An automated SPME sampling

An automated SPME sampling BMS-907351 solubility dmso unit (CombiPal. Zwingen, Switzerland) was used with a SPME StableFlex fibre with 50/30 μm divinylbenzene/carboxen on polydimethylsiloxane coating (DVB/CAR/PDMS) purchased from Supelco (Sigma Aldrich, UK). Five mL of juice sample was transferred to a 30 mL vial crimp-sealed with 23 mm diameter aluminium seal and a Teflon septum. In addition, pure aqueous systems of cis-3-hexenol (25 μL/L) were prepared and analysed together with apple juice samples in a fully randomised order. After 10 min

equilibration at 20 °C, the SPME fibre was exposed to the sample headspace for 15 min. The fibre was then removed from the vial and immediately inserted into the injector port of the GC–MS system for thermal desorption at 220 °C for 10 min. Analysis of the aroma components were performed on a Trace GC Ultra (Thermo Scientific, USA) that was attached to a DSQ series mass spectrometer (Thermo Scientific, USA). The gas chromatograph was equipped with a low bleed/fused-silica ZB-Wax capillary column (100% polyethylene glycol phase, 30 m × 0.25 mm × 1.0 μm) (Phenomenex, UK). Helium was the carrier gas

with a constant flow rate of 1.5 ml/min into the GC–MS. The GC oven was held for 2 min at 40 °C and heated to 220 °C at a rate of 8 °C/min. The GC to MS transfer line was maintained at 250 °C. Analysis was carried out in the electron impact mode with a source temperature of 230 °C, ionising voltage of 70 eV, and a scanned mass range Phosphatidylinositol diacylglycerol-lyase of m/z = 50–200. Pure apple juices were run in triplicate. Compounds were identified by comparison to NIST Library and the retention time of authentic standards. A MS Nose interface (Micromass, Manchester, UK) fitted to a Quattro Ultima mass spectrometer (Milford,

Waters) was used for the static headspace analysis of apple juice samples. Fifty mL aliquots of samples were placed in 100 mL flasks fitted with a one port lid. After a 30 min equilibration period at room temperature (20 °C), the headspace was drawn into the APCI-MS source at a rate of 5 mL/min. The samples were analysed in full scan mode, monitoring ions of mass to charge (m/z) ratios from 40 to 200. The intensity of these ions was measured at cone voltage of 20 V, source temperature of 75 °C and dwell time of 0.5 s. Moreover, headspace analysis was carried out in the splitless injection mode, at a flow of 20 mL/min, splitless valve time of 1.5 min and constant pressure of 124 kPa. All analyses were run in triplicate. The chromatographic data was subject to one-way ANOVA followed by Duncan’s post hoc means comparison test. Moreover, principal components analysis (PCA) was also performed on the chromatographic dataset (36 samples, 16 variables) after standardization in order to explore the clustering of the apple juices in terms of their flavour volatile compounds composition. All analysis were performed using MINITAB release 16 (Minitab Inc., Pennsylvania, US).

Volatile components were identified by comparing a private librar

Volatile components were identified by comparing a private library spectra, built with chemical standards, and the spectral library (NIST 98 /EPA/MSDC 49 K Mass Spectral Database, Hewlett–Packard Co., Palo Alto, CA, USA). When available, MS identifications were confirmed by comparing GC retention times with pure standards. Total RNA was extracted according to manufacturer’s instructions (Pure Link, Invitrogen®). For RT- PCR, DNase-treated RNA (2 μg) was reverse transcribed in NVP-BGJ398 in vivo a total volume of 20 μl using Omniscript Reverse Transcription Kit (Qiagen, Valencia, CA, USA) and then PCR was performed using 2 μl of cDNA in a 25 μl reaction

volume using SYBR GREEN PCR Master Mix (PE-Applied Biosystems, Foster City, CA, USA) on an ABI PRISM 7500 sequence-detection system. Primer Express software (Applied Biosystems) was used to design gene-specific primers ( Table 1). Fourteen genes were chosen based on putative roles in strawberry quality traits, such as cell wall disassembling (Exp2 from Civello, Powell, Sabehat, & Bennett, 1999; Exp5 from Harrison, McQueen-Mason, and Manning, 2001; PLa, PLb and PLc from Benítez-Burraco et al., selleck chemicals llc 2003;

