OBJECTIVE

Human milk provides a complex mixture of animal lipids, whereas the fat supply of most modern infant formula is based on vegetable oils. We studied the effects of breast-feeding and of feeding infant formula either without or with dairy goat lipids on the composition of infant plasma glycerophospholipids.

METHODS

Healthy-term infants were randomized double blind to feeding with infant formula based on whole goats' milk (GIF, approximately 60% milk fat and 40% vegetable oils) or a control cows' milk infant formula based on vegetable oils (VIF) from 2 weeks after birth. A reference group of fully breast-fed infants was also followed. At the age 4 months, blood samples were collected and plasma glycerophospholipids were analyzed with liquid chromatography coupled to triple quadrupole mass spectrometry.

RESULTS

The group of breast-fed infants showed significantly higher contents of glycerophospholipid species containing sn-2 palmitic acid [PC(16:0/16:0) and PC(18:0/16:0)] and significantly higher contents of glycerophospholipid species containing long-chain polyunsaturated fatty acids than infants in both formula groups. The GIF group demonstrated significantly higher glycerophospholipid species containing myristic acid [LPC(14:0), PC(14:0/18:1), PC(16:0/14:0)] and palmitoleic acid [LPC(16:1), PC(16:0/16:1), and PC(16:1/18:1)] than the VIF group.

CONCLUSIONS

We conclude that breast-feeding induces marked differences in infant plasma glycerophospholipid profiles compared with formula feeding, whereas the studied different sources of formula fat resulted in limited effects on plasma glycerophospholipids.

Chloramination has been widely applied for drinking water disinfection, with monochloramine (NH2Cl) the dominant chloramine species. However, under neutral pH, NH2Cl can autodecompose and react with chemical components in drinking water, thus decreasing disinfection efficiency. In tap water, the NH2Cl loss rate can be influenced by temperature, pH, Cl/N molar ratio, the initial NH2Cl concentration, and the natural organic matter (NOM) concentration. A good prediction of NH2Cl loss can assist in the operation of drinking water treatment plants. In this research, a kinetic rate constant>)and a reactive site fraction (S = 0.43 ± 0.06) for the reaction between free chlorine released from NH2Cl autodecoposition and tap water NOM were derived from a kinetic model to predict the NH2Cl loss under various conditions. A temperature-dependent model was also developed. The model predictions match well with the experimental results, which demonstrates the validity of the model and provides a convenient and accurate method for NH2Cl loss calculations.

Fiberendoscopy has become a diagnostic and therapeutic procedure of the outmost importance also in pediatric gastroenterology. 100 gastrointestinal fiberoscopies have been carried out on 81 patients ranging in age from 1 month to 14 years during a three-year period (November 79 - October 82), using general anesthesia for 9 patients. The 70 upper GI endoscopies, almost always performed with the Olympus GIF P2 instrument, showed acute or chronic, limited or diffuse inflammatory changes in most cases; post-bulbar areas were successfully visualized in 46 patients. The 30 colonoscopies were carried out with the standard adult equipment in most part of cases; in 50% of cases the inspection was extended to the caecum. Inflammatory diseases have been frequently revealed, but more frequently no remarkable changes were found. Indications for "operative" endoscopy were dilatation of an esophageal achalasia and removal of four gastrointestinal bleeding polyps. All procedures gave satisfactory results, and no morbidity occurred to patients.

OBJECTIVE

Ultra-thin caliber endoscopes (UTCEs) are versatile and applicable in various conditions. However, only limited data exist on the actual daily clinical use of UTCEs. The aim of our study was to determine indications for UTCEs in a large patient cohort. In turn, our 2 main objectives were (1) to evaluate patient comfort and safety and (2) to determine benefits and potential advantages associated with the use of UTCEs in this same cohort.

METHODS

We performed a retrospective analysis of our prospective database of 1028 procedures with UTCEs in 457 patients. All procedures were carried out in the Department of Gastroenterology and Hepatology, VU University Medical Center, in Amsterdam, the Netherlands, between May 2008 and May 2014. In these procedures, either the Fujinon (Tokyo, Japan) EG-530N UTCE or the Olympus (Tokyo, Japan) GIF N-180 UTCE was used.

