Reports of strategies of thrombus removal for acute DVT, especially in patients with iliofemoral DVT, consistently demonstrate improved outcomes relative to postthrombotic morbidity. This summary reviews

the evidence supporting this strategy as the preferred initial management of patients with extensive proximal DVT. (J Vase Surg 2012;55: 607-11.)”
“Paraquat (PQ) is an organic heterocyclic herbicide that is widely used throughout the world. Epidemiological and neuropathological studies have shown that chronic exposure to PQ increases the risk of Parkinson’s disease. Patients with acute PQ poisoning show damage to the lungs, liver, and kidneys, and some also show symptoms of central nervous system (CNS) toxicity. However, few studies have focused on the acute neurotoxic changes caused by PQ. Dynamic pathological changes in the human brain cannot be explored in animal models. Thus, to elucidate the impact of acute.PQ poisoning selleck chemicals on the CNS, neuroimaging studies of poisoned IACS-10759 datasheet victims, and especially survivors, should be performed. This study reports the first application of magnetic resonance imaging (MRI) techniques on patients with acute PQ poisoning, including survivors. We found significant abnormal signals

in the brains of two patients during the acute post-poisoning phase. Using susceptibility weighted imaging (SWI), we documented changes in the corrected phase values for the extrapyramidal ganglia of survivors, and these values correlate with excessive iron deposition. Our diffusion tensor imaging (DTI) results were suggestive of

microstructural changes in the extrapyramidal ganglia and hippocampus after PQ poisoning. These neuroimaging results provide an indirect demonstration that acute PQ neurotoxicity exerts a sustained effect during the Flucloronide acute and recovery stages of poisoning. (C) 2012 Elsevier Inc. All rights reserved.”
“We treated the high salt-washed canine pancreatic rough ER (KRM) with 0.18% Triton X-100, separated the extract from the residual membrane (0.18%Tx KRM), and processed the extract with SM-2 beads to recover membrane proteins in proteoliposomes. To focus on integral membrane proteins, KRM, 0.18%Tx KRM and proteoliposomes were subjected to sodium carbonate treatment, and analyzed by 2-D gel electrophoresis. Consequently we found that a distinct group of integral membrane protein of KRM preferentially extracted from the membrane and recovered in proteoliposomes did exist, while majority of KRM[ integral membrane proteins were fractionated in 0.18%Tx KRM, which retained the basic structure and functions of KRM. Protein identification showed that the former group was enriched with proteins exported from the ER and the latter group comprised mostly of ER resident proteins. This result will potentially affect the prevailing view of the ER membrane structure as well as protein sorting from the ER.

Given the inverse correlation of learning and memory deficits with social and vocational functioning in established schizophrenia, our findings substantiate the rationale for developing preventive treatment strategies that maintain cognitive capacities in the at-risk mental state.”
“Do nonhuman animals share humans’ capacity for metacognition-that is, for monitoring or regulating their own cognitive states? Comparative psychologists have approached this question by testing a dolphin, pigeons, rats, monkeys and apes using perception,

memory and food-concealment paradigms. There is growing evidence that animals share functional parallels with humans’ conscious metacognition, although the field has not confirmed full experiential parallels and this remains an open question. This article reviews this new area of comparative inquiry and describes significant Fulvestrant molecular weight empirical milestones, remaining theoretical millstones and the prospects for continuing progress in a rapidly developing area. This research area opens a new window on reflective mind in animals, illuminating its phylogenetic emergence and allowing researchers to trace Selleckchem Quizartinib the antecedents of human consciousness.”
“Advances in telecommunication technologies have created

new opportunities to provide telemedical care as an adjunct to medical management of patients with heart failure. Meta-analyses suggest that telemedicine can reduce morbidity and mortality in such patients; however, two prospective clinical trials not included in the analyses do not support these findings. Therefore, the effectiveness of telemedicine in heart failure is not established. Telemedicine approaches range from computer-based support systems to programmes led by nurses and physicians. Standardisation and appropriate classification of telemedical systems are needed to enable accurate interpretation of

clinical trials. Here we propose a classification of four generations of telemedicine in heart failure. Not all approaches are the same and not every patient with heart failure will need Resveratrol telemedicine. Crisis prevention and treatment, and stabilisation and self-empowerment of patients are focuses of telemedicine in heart failure. The profile of patients who can potentially benefit from telemedicine is unknown and should be investigated in adequately powered randomised clinical trials. We are optimistic that telemedicine is an efficient approach and will become an important feature of management in heart failure.”
“Presynaptic metabotropic glutamate receptors (mGluRs) at glutamatergic synapses play a major role in governing release probability. Previous reports indicated a downregulation of group III mGluRs at the lateral perforant path-granule cell synapse in the chronically epileptic hippocampus.