PME from Castillejo, Fluente, Iannetta, Botella, & Valpuesta, 2004; PG from Redondo-Nevado et al., 2001; and β-Gal from Trainotti et al., 2001), phenolic and anthocyanin compounds synthesis (PAL from Usami, Kantou, & Amemiya, 2007; and ANS from Almeida et al., 2007), ascorbic acid synthesis (LGalDH from Gatzek, Wheeler, & Smirnoff, 2002; and GLDH from Pineau, Layoune, Danon, & De Paepe, 2008) and esters synthesis (ADH from Longhurst et al., 1990; AAT

from Aharoni et al., 2000). Optimal primer Clomifene concentration was 50 nM. Real time-PCR conditions were as follows: 50 °C for 2 min, 95 °C for 10 min, followed by 40 cycles of 95 °C for 30 s, 60 °C for 1 min, 72 °C for 1 min, and one cycle 72 °C for 5 min. Samples were run in triplicate on a 96-well plate. For each sample, a Ct (threshold cycle) value was calculated from the amplification curves by selecting the optimal ΔRn (emission of reporter dye over starting background fluorescence) in the exponential portion of the amplification plot. Relative quantitation (RQ) was calculated based on the comparative Ct method ( Livak & Schmittgen, 2001), using β-actin ( Almeida et al., 2007) as an internal standard. All experiments were done in triplicate. Data was analysed using analysis of variance (ANOVA) and means comparison using Tukey’s test at P ⩽ 0.05 using SAS. Transcript accumulation of Exp2 and Exp5, and of genes encoding enzymes acting in cell wall disassembly (PLa, PLb, PLc, PME, PG and β-Gal) was monitored in order to understand the role of these putative genes during the development of strawberry. Firmness decreased over time during fruit development; descending from 26.5 N at stage 1 (green, 3.0 g ± 0.9) to 2.7 N at stage 5 (red, 16.2 g ± 1.2) ( Fig. 1A).

For validation purposes, five liver extracts with low recoveries

For validation purposes, five liver extracts with low recoveries were diluted up to 1000 times and analyzed on a Xevo TQ-S mass spectrometer (Waters Corporation, Milford, USA), which is a more sensitive instrument compared to the Quattro Premier Selleckchem MLN0128 XE. The recoveries of 13C4-PFOS increased from 10–44% to 36–80% in the × 100 and × 1000 diluted samples (Fig. S1, Supplementary data). To compare PFOS concentrations in undiluted (u) and diluted (d) extracts, the mean normalized difference (%) was calculated using the formula: ((u − d) / ((u + d) / 2) × 100). The calculated concentrations

of all the diluted extracts, except for one sample, were well in range with the initial concentrations (average mean normalized difference of 18%). Consequently, reliable results can be produced even when recovery rate is low since the internal standard and the native compound are equally suppressed. Recoveries, method reproducibility and method detection limits (MDL) for all samples are presented

in Table S1, Supplementary data. One milliliter of ultra pure water was used as procedural blanks and extracted in the same way as the real samples. The MDL was defined as the mean concentration in the procedural blanks plus three standard deviations, and the limit of detection (LOD) for individual samples was calculated as three times the noise level. Overall good recoveries (> 50%) of 13C-PFOS and 13C-PFOA were measured for the samples after the replacement of the recovery standard 7H-PFHPA

to 13C8-PFOS and 13C8-PFOA in the middle of the project. One two year old mink caught in autumn in the G area was excluded due to non-reproducible results of the diluted extracts. Using the general linear model (GLM) procedure of SAS (SAS Institute Inc., Cary, NC, USA, version 9.02.01), a multiple regression model with the concentrations Ergoloid of PFHxS, PFOS, PFNA, PFDA or PFUnDA as dependent variable and the sample area, sample season, age, body condition, year (of capture) and body weight as independent variables were elaborated on. PFBS, PFOA, PFDoDA and PFTrDA were excluded from this model since the concentrations were consistently low (< 17 ng/g). The model was fitted manually, starting with all variables in the model. Variables that were unsignificant (p > 0.05) for all dependent variables were removed. Relevant interactions between the effects were tested but none were included in the model due to insignificance or small sample size. The variable age was tested in several ways (different assignments into categories and numerical approaches), but had no significant effect. Area and season were the only variables that had a significant effect and were therefore the only variables kept in the final model: Y=μ+AREA+SEASON+ERROR.Y=μ+AREA+SEASON+ERROR.