RESULTS

Mean (standard deviation [SD]) age of patients was 64 (20) years, and most (60 %) of the patients were men. Most (61 %) of the underlying diseases, requiring endoscopic procedures, were found in the esophagus. Of the procedures performed, 91 % were successful, and 82 % were therapeutic. In comparison with regular endoscopes, the most important advantage of the UTCE was the ability to pass a stenosis (37 %), followed by nasogastric feeding tube placement (13 %). Newer and more innovative uses of the UTCE were percutaneous endoscopic gastrostomy (PEG)-jejunal extension placement with endoscope introduction through existing PEG tract, retrograde esophageal introduction through existing PEG tract, inspection of colonic neovagina stenosis, and direct inspection of the common bile duct.

CONCLUSIONS

In everyday clinical practice, the UTCE has specific advantages over conventional endoscopes because of its small caliber. The 3 main advantages are (1) introduction of high-grade strictures; (2) introduction of fistulas, including PEG fistula; and (3) increased patient comfort. The endoscopist should appreciate these advantages and consider use of the UTCE accordingly.

The patient was a 76-year-old man with advanced gastric cancer located in cardia, and was diagnosed to have an invasion to diaphragma and multiple lymph node metastases. We treated successfully with 12-course of S-1 chemotherapy. But second primary gastric cancer was detected in antrum 26 months after primary therapy. We treated with S-1/paclitaxel ( PTX) combined chemotherapy. S-1 (80 mg/m2) was orally administered for 2 weeks followed by a week interval and PTX (50 mg/m2) was also administered days 1 and 8. One course of chemotherapy was 21 days. GIF and abdominal CT revealed complete response (CR) after 3 courses of chemotherapy. We are now going on 6 courses of chemotherapy and the patient did not experience any grade 3 adverse effects.

Here, we report a case of advanced gastric cancer that demonstrated CR after treatment with S-1 and paclitaxel. The patient was an 80-year-old woman with gastric cancer in whom upper gastrointestinal endoscopy (GIF) revealed a type 3 tumor in the cardia of the stomach that was pathologically diagnosed as a well-differentiated adenocarcinoma. Computed tomography showed no lymph node involvement or metastasis. Considering her advanced age and cardinal functional disorder, she was administered chemotherapy consisting of S-1 and paclitaxel. Depending on a state, a side effect, I changed a dose and inter-dose interval from head to foot and I treated it by foreign going to hospital and continued it. Gradual tumor reduction was observed on GIF (2011/1/25). CR was diagnosed without tumor disappearance, with accepted malignant findings on biopsy. The patient has now survived for 7 years 9 months after diagnosis. The present case demonstrates that combination therapy of S-1 and paclitaxel is safe and useful for patients with risk factors such as advanced age and underlying disease.

A growth-inhibiting activity was identified in supernatants of the neoplastic V79 Chinese hamster cell line based on its ability to inhibit the proliferation of the same cell line. The partially purified activity, provisionally termed "growth inhibiting factor" (GIF) activity, inhibited the growth of a wide variety of human tumor cells, but not various normal human fibroblasts. This species-nonspecific activity was reversible, saturable, and highly potent in tumorigenic cell lines, and was noted in both monolayer culture and in soft agar. The inhibitory activity of GIF was also exhibited in a chemically defined serum-free medium supplemented with insulin and transferrin. GIF activity was stable to acid, heat, trypsin, and dithiothreitol but sensitive to alpha-chymotrypsin. The pattern of growth modulation by GIF on V79 cells was apparently different from those exhibited by bifunctional peptides such as transforming growth factor-beta, tumor necrosis factor-alpha, and interleukin-1-alpha. In addition, GIF activity cannot be ascribed to these cytokines based on the physicochemical and immunologic properties. Although GIF has yet to be purified to homogeneity, these data suggest that GIF might be a novel growth regulator which has a critical role in regulating growth of V79 cells. The growth modulation of tumor cells by this tumor-derived growth inhibiting activity suggested the presence of an autocrine growth regulatory mechanism even in tumor cells.