Methods: We performed a candidate gene association study of polymorphisms in genes coding matrix metalloproteinases

Poziotinib mw (MMPs), tissue inhibitors of MMPs (TIMPs), and elastin (ELN) in AAA. DNA samples from 423 AAA patients and 423 controls were genotyped for 12 polymorphisms in 10 genes: MMP1 (-1607G/GG), MMP2 (-735C/T; -1306C/T; -1575 G/A), MMP3 (5A/6A), MMP9 (-1562C/T), MMPIO (A180G), MMP-12 (-82A/G), MMP-13 (-77A/G), TIMP 1 (C434T), TIMP3 (-1296T/C), and ELN (G1355A).

Results: Genotype distribution was significantly different between patients and controls for the following polymorphisms: -1306C/T MMP2; 5A/6A MMP3; -77A/G MMP-13; G1355A ELN; and C434T TIMP1. In a multivariable logistic regression analysis adjusted for traditional cardiovascular risk factors and chronic obstructive pulmonary disease, 1306C/T MMP2 (odds ratios [OR] = 0.55 [95% confidence interval, CI.34-.85], P < https://www.selleckchem.com/products/bromosporine.html .007) and G1355A ELN (OR = 0.64 ([95%. CI.41-.99], P = .046) polymorphisms resulted in independent protective factors for abdominal aortic aneurysm (AAA), whereas 5A/6A MMP3 (OR = 1.82 [95% CI

1.04-3.12], P = .034) and -77 A/C MMP-13 (OR = 2.14 [95% CI 1.18-3.86], P = .012) polymorphisms resulted in independent risk factors for AAA. In a multivariable logistic regression analysis adjusted for traditional cardiovascular factors and chronic obstructive pulmonary disease, the prevalence of the contemporary presence of three or four genetic risk conditions was

a strong and independent determinant of AAA disease (OR = 2.96, 95% CI 1.67-5.24, P < .0001). For those polymorphisms independently associated with AAA in this study (-1306C/T MMP2, 5A/6A MMP3, -77A/G MMP-13, and G1355A ELN polymorphisms), we performed a meta-analysis of the available data (this paper and literature data). We found a significant association with an increased risk of AAA for MMP3 (AAA patients n = 1258, controls n = 1406: OR = 1.48 [95% CI = 1.23-1.78], I-2 = 0%) and MMP-13 (AAA patients n = 800, controls n = 843: OR = 1.37 [95% CI = 1.04-1.82], Histidine ammonia-lyase I-2 = 25%) polymorphisms and a trend that did not reach the statistical significance, toward a decreased risk of AAA for MMP2 (AAA patients n = 1090, controls n = 1077: OR = 0.83 [95% CI = .60-1.15], I-2 = 7 1%) and ELN (AAA patients n = 904, controls n = 1069: OR = 0.79 [95% CI = .53-1.18], I-2 = 72%) polymorphisms.

Conclusions: These findings suggest that polymorphisms in MMP2, MMP3, MMP-13, and ELN genes may independently contribute to the pathogenesis of AAA. (J Vase Surg 2012;55:171-9.)”
“Many of the fundamental molecular mechanisms underlying tumor biology remain elusive and, thus, developing specific anticancer therapies remains a challenge.

Together with the results of a parallel event-related potential study [Hayama, H. R., Johnson, J. D., & Rugg, M. D. (2008). The relationship between the right frontal old/new ERP effect and post-retrieval monitoring: Specific or non-specific? Neuropsychologia,