Where no comparable studies are available, the growth of dominant

Where no comparable studies are available, the growth of dominant trees is a useful lower threshold. Theoretically the diameter of an open-grown tree should be approximately twice as large as that of a mean stem at maximum density (Sterba, 1975). This is confirmed by comparisons between open-grown trees and stand-grown dominant trees (Lässig, 1991). For spruce on good sites (SI = 38 m), open-grown tree dbh of 68 cm, 99 cm, 107 cm, and 245 cm were simulated with Silva, Prognaus, Moses and BWIN, respectively. Lässig (1991) reported a dbh of 91 cm for a reference open-grown spruce tree (constructed

from stem analysis on 12 open-grown trees on 5 sites) at the age of 100. However, individual-tree diameters from stem analysis varied as much as 20 cm at the same age and site index. Gerecke selleck screening library (1991) investigated dominant trees on good sites IDH inhibition (SI = 36 m). At a breast height age of 90 years (corresponding approximately to 100 years), he reported an average dbh of 58 cm. Thus, the simulated values for open-grown trees are all higher than observed values

for dominant trees. Furthermore, the simulated diameters of Silva, Prognaus and Moses seem to be in good agreement with the results from Lässig (1991). BWIN clearly overestimates open-grown spruce growth. Open-grown trees on an alpine site were investigated by Rossi et al. (2008). He reported the average age, dbh, height, and standard deviation of his 5 sample trees. At an average age of 300 years, dbh was 81 cm, and average height was 23 m. The diameters observed compare surprisingly well to a 300-year simulation of a 14 m site index with Prognaus, Moses and Silva; predicted dbh was 86 cm, 98 cm, and 107 cm, respectively. In contrast, BWIN overestimates the dbh of open-grown spruce and predicts a dbh of 216 cm. The heights predicted by the growth models were 16, 28, 32, and 36 m for Silva, Prognaus, BWIN, and Moses, respectively. The height growth of Silva is lowest, because of a strongly curved site-index function for poor sites. The other

growth models seem to over-predict the height growth, with values ifenprodil obtained from Moses being clearly too high. For pine, Thren (1986) reported an open-grown tree diameter of 57 cm for a site index of 22 m. The diameters simulated by all growth models are lower, but do not deviate more than 15 cm from Thren’s (1986) results. Thus, open-grown pine growth is reasonably well predicted by all four growth models. Again, site has a different weight in the four models: differences in diameter between poor and good sites vary from 7 to 62 cm. All models predict an increase in height:diameter ratios with increasing stand density, which corresponds to results from growth and yield experiments. The observed effects of density are both overestimated and underestimated in Arnoldstein, depending on the growth simulator. The magnitude of the discrepancy was within a reasonable range. Schmid et al.

The recent rapid development of molecular marker techniques (Alle

The recent rapid development of molecular marker techniques (Allendorf et al., 2010) has greatly facilitated the identification of state indicators at the level of the management unit of identified priority species (Aravanopoulos, 2011, Funk et al., 2012, Geburek et al., 2010, Hansen et al., 2012, Konnert et al., 2011, Laikre et al., 2008, Luikart et al., 2010, Schwartz et al., 2007 and Stetz et al., 2011). Such techniques selleck inhibitor are

available at the scientific level and within reach at a practical level, at least where facilities are available. However, in practice availability depends on access to resources and facilities which varies enormously among countries and world regions. In Europe, work by the European Forest Genetic Resources Network (EUFORGEN) has reached a point where implementation of molecular based techniques is likely to begin within a few years (Aravanopoulos et al., 2014). While the increasing utility and the decreasing costs of molecular techniques

hold great promise for providing efficient means for monitoring genetic diversity, it is imperative that the basic importance of taxonomy, ecology and field testing are not neglected. The diminishing priority of sustainable forest management in the national policies of some countries (Wijewardana, 2006), loss of competence in taxonomy (Drew, 2011, Hoagland, 1996 and Kim and Byrne, 2006) and erosion of applied programs of genetic Ceritinib resource management (Graudal and Kjær, 1999 and Graudal and Lillesø, 2007) are therefore of great concern. There seems to be an on-going world-wide trend of loss of practical knowledge and ability

