Volume 88  ·   Issue 46  ·  2008

Prenatal diagnosis is a high-risk service, with complicated diseases and many links in the detection process, and errors will occur if there is a slight omission. Prenatal genetic diagnosis is more pertinent, not to determine whether the fetus is abnormal in the usual sense, but to determine whether the fetus obtains the same genotype as the proband. In this paper, the factors leading to the error of prenatal genetic diagnosis are analyzed from different links.

Mitochondrial diseases are a group of important defects with similar manifestations and common pathogenesis, involving various age groups and tissues and organs, which are mainly caused by mitochondrial genome mutations located outside the nucleus. This mitochondrial genome (mtDNA) consisting of 16 569 bp circular double-stranded DNA is one of the earliest genomes to be sequenced. Although it only encodes 37 genes, including 2 rRNA, 22 tRNA and 13 polypeptides constituting the respiratory chain, it has some characteristics different from nuclear genome, such as multiple copies, no introns, unequal replication, maternal inheritance, heteroplasmy and threshold effect, etc. Because of the high oxidation environment in mitochondrial inner membrane and the easy damage of circular mtDNA without protein encapsulation, various mutations accumulate, resulting in various diseases with energy deficiency as the core manifestation. Because different tissues and organs depend on energy in different degrees, such as brain, heart and skeletal muscle, which are high energy demand tissues, the threshold of mitochondrial dysfunction is low, Thereby being more sensitive to mitochondrial metabolic disorders. Many studies extended therefrom involve species evolution,human origin and migration, tumorigenesis,DNA repair diseases,sports injury and aging [1].

Objective To investigate the effect of multiplex ligation-dependent probe amplification (MLPA)in molecular diagnosis of spinal muscular atrophy(SMA).Methods Peripheral blood samples were collected from 13 SMA patients.31 parents of SMA patients,50 healthy individuals without family history of SMA,and 10 specimens of amniotic fluid from these families were collected too.Genomic DNA was analyzed by MLPA,conventional PCR-RFLP,and allele-specific PCR.Results In complete agreement with the results of conventional PCR-RFLP and allele-specific PCR.MLPA analysis showed that all of the 13 patients had homozygous deletion of the Survival of motor neuron 1(SMN1