46(5),1211-1223, doi:S0028-3932(07)00390-9], the present findings indicate that putative right DLPFC correlates of post-retrieval processing are not associated exclusively with monitoring or evaluating episodic content. BX-795 cost Rather, the effects likely reflect processing associated with monitoring or decision-making in multiple cognitive domains. Published by Elsevier Ltd.”
“The contralesional line bisection error in hemianopia is a well-known clinical phenomenon. Its origin, however, is still unclear. We therefore investigated the causes of the hemianopic bisection error in 84 patients with unilateral homonymous hemianopia without visuospatial neglect. Our results suggest that the contralesional bisection error is neither a consequence of the visual AZD5363 ic50 field defect itself nor a manifestation of strategic adaptation

of attention and eye movements into contralesional hemispace. Additional extrastriate brain injury, presumably to occipito-temporal areas including the occipital white matter, seems to be critical for the emergence of the contralesional bisection error that is frequently associated with but separable from homonymous hemianopia. (C) 2009 Elsevier Ltd. All rights reserved.”
“There are substantial individual differences in the size and shape of the corpus callosum and such differences are thought to relate to behavioral lateralization. We report findings from a large scale investigation of relationships between brain anatomy and behavioral asymmetry on a battery of visual word recognition tasks. A sample of 200 individuals was divided into groups on the basis of sex and consistency of handedness. We investigated differences between sex/handedness groups in callosal area and relationships between

callosal area and behavioral predictors. Sex/handedness groups did not show systematic differences in callosal area or behavioral asymmetry. However, the groups differed in the relationships between area of the corpus callosum and behavioral asymmetry. Among consistent-handed males, callosal area GABA Receptor was negatively related to behavioral laterality. Among mixed-handed males and consistent-handed females, behavioral laterality was not predictive of callosal area. The most robust relationship was observed in mixed-handed females, in whom behavioral asymmetry was positively related to callosal area. Our study demonstrates the importance of considering brain/behavior relationships within sub-populations, as relationships between behavioral asymmetry and callosal anatomy varied across subject groups. (C) 2009 Elsevier Ltd. All rights reserved.

Questions have been raised regarding the possible neurotoxic effects of DU in humans based on follow-up studies in Gulf War veterans, where a decrease in neurocognitive

behavior in a small population was noted. Additional studies in rodents indicated that DU readily traverses the blood-brain barrier, accumulates in specific brain regions, and results in increased oxidative stress, altered electrophysiological profiles, and sensorimotor deficits. This review summarizes the toxic potential of DU with emphasis on studies on thiol metabolite levels, high-energy phosphate levels, and isoprostane levels in primary rat cortical neurons. Studies in Caenorhabditis elegans detail the role of metallothioneins, small thiol-rich proteins, in protecting against DU exposure. In addition, recent studies

also demonstrate that only one of the check details two forms, metallothionein-1, is important in the accumulation of uranium in worms.”
“The effect of endogenous dopamine on the activity of target neurons recorded with patch clamp or Ca(2+) imaging techniques in slices has been studied to date with intrastriatal stimuli. Yet, this approach is severely handicapped by the non physiological and nonspecific stimulation of local neurons and fibers within the striatum. We now report a new juvenile and adult mouse slice preparation in which a component of the nigro-striatal dopaminergic click here pathway is preserved in its entirety, from cell bodies to axon terminals. This tilted U0126 price parasagittal slice (380-400 mu m) just medial to the subthalamic nucleus contains functional nigro-striatal neurons as assessed by morphological examination of tyrosine hydroxylase positive cell bodies and axons, combined with electrochemical assays of dopamine

release in the striatum in response to stimulation of the substantia nigra pars compacta. The nigro-striatal slice constitutes a suitable in vitro preparation to determine the impact of endogenously released dopamine on target neurons of the striatum. (C) 2009 IBRO. Published by Elsevier Ltd. All rights reserved.”
“Transport of the glutathione conjugates (GS-E) of electrophilic compounds generated during biotransformation of drugs and environmental pollutants is central to the mechanisms of defense against oxidative/electrophilic stress. In recent years emphasis has been placed on ATP-binding cassette (ABC) transport proteins in the transport of GS-E and their involvement in the detoxification mechanisms, including drug resistance. Recent studies, however, suggested that the majority of GS-E transport in human and rodent cells is mediated by a non-ABC, multifunctional stress-response protein, RLIP76 or RalBP1 (ral-binding GTPase activating protein 1), which also functions as an effector in the Ral-Ras-Rho signaling pathway.