in tree species identification, tree seed handling, tree breeding and tree genetic resource conservation management (Graudal and Lillesø, 2007), which will be an impediment for the implementation of any program to use and conserve tree genetic diversity. Indicators to monitor this area of response policy would therefore be highly relevant and can be measured through national surveys. Management responses can be measured by the extent of physical management and conservation Sclareol activities in the field, and by the integration of response measures in policy, planning and the implementation of programs, including in legislation. Some of these elements are, in principle, easily evaluated by quantification of breeding and gene conservation activities at the national level and are already available and being used in some geographical areas. Measuring legislation or regulation responses is probably more difficult but one approach would be for example to quantify the adoption of certification schemes for distribution and exchange of reproductive material. Schemes exist for some areas, but it is important to validate whether such schemes are relevant for the purpose they are intended before they are used as a positive measure of action (Lillesø et al., 2011b).

See Table 2 for pre and posttreatment diagnostic profile Lance t

See Table 2 for pre and posttreatment diagnostic profile. Lance took no psychotropic medication. His SR began in 8th grade, following an illness, and he finished the school year with home tutoring. In 9th grade he had difficulty returning

after a weather-related school closure and again after an illness. At intake (mid-January), he had not attended school for six weeks though winter break made up several of those weeks. Lance’s refusal behaviors related to fears of explaining his absence to others at school or elsewhere, performance fears, social evaluation, and catching up on schoolwork/homework. Selleckchem U0126 He reported no short-term impairment but was concerned that continued absences may negatively affect long-term goals, like going to college and getting a job. Lance noted numerous benefits to staying home, including sleeping in, watching

TV, playing video games, being free of worry about school, and spending more time with good friends because he did not have to commute to school or do homework. His parents reported that SR interfered with grades, social relationships, and family functioning. Numerous DBT skills were essential to the family’s progress. Walking the Middle Path skills were a central skill. Broadly, therapy focused on helping parents move towards synthesis of the “Holding on too tight-Forcing independence too soon” dialectical dilemma (Miller et al., 2007). The parents often yielded selleck authority to Lance on school reentry (if, when, and how), yet they avoided ATM/ATR inhibitor talking about school with Lance or in front of him, because they considered it “too upsetting for him” (e.g., they gave Lance permission

to miss therapy and stop WBC because talking about school and going to therapy was too stressful). Here, parents expected adult-like decisions on one hand but acted in very protective ways on the other. Therapy focused on helping parents take more control over decisions reserved for parents (e.g., school attendance, choice of schools) while remaining emotionally supportive. As an example of the “Too loose – Too strict” dialectic, Lance would often refuse to go to bed but then blame his parents for being tired in the morning and fail to get up. Here, the therapist highlighted the need to consistently implement the contingency management plan (using laptop time as a reward and maintaining structure over its use), as opposed to allowing un-restricted use and then arbitrarily removing it when angry. Validation was also critical, as the family had a history of conflict, criticism, and blame that often led to escalating emotional arguments. The therapist used session time to have family members practice using validation with each family member. Practicing validation appeared to deescalate conflictual conversations, decrease judgment by increasing perspective taking, and increase acceptance.

Clinical trials will also be needed for the m102 4 human antibody

Clinical trials will also be needed for the m102.4 human antibody therapy, and both the United States

and Australia are developing the m102.4 antibody for human use as a Nipah and Hendra virus countermeasure. Nipah virus has not occurred in Malaysia since 1998 and requests for compassionate use of the m102.4 antibody in India or Bangladesh following high-risk Nipah virus exposure or cases of infection have not occurred and may be difficult to orchestrate. Whether the antibody could be pre-positioned in Nipah virus endemic areas INCB024360 concentration will largely depend on international cooperation and financial support. The views expressed in the manuscript are solely those of the authors, and they do not represent official views or opinions of the Department of Defense or The Uniformed Services University of the Health Sciences. CCB, KNB and TWG are supported in part by grants from the United States, Department of Health and Human Services, National Institutes of Health (NIH). ZZ and DSD are supported by the Intramural Research Program of the NIH, National Cancer Institute, Center for Cancer Research. “
“Sandfly-borne viruses belong to the genera Phlebovirus