Carbonyl sulfide (COS) has been proposed as a proxy for carbon dioxide (CO2) taken up by plants at the leaf and ecosystem scales. However, several additional production and removal processes have been identified which could complicate its use at larger scales, among which are soil uptake, dark uptake by plants, and soil and anthropogenic emissions. This study evaluates the significance of these processes at the regional scale through a top-down approach based on atmospheric COS measurements at Gif-sur-Yvette (GIF), a suburban site near Paris (France). Over a period of four and a half years, hourly measurements at 7 m above ground level were performed by gas chromatography and combined with 222Radon measurements to calculate nocturnal COS fluxes using the Radon-Tracer Method. In addition, the vertical distribution of COS was investigated at a second site, 2 km away from GIF, where a fast gas analyzer deployed on a 100 m tower for several months during winter 2015-2016 recorded mixing ratios at 3 heights (15, 60 and 100 m). COS appears to be homogeneously distributed both horizontally and vertically in the sampling area. The main finding is that the area is a persistent COS sink even during wintertime episodes of strong pollution. Nighttime net uptake rates ranged from -1.5 to -32.8 pmol m-2 s-1, with an average of -7.3 ± 4.5 pmol m-2 s-1 (n = 253). However, episodes of biogenic emissions happened each year in June-July (11.9 ± 6.2 pmol m-2 s-1, n = 24). Preliminary analyses of simulated footprints of source areas influencing the recorded COS data suggest that long-range transport of COS from anthropogenic sources located in Benelux, Eastern France and Germany occasionally impacts the Paris area during wintertime. These production and removal processes may limit the use of COS to assess regional-scale CO2 uptake in Europe by plants through inverse modeling.

Structural characterization of peptides in the range of 500-5000 Da, using fast atom bombardment (FAB) and Cs+ ion liquid secondary ion mass spectrometry (SIMS), is reviewed. These include synthetic peptides Kemptamide (mol wt 1516); GIF-C15 (mol wt 1875), an isolated natural product as an acylated pentapeptide; and polypeptides generated from enzymatic digests of proteins. MS data is shown to reveal molecular weight and sequence information as well as determine disulfide bonds between cysteine residues and glycosylation sites in the case of a glycopeptide. The complementarity of MS technique to classical biochemical methods for peptide characterization is highlighted. The reader is briefly acquainted with two newer ionization techniques namely, electrospray ionization (ESI) and matrix-assisted laser desorption ionization (MALDI). Synthetic chemists and biochemists can refer to the in-depth review articles that are cited throughout this article.

We present Admiral (Automated Docking and Molecular dynamics InfoRmatics and AnaLysis), a platform which automates the process of running molecular docking and molecular dynamics on compound designs for medicinal chemistry project teams. In addition to running the simulations, Admiral analyzes the simulation and automatically generates a PowerPoint slide, with the goal of having all the information required to decide whether to synthesize the compound in one place. This information includes results and analyses from the MD simulation, predicted ADME and physical-chemical properties, information on similar compounds in the SAR, and an animated GIF of the simulation. This report is then emailed to the compound designer, generally within the same day. Within Eli Lilly and Co., we have developed and deployed Admiral on an internal discovery project where it has been heavily used by the project team. Several additional discovery projects have adopted the platfom in recent months.

Neuronal growth inhibitory factor (GIF), known also as metallothionein-III (MT-III), was the first validated to be capable of inhibiting growth of neuronal cells in nervous system, its beta-domain being functional. GIF functional di-domain (GIFbeta- beta) was constructed to study the structure and function of GIF. N terminal beta-domain and C terminal beta-domain cDNAs were amplified by PCR, inserted into vector pGEX-4T-1 and expressed in Escherichia coli, as carboxyl terminal extension of glutathione-S-transferase (GST), by IPTG induction. After digestion by thrombin, the fusion protein was isolated by passing through a glutathione-Sepharose 4B affinity chromatography column and was purified by gel fit ration on Sephacryl-S100. About 60 mg protein per liter of bacterial cell culture was achieved. The results of SDS-PAGE, amino acid composition, molecular mass, the ratio of metal/protein and sulfhydryl group/protein showed that the purified protein was the GIFbeta- beta. Circular dichroism (CD) spectroscopy show GIFbeta- beta has characteristic metal-sulfhydryl clusters of metallothionein family. Inhibitory activities detected by the MTT reduction assay are: GIF>> GIFbeta-beta>> GIF beta-domain.