We conclude that this line of development is a promising one for arriving at general theories of associative CA3 cell line learning and memory.”
“Previous studies have demonstrated alterations to fronto-limbic circuitry and callosal structure in borderline personality disorder (BPD). We

predicted that a first-presentation BPD cohort who demonstrated orbitofrontal cortex (OFC) reductions would show regional reductions in the anterior corpus callosum. Method: Twenty teenage first-presentation BPD patients and twenty matched healthy controls underwent Magnetic resonance imaging (MRI) was performed in 20 teenaged first-presentation BPD patients and 20 matched healthy controls. Corpus callosum size and shape and ventricular volume were estimated using established methods and compared between the two groups. The relationship between illness variables and callosal morphology was also Tubastatin A datasheet examined. OFC volume was correlated with callosal and ventricular variables. Results: BPD participants and controls did not differ on measures of callosal size or shape, or ventricular size. BPD participants showed

an alteration to the pattern of age-related expansions seen in the callosum. BPD participants with a history of trauma did not demonstrate significant neuroanatomical differences from those without. OFC volumes did not correlate with the thickness of the anterior corpus callosum. Conclusion: Gross neuroanatomical changes are not present at the level of the callosum in teenagers with first-presentation BPD. Changes seen in other studies might reflect factors associated with the duration Edoxaban of BPD, such as recurrent comorbidity with axis I disorders, or treatment.

(C) 2010 Elsevier Ireland Ltd. All rights reserved.”
“We report on a previously not recognized mutation in exon 6 of presenilin-1 (PSEN1)(c.520_522delCTG) in a male patient with early onset familial Alzheimer disease. The mutation results in the deletion of a leucine at amino acid position 174 of the protein. The index patient presented with progressive memory loss at 50 years of age. Initially, depression was the only ancillary symptom. At age 53 clinical diagnosis of early Alzheimer disease was made based on neuropsychological, neuroimaging, and CSF findings. The patient’s father and his paternal grandmother also suffered from memory loss and cognitive decline. The clinical findings in the patient are similar to signs and symptoms in previously reported patients with missense mutations at codon 174 of PSEN1. (C) 2013 Elsevier Ireland Ltd. All rights reserved.”
“Harris and Livesey. Learning & Behavior, 38, 1-26, (2010) described an elemental model of associative learning that implements a simple learning rule that produces results equivalent to those proposed by Rescorla and Wagner (1972), and additionally modifies in “”real time”" the strength of the associative connections between elements.

Biochemical and structural studies on ENT proteins have been limited by their low endogenous expression levels, hydrophobicity and labile nature. To address these issues, we developed an approach whereby tagged mammalian ENT1 protein was over-expressed in mammalian cell lines, confirmed to be functional and isolated by affinity purification to sufficient levels to be analyzed using MALDI-TOF and tandem MS mass spectrometry.

check details This proteomic approach will allow for a more detailed analysis of the structure, function and regulation of ENTs in the future. (C) 2010 Elsevier Inc. All rights reserved.”
“A canine influenza virus (CIV) strain of avian origin designated A/Canine/Jiangsu/06/2010 (H3N2) was isolated from dogs exhibiting severe respiratory disease in Jiangsu, China. We announce the complete genome sequence of this viral strain and report major findings from the genomic analysis. This sequence will help us understand the molecular characteristics and evolutionary of H3N2 CIV in China.”
“Bv8 is an amphibian peptide belonging to the widely distributed AVIT protein family. The mammalian orthologues of Bv8 were named prokineticin 1 and prokineticin

2. Two G-protein-coupled receptors for Bv8-prokineticins have been identified. The biological activities of Bv8/PK proteins range from angiogenesis and involvement in reproduction and cancer, to neuronal survival and neurogenesis, hypothalamic hormone secretion, circadian rhythm control and immunomodulatory

Selleck Panobinostat processes. Identifying the structural determinants required for receptor binding of Bv8-PKs is mandatory for the design of PKR antagonists, which may be useful in the treatment and prevention of various disease states.