PLX3397 molecular weight (family Bunyaviridae), Vesiculovirus (family Rhabdoviridae) and Orbivirus (family Reoviridae). In this review, we focus on phleboviruses transmitted by sandflies in Eurasia and Africa, which are associated with sandfly vectors that belong to the genus Phlebotomus. Sandfly-borne phleboviruses are widely distributed in the Mediterranean region, in Africa, the Indian subcontinent, the Middle East and central Asia. Except for Regorafenib Toscana virus, which has a marked tropism for central and peripheral

neurological systems, sandfly fevers cause moderately severe disease, and are often given little attention by physicians. There is also much less scientific interest in sandfly-transmitted viral diseases than in other arboviruses. For instance, a PubMed-based bibliographic search using “Toscana virus”, “sandfly virus”, and “sandfly fever virus” retrieved 232, 385, and 265 references, respectively, while searches with the keywords “West Nile virus” and “dengue virus” retrieved more than 4500 and 6000 papers. It is therefore difficult to provide accurate estimates of infection rates due to sandfly-transmitted viruses because of the lack of data. However, their significance in terms of public health and human diseases should be underlined and merit increased attention from physicians, public health agencies and diagnostic virology laboratories. In regions where sandflies are present, high seroprevalence rates have been recorded in human populations and in domestic animals. Most published studies have focused on travelers and on soldiers stationed in endemic areas.

Interestingly, REKRG administration for 6 weeks resulted in decre

Interestingly, REKRG administration for 6 weeks resulted in decreased aortic intima-media thickness and cross sectional area in SHRs, suggesting that chronic administration of REKRG may change vascular tone and structure. High blood pressure produces chronic stress in the body and is a major risk factor for vascular disease. It is associated with morphological alteration and dysfunction of vascular endothelial cells, which can lead to atherosclerosis. The protective effects of ginseng and ginsenosides have been widely studied and shown to have new beneficial effects on hypertension [14] and various diseases, such

as atherosclerosis, cancer, and thrombosis [19], [22], [23] and [24]. In this study, we showed that REKRG increases NO production and induces endothelium-dependent JNJ26481585 vasorelaxation in aortic rings from SHRs. Furthermore, REKRG administration via gastric gavage increased serum NO levels and reduced blood pressure and aortic intima-media thickness. It is unclear whether

absorption of intact ginsenosides can take place in the human gastrointestinal tract and whether their hydrolysis products, protopanaxadiol (PPD) and protopanaxatriol (PPT), reach the systemic circulation. buy Vemurafenib Pharmacokinetic analysis of Rg3 showed that the time to reach the peak plasma concentration after oral administration was 150.0 ± 73.5 h [25]. The data showed that the oral bioavailability of Rg3 was 2.63, which limits its beneficial effect. Furthermore, the amount of Rg3 in Korean Red Ginseng is usually less

than 0.5%, even when steam heat treatment of ginseng roots, which strongly increases the amount of Rg3, is used. Therefore, in order to improve the biodistribution of Rg3 in Casein kinase 1 vivo, we used REKRG, a ginsenoside fraction containing a high percentage of Rg3 isolated from P. ginseng, in this study. NO from vascular endothelial cells plays an important role in the regulation of vascular function, as well as in inhibition of platelet aggregation and adhesion to the endothelium [26]. In addition, endothelium-derived NO inhibits not only smooth muscle cell proliferation but also migration to form the neointima. It is well known that the reduction in blood pressure by Korean Red Ginseng may be mediated by vascular endothelial cell-derived NO, and that Korean Red Ginseng promotes NO production in vascular endothelial cells [13] and [14]. Korean Red Ginseng induces angiogenesis by activating PI3K/Akt-dependent extracellular signal-regulated kinase 1/2 and eNOS pathways in HUVECs [27]. The ginsenoside Re activates potassium channels of vascular smooth muscle cells through PI3k/Akt and NO pathways [28]. Moreover, the ginsenoside Rg3 increases NO production through the PI3K/Akt pathway [20].