The so called Geographical Information System (GIS) is one of the basic tools for wide range of public health applications. We had developed a general purpose GIS and applied it to represent geographical distribution of patients of the bacterium E. coli O-157 which bursted out in Japan last early summer particularly at Sakai City in Osaka Prefecture. The patient record have been supplied from the Food Safety Office of the Ministry of Health and Welfare. These records were handled by EXCEL. The basic geographical data was constructed from the map data provided by Japan Geographical Survey Institute, and ArcView 2 was used as the map system. The maps were converted to Graphics Interchange Format (GIF) files and put on our Web server.

There is urgent need in effective and cost-efficient data storage as worldwide requirement of data storage rapidly growing. DNA has introduced a new tool for storing digital information. Recent studies successfully store digital information such as text and gif animation. Previous studies tackle technical hurdles due to errors from DNA synthesis and sequencing. Studies also have focused on the strategy which makes use of 100-150 bps of read size in both synthesis and sequencing. In this paper, we suggest novel data encoding / decoding scheme which makes use of long read DNA (~1,000bp). This enables accurate recovery of stored digital information with a smaller number of reads than previous approach. Also, the approach reduces sequencing time.

This group-randomized controlled trial examines the effects of a school garden intervention on availability of fruits and vegetables (FV) in elementary school children's homes. Within each region, low income U.S. schools in Arkansas, Iowa, New York, and Washington State were randomly assigned to intervention group (n = 24) or waitlist control group (n = 22). Children were in grades 2, 4, and 5 at baseline (n = 2768). The garden intervention consisted of both raised-bed garden kits and a series of grade-appropriate lessons. FV availability at home was measured with a modified version of the GEMS FJV Availability Questionnaire. The instrument was administered at baseline (Fall 2011) and throughout the intervention (Spring 2012, Fall 2012, Spring 2013). Analyses were completed using general linear mixed models. The garden intervention led to an overall increase in availability of low-fat vegetables at home. Among younger children (2nd grade at baseline), the garden intervention led to greater home availability of vegetables, especially, low-fat vegetables. Moreover, for the younger group, garden intervention fidelity (GIF) or robustness predicted home availability of fruit, vegetables, and low-fat vegetables. School gardens have potential to affect FV availability in the home environment.

To evaluate the relationship between measures of maintenance and body composition, data were collected on 12 mature, nonpregnant, nonlactating ewes from each of seven breeds following 6 wk of ad libitum (AL) or maintenance (MN) feeding (six per breed-level). After fasting 56 h, fasting heat production (FHP) was measured for each of 42 pairs of ewes over a 16-h period. Ewes then were slaughtered and the empty body divided into visceral organs and blood (ORB); gastrointestinal tract and internal fat (GIF); head, hooves and pelt (HHP); and carcass (CAR). Each fraction was chemically analyzed for water, fat, ash and (by difference) fat-free dry organic matter (FFDOM or protein). Correlations with FHP/d were highest (.86 to .87) for weights of empty body and body water or lean (FFDOM + water) and were lower (.77) for weight of empty body fat. Best nonlinear LWT predictors of FHP/d were LWT.63 and water.71 or lean.71 (R2 = .76). Correlations of metabolic FHP (kcal/kg.75) with percentage lean and fat, respectively, were .53 and -.55 for the empty body and .60 and -.60 for the GIF fraction. For AL ewes, the better predictors of FHP/d were weights of lean in GIF + ORB (R2 = .88, ESD = 106), live weight (LWT) plus fat and lean in GIF fraction (R2 .88, ESD = 112) or LWT plus fat in HHP and GIF fractions (R2 = .90, ESD = 103). For MN ewes, LWT alone was as accurate (R2 = .80, ESD = 123) as any combination of components. Breed mean daily FHP was predicted very accurately (R2 = .94) from total weight of empty body lean plus the proportion of total body lean located in the GIF fractions.

Humans can discriminate whether a change in the direction of gravito-inertial force (GIF) is caused by body tilt or by linear translation. This ability, attributed to vestibular sensory fusion, is often examined by asking subjects to adjust an indicator to match their subjective earth-fixed vertical (SV). We used two different modalities, visual and haptic, to examine continuous adjustment during different combinations of roll rotation and linear translation on a hexapod motion device. We conclude that, in conditions of combined translational and rotational motion, the modality of indication plays a major role for the perception of verticality of the indicator.