Here we describe a procedure for the production in Pichia pastoris of Bv8 and 3 mutants: W24A-Bv8, in which the tryptophan in position 24 is substituted by alanine, the double mutant M1-W24A-Bv8, that contains an additional methionine at the N-terminus and Bv8-TyrTyr that includes two additional tyrosines these at the C-terminus. The results evidence a relevant role of tryptophan 24 in Bv8-PKRs interaction. (C) 2010 Elsevier Inc. All rights reserved.”
“Enterobacter cancerogenus is widely distributed in nature and is generally recovered from environmental or vegetal sources. In some cases, it has also been associated with human infections. In this study, the complete genomic sequence of virulent E. cancerogenus bacteriophage Enc34 was determined. The Enc34 genome is 60,364 bp in length and contains 80 open reading frames. To our knowledge, this is the first report of a bacteriophage infecting E. cancerogenus.”
“Wheat-embryo cell-free protein expression system allows efficient production of a wide variety of proteins. Homogeneity of the end products is an important characteristic of an advanced cell-free system that will be used in a field of protein science such as structural biology.

Stimulation of EGFR signaling in articular CHIR-99021 clinical trial chondrocytes by TGF alpha resulted in the activation of RhoA/ROCK (Rho kinase), MEK (MAPK/ERK kinase)/ERK (extracellular-signal-regulated kinase), PI3K (phosphoinositide 3-kinase) and p38 MAPK (mitogen-activated protein kinase) pathways. Modification of the chondrocyte actin cytoskeleton was stimulated by TGF alpha, but inhibition of only Rho or ROCK activation prevented morphological changes. TGF alpha suppressed expression of anabolic genes including Sox9, type II collagen and aggrecan, which were rescued only by inhibiting MEK/ERK

activation. Furthermore, catabolic factor upregulation by TGF alpha was prevented by ROCK and p38 MAPK inhibition, including matrix metalloproteinase-13 and tumor necrosis factor-alpha, which are well known to contribute to cartilage digestion in OA. To assess the ability of TGFa to stimulate degradation of mature articular cartilage, type II collagen and aggrecan cleavage fragments were analyzed in rat osteochondral explants exposed to exogenous TGF alpha. Normal articular cartilage contained low levels of both cleavage fragments, but high levels were observed in the cartilage treated with TGF alpha. Selective inhibition of MEK/ERK and Rho/ROCK activation greatly reduced or completely prevented excess type II

collagen and aggrecan degradation in response to TGF alpha. These data suggest that TGF alpha is a strong stimulator of cartilage degradation and that Rho/ROCK and MEK/ERK signaling have critical roles in mediating these effects. Laboratory Investigation (2010) 90, 20-30; doi:10.1038/labinvest.2009.111; published online 12 October 2009″
“The Cl-amidine price role of GABA(A) and GABA(B) receptors in the substantia nigra pars reticulata and the globus pallidus in turning behaviour of rats was studied. Unilateral injection of the GABA(A) receptor agonist muscimol (25 and 50 ng) into the substantia nigra pars reticulata elicited contralateral pivoting, namely tight head-to-tail turning marked by abnormal hindlimb backward stepping.

This effect was GABA(A) receptor specific, since it was dose-dependent and prevented by co-administration of the GABA(A) receptor antagonist bicuculline (100 and 200 ng) which alone did not elicit this website turning behaviour. Unilateral injection of the GABA(B) receptor agonist baclofen (100 and 200 ng) into the substantia nigra pars reticulata also produced contralateral pivoting. This effect was GABA(B) receptor specific, since it was dose-dependent and inhibited by the GABA(B) receptor antagonist CGP 55845 (200 ng) which alone did not elicit turning behaviour. In contrast, unilateral injection of bicuculline (100 and 200 ng) into the globus pallidus produced contralateral circling, namely turning marked by normal stepping. This effect was GABA(A) receptor specific, since it was dose-dependent and prevented by muscimol (50 ng), which alone did not elicit turning behaviour.

There is need for prospective longitudinal studies of externalizing behavior problems in boys and girls in relation to their HPA-axis activity. It would be useful to consider how other risk factors such. as life events and family and parenting factors as well as genetic risks affect the complex relationship between externalizing behavior problems and HPA-axis activity. (c) 2008 Elsevier Ltd. All rights reserved.”
“The enzymes of bacteriophages and other viruses have been essential research tools since the first days of molecular biology. However, the current repertoire of viral enzymes only hints at their overall potential. The most commonly used enzymes are derived from

a surprisingly small number of cultivated viruses, which is remarkable considering the extreme abundance and diversity of viruses revealed over the past decade by metagenomic analysis. To access the treasure trove of enzymes hidden in the global Verubecestat mw selleck chemicals virosphere and develop them for research, therapeutic and diagnostic uses, improvements. are needed in our ability to rapidly and efficiently discover, express and characterize viral genes to produce useful proteins. In this paper, we discuss improvements to sampling and cloning methods, functional and genomics-based screens, and expression systems, which should accelerate discovery of new enzymes and other viral proteins for use in research and medicine.”
“A critical component

