively. The overall success rate for DBE-assisted polypectomy

was 82.3% (95% confidence interval: 66.5–91.6%). The median size of resected polyps was 2 cm (range 1–5 cm) and all were hamartomas. Minor adverse events occurred in four (11.8%) procedures, including abdominal pain (n = 2), immediate post-polypectomy bleeding (n = 1), and self-limited hematochezia (n = 1). DBE-assisted polypectomy was successful in over 80% of HPS patients with an acceptable margin of safety. To the knowledge of the authors, this is one of the largest single-center studies to report on the performance and safety of DBE-assisted polypectomy in HPS Trichostatin A patients. “
“Department of Microbiology, Ewha Womans University School of Medicine, Seoul, Republic of Korea Mixed cryoglobulinemia (MC) is the most common extrahepatic manifestation of chronic hepatitis C virus (HCV) infection. Although the formation of inflammation-triggering immune complexes is driven by clonal expansions of autoreactive B

cells, we found total B cell numbers paradoxically reduced in HCV-infected patients with MC. HCV patients with MC (n = 17) also displayed a reduced number and a reduced frequency of naïve B cells compared with HCV-infected patients without MC (n = 19), hepatitis B virus–infected patients (n = 10), and uninfected controls (n = 50). This was due to an increased sensitivity of naïve B cells to apoptosis resulting in a reduction in the size of the naïve B cell subset. In addition, 4-fold expansion and skewing (lower T1/T2-ratio) 上海皓元 of the immature B cell subset was noted in MC patients, suggesting that apoptosis of naïve B cells triggered the release of B cell precursors from bone marrow in an attempt to maintain normal B cell numbers. Following treatment of MC with the B cell–depleting antibody rituximab, the size of all B cell subsets, the T1/T2-ratio, and the cyroglobulin levels all normalized. Cryoglobulin

levels correlated with in vivo proliferation of T2 B cells, suggesting a link between the skewing of the T1/T2 ratio and the formation of immune complexes. Conclusion: This study provides insight into the mechanisms maintaining B cell homeostasis in HCV-induced MC and the ability of rituximab therapy to restore normal B cell compartments. (HEPATOLOGY 2012;56:1602–1610) Chronic hepatitis C virus (HCV) infection is associated with extrahepatic manifestations that include B cell disorders. Mixed cryoglobulinemia (MC), the most common of these B cell abnormalities, is characterized by clonal proliferation of B cells and the formation of cold-precipitable cryoglobulin complexes composed of immunoglobulin M antibodies with rheumatoid factor activity (reviewed by Agnello et al.1 and Charles and Dustin2).