A connectivity

A connectivity Compound C index was computed according to the method developed by Borselli et al. (2008) to outline the spatial linkages and the potential connection between the sediment eroded from hillslopes by runoff processes and the different storage areas identified within catchments. These areas may either store sediment temporarily (i.e., reservoirs, lakes or local depressions in the floodplain) or definitively (i.e., outlets). Considering the lack of specific-event data such as soil erosion rates, discharge and suspended sediment concentrations, this index of connectivity

based on GIS data tended to describe the general hydro-sedimentary behaviour of the investigated catchments. To calculate this index, landscape morphological characteristics and recent land use patterns were derived

from high resolution databases. The potential of various land use surfaces to produce or store sediment was also assessed. The calculation was conducted on a Digital Elevation Model (DEM) with a 10-m regular grid provided by the Geospatial Information PCI 32765 Authority of Japan (GSI) from the Ministry of Land, Infrastructure, Transport and Tourism ( This DEM was computed by the GSI from data obtained by LIDAR airborne monitoring surveys. Values of the weighting cropping and management parameter (the so-called ‘C-factor’), originally used in the USLE equation (USDA, 1978), were determined based on data found in the literature (Borselli et al., 2008, Kitahara et al.,

2000 and Yoshikawa et al., 2004) and applied to the different land use classes observed in the catchments and determined by a multitemporal and multispectral classification of SPOT-4 and SPOT-5 satellite images. SPOT-4 20-m resolution images dated from May 5, June 3 and September 10 2010, and SPOT-5 10-m resolution images dated from March 18, April 13 and 24, 2011. Differences in spectral responses (reflectances) between land uses allowed their spatial discrimination using ENVI 4.8 software. Then, based on their respective vegetal cover density during the spring Protirelin season and their implications on soil sensitivity to erosion, three main land uses were identified (i.e., forests, croplands and built-up areas). Additionally, surface water areas (i.e., rivers, lakes, reservoirs) were delineated. The land use map was validated by generating a set (n = 150) of random points on the map and by comparing the classification output with the land use determined visually on available aerial photographs of the study area. Hydrological drainage networks were derived from the GSI 10-m regular grid DEM using hydrologic analysis tools available from ArcGIS10 (ESRI, 2011).

At 12-weeks post EMR radiofrequency ablation (RFA) was carried ou

At 12-weeks post EMR radiofrequency ablation (RFA) was carried out using the Halo90 catheter (BÂRRX Medical Inc., Sunnyvale, CA, USA) fitted on the tip of a standard endoscope (Fig. 3B–C). Barrett’s epithelium was positioned at the 12 o’clock position in the endoscopic video image. Areas were ablated twice by using the “double-double” 15 J/cm2 regimen (2 consecutive ablations with 15 J/cm2 each, with cleaning of the ablated area after the first pass). The patient

was kept on esomeprazole (40 mg BID for 2 months and 40 mg/day thereafter) and follow-up at 2, 6, 9 and 12 months after RFA showed a esophagus covered with normal-appearing IPI-145 mouse neosquamous epithelium (Fig. 3D). Biopsies were negative for IM and dysplasia. In recent years, endoscopic therapy of early BE neoplasia has become a safe and effective alternative to esophagectomy.1 and 2 Only patients with high-grade intraepithelial neoplasia or well and moderately differentiated intramucosal carcinoma without lymphatic involvement are eligible for curative endoscopic treatment.3 and 4

Lesions showing invasion of the submucosa are associated with a significant risk of lymph node metastases and therefore patients should be treated surgically.5 Due to the risk of synchronous Antidiabetic Compound Library cell assay and metachronous lesions in the remaining BE, complete ablation of the metaplastic epithelium should follow a successful resection of dysplastic lesions. The authors declare that no experiments were performed on humans or animals for this investigation. The authors declare that they have followed the protocols of their work center on the publication of patient data and that

all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study. The authors must have obtained the informed consent of the patients and/or subjects mentioned in the article. The author for correspondence must be in possession of this document. The authors have no conflicts of interest to declare. Thymidylate synthase
“A 53-year-old woman was admitted to the emergency department with melena over the preceding 12 h. The patient reported previous symptoms of bloating and early satiety for about 6 months, but no past history of gastrointestinal or liver diseases was known. The physical examination evidenced a deformity in the abdominal wall, secondary to a large palpable stony mass in the epigastrium, and hepatomegaly. No other signs of liver disease were apparent and the hemodynamic parameters were normal. The initial laboratory study disclosed anemia (hemoglobin 9.5 g/dL), and a slight elevation of alkaline phosphatase (185 U/L) and gamma-glutamyltransferase (40 U/L). An emergent upper gastrointestinal endoscopy was performed, showing an active spurting bleed from a subcardial gastroesophageal varix, successfully controlled with endoscopic band ligation.