of the cellular stress response, the p53 tumor suppressor protein must be functional for many cancer therapies to be effective. Adjuvant therapies that augment p53 function are predicted to sensitize tumor cells to cancer therapies that www.selleck.co.jp/products/pazopanib.html rely upon p53 for their efficacy. Of those strategies currently being explored to enhance p53 function, inhibition of the ubiquitin ligase, MDM2, a negative regulator of p53, has shown promise. Here, we investigated whether MDM2 antagonism might be effective in inducing

cell death in human medulloblastoma (MB) cells. Nutlin-3, a small-molecule inhibitor of MDM2, potently induced apoptosis in MB cells with wild-type TP53. Moreover, nutlin-3 potentiated p53 activation and growth impairment of MB cells in combination with the classic DNA-damaging agent doxorubicin. Together, these results support the concept that MDM2 antagonists may be therapeutically beneficial for patients with MB tumors. (c) 2012 Elsevier Ireland Ltd. All rights reserved.”
“Performances of serological parallel and serial testing algorithms were analyzed using a combination of three ELISA and three rapid tests for the confirmation of HIV infection.

Each was assessed individually for their sensitivity and specificity on a blinded panel of 769 retrospective sera of known HIV status. Western blot was used as a confirmatory assay for discordant results. Subsequently, one parallel and one serial testing algorithm were assessed on a new panel of 912 HIV-positive and negative samples.

Compared to the pretreatment level soluble B7-H3 in expressed prostatic secretions was significantly increased in patients with a greater than 25% decrease in the Chronic Prostatitis Symptom Index total score (p = 0.016).

Conclusions: Data indicate that the soluble B7-H3 level in expressed prostatic secretions is a novel chronic prostatitis marker that correlates negatively with subjective symptoms.”
“Cysteinyl leukotrienes (CysLTs), potent inflammatory mediators, are released from ischemic brain, and may regulate ischemic

injury through activating CysLT and CysLT(2) receptors. The CysLT, receptor is closely associated with ischemic injury and post-ischemic repair; however, the CysLT(2) receptor-mediated responses remain unknown. Here, we investigated the spatiotemporal profiles selleck chemical and implications of CysLT(2) receptor expression and localization in rat brain after focal cerebral ischemia. CysLT(2) receptors were normally localized in astrocytes in the cortex and around

the ventricles. After focal cerebral ischemia, Cy5LT(2) receptor expression was up-regulated in concert with neuronal and glial responses. In the acute phase (6-24 h), up-regulated CysLT(2) receptors were restricted to injured neurons in the ischemic core; while in the late phase (3-28 days), the upregulation was restricted to hypertrophic microglia (ischemic core) and mainly localized in hypertrophic astrocytes (boundary zone). Thus, the spatiotemporal profiles Selleck GANT61 of CysLT(2) receptor expression suggest that it plays regulatory roles in acute neuron injury, and astrocytosis and microgliosis in the late phase. (C) 2011 IBRO. Published by Elsevier Ltd. All rights reserved.”
“Purpose: Managing the encrusted and retained ureteral stent is

a potentially complex challenge. To improve surgical planning, we hypothesized that proximal stone burden is Protein kinase N1 the most important factor associated with complicated removal, and that computerized tomography more accurately estimates stone burden than plain film x-ray of the kidneys, ureters and bladder.

Materials and Methods: Records were reviewed of patients undergoing surgical removal of an encrusted and retained ureteral stent or nephrostomy at Ben Taub General Hospital from 2007 to 2009. Preoperative imaging consisted of a plain x-ray of the kidneys, ureters and bladder and/or computerized tomography of the abdomen/pelvis. Each encrusted tube was assessed using the FECal (forgotten, encrusted, calcified) grading system and associated stone burden was calculated. Univariate and multivariate analyses were performed to determine factors associated with the need for multiple surgeries.

Results: A total of 55 encrusted and retained ureteral stents and 1 nephrostomy were removed from 52 patients. Mean tube duration was 24.9 months. Most tubes were removed endoscopically (94.2%). Of the patients 21.2% required multiple surgical procedures to remove each tube.