Curly-leaf pondweed (Potamogeton crispus) was utilized as the representative to investigate the biodecomposition process of aquatic plants under different reducible conditions. Results showed that the methane production was inhibited when different electron acceptors (Fe(III),> and>) were available. The methane production was decreased by 57% when Fe(III) and> or> were both available compared to the control. The degradation efficiency of hemicellulose and lignin with Fe(III) and> were increased significantly. This provided a theoretical basis for slowing down the emissions of methane.

This study aims to explore, within the framework of theories of self-regulation, risk profiles for anorexia nervosa and bulimia nervosa, in two countries of different cultures: Poland and France The studied population consists of 106 women of Polish (from Silesia) and French (from the region around Metz) nationality. We examine a group of 30 Polish and 32 French anorexics as well as 30 Polish and 14 French bulimics. All the participants filled in the EDI by Garner and al. (1983), the SEI by Coopersmith (1984), the GIFS by Maes et al. (2000), the Brief COPE by Carver (1997), the SECS by Van Elderen et al. (1997), the HADS by Zigmond and Snaith (1983) and the IPC by Levenson (1981). Our results indicate that the profile of Polish anorexics closely resembles that of French anorexics. There are two independent variables which play an equally important role: the interiorisation of anger and conflicts in the goals of intellectual development (the importance and at the same time the difficulty of reaching these goals). The factors predicting bulimia nervosa are not the same in the two populations under study.

Background: Adolescents and young adults in the age range of 13-24 years are at the highest risk of developing HIV infections. As social media platforms are extremely popular among youths, researchers can utilize these platforms to curb the HIV epidemic by investigating the associations between the discourses on HIV infections and the epidemiological data of HIV infections.

Objective: The goal of this study was to examine how Twitter activity among young men is related to the incidence of HIV infection in the population.

Methods: We used integrated human-computer techniques to characterize the HIV-related tweets by male adolescents and young male adults (age range: 13-24 years). We identified tweets related to HIV risk and prevention by using natural language processing (NLP). Our NLP algorithm identified 89.1% (2243/2517) relevant tweets, which were manually coded by expert coders. We coded 1577 HIV-prevention tweets and 17.5% (940/5372) of general sex-related tweets (including emojis, gifs, and images), and we achieved reliability with intraclass correlation at 0.80 or higher on key constructs. Bivariate and multivariate analyses were performed to identify the spatial patterns in posting HIV-related tweets as well as the relationships between the tweets and local HIV infection rates.

Results: We analyzed 2517 tweets that were identified as relevant to HIV risk and prevention tags; these tweets were geolocated in 109 counties throughout the United States. After adjusting for region, HIV prevalence, and social disadvantage index, our findings indicated that every 100-tweet increase in HIV-specific tweets per capita from noninstitutional accounts was associated with a multiplicative effect of 0.97 (95% CI [0.94-1.00]; P=.04) on the incidence of HIV infections in the following year in a given county.

Conclusions: Twitter may serve as a proxy of public behavior related to HIV infections, and the association between the number of HIV-related tweets and HIV infection rates further supports the use of social media for HIV disease prevention.

Keywords: HIV/AIDS; natural language processing; social media; surveillance; youth.

Background: Advanced ovarian cancer (AOC) requires an aggressive surgery with large visceral resections in order to achieve an optimal or complete cytoreduction and increase the patient's survival. However, the surgical aggressiveness in the treatment of AOC is not exempt from major complications, such as the gastrointestinal fistula (GIF), which stands out among others due to its high morbidity and mortality.

Methods: We evaluated the clinicopathological features in patients with AOC and their association with GI. Data for 107 patients with AOC who underwent primary debulking surgery were analyzed retrospectively. Clinicopathological features, including demographic, surgical procedures and follow-up data, were analyzed in relation to GIF.

Results: GIF was present in 11% of patients in the study, 5 (4.5%) and 7 (6.4%) of colorectal and small bowel origin, respectively. GIF was significantly associated with peritoneal cancer index (PCI) >20, more than 2 visceral resections, and multiple digestive resections. Overall and disease-free survival were also associated with GIF. Multivariate analysis identified partial bowel obstruction and operative bleeding as independent prognostic factors for survival. The presence of GIF is positively associated with poor prognosis in patients with AOC.

Conclusion: Given the importance of successful cytoreductive surgery in AOC, the assessment of the amount of tumor and the aggressiveness of the surgery to avoid the occurrence of GIF become a priority in patients with AOC.

Keywords: advanced ovarian cancer surgery; complications; intestinal fistula; intestinal leakage.

Researchers have recently begun to evaluate video-based preference assessments; however, only two studies have evaluated the efficacy of this preference assessment modality in assessing preference for social interactions. Four individuals diagnosed with autism spectrum disorder who could not match pictures or graphic-interchange-format images (GIFs) of social interactions to in vivo interaction participated. We compared picture and GIF-based paired-stimulus preference assessments for social interaction and evaluated the preference assessment hierarchies by conducting a concurrent-operant reinforcer assessment including all social interactions. The GIF-based preference assessment produced similar hierarchies to the reinforcer assessment for all participants, whereas the picture-based preference assessments produced similar hierarchies to the reinforcer assessment for 2 of 4 subjects. Additionally, we conducted a modality preference assessment in which we evaluated participants' preference for viewing GIFs or pictures of social interactions, and found that 3 out of 4 subjects displayed a preference for GIFs.

BACKGROUND

We proposed previously that the mean lysine requirement value is approximately 30 mg * kg(-)(1) * d(-)(1) rather than the proposed 1985 FAO/WHO/UNU estimate of the upper range of the requirement, which is 12 mg * kg(-)(1) * d(-)(1).

OBJECTIVE

Our objective was to explore the 24-h pattern and rate of whole-body lysine [l-(13)C]oxidation and status of whole-body lysine balance in healthy, young adults given an L-amino acid diet supplying either a low lysine intake (14-15 mg * kg(-)(1) * d(-)(1)) or an intermediate lysine intake (29 mg * kg(-)(1) * d(-)(1)) for 6 d before a continuous tracer study with L-[1-(13)C]lysine.

METHODS

Five subjects received the low lysine intake, 6 subjects received the intermediate intake, and all were studied by using a standard 24-h oral tracer protocol that was described earlier for studies at a generous lysine intake.

RESULTS

The rate of lysine oxidation was not significantly different between the 12-h fasted and 12-h fed states. The daily oxidation rate (f1.gif" BORDER="0"> +/- SD) was 27. 9 +/- 8.8 and 27.3 +/- 17.6 mg lysine * kg(-)(1) * d(-)(1) for the low- and intermediate-intake groups, respectively (NS). Daily lysine balance was -12.4 +/- 92 and 1.8 +/- 17.7 mg * kg(-)(1) * d(-)(1), respectively (P < 0.025), for the low and intermediate intakes. The balance was significantly less than zero (P < 0.001) for the low intake.

CONCLUSIONS

The FAO/WHO/UNU lysine requirement value is not sufficient to maintain lysine homeostasis in healthy adults. From the results of this and tracer studies done by others, the mean lysine requirement of healthy adults was determined to be 30 mg * kg(-)(1) * d(-)(1).

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is used for malignant biliary obstruction (MBO) when endoscopic retrograde cholangioscopy is technically challenging. Clinical practical guideline recommends self-expandable metallic stents (SEMS) of >10 cm to prevent stent migration; however, additional endoscopic reintervention occasionally becomes difficult because of the length [1-4]. Here, we present a case of biloma caused by stent migration after EUS-HGS, and plastic stent placement was successfully performed using a dual-channel endoscope. A 57-year-old man with unresectable pancreatic cancer underwent transpapillary biliary metallic stent (BMS) placement for MBO. Then, EUS-HGS was performed using an end-bare-type fully covered SEMS (Niti-S, 8 mm × 10 cm; Taewoong Medical, Seoul, Korea) for stent obstruction with duodenal invasion due to tumor. However, he developed a high fever 10 days after EUS-HGS. Contrast-enhanced computed tomography indicated biloma formation caused by stent migrated in the liver parenchyma (Fig. 1). We could not remove the EUS-HGS stent, therefore drainage from the stomach through the stent using a dual-channel endoscope (GIF-2TQ260M; Olympus, Tokyo, Japan) was performed. The edge of the stent was fixed by a snare from one channel, and a catheter with a hairpin-curved guidewire was inserted through the fixed stent from the other channel (Fig. 2) [5]. The guidewire was easily passed through the stent, and a 7-Fr plastic stent was successfully placed into the biloma (Figs. 3-5). The biloma resolved immediately, after which the ultrathin endoscope could pass through the duodenal stenosis, and transpapillary BMS placement for MBO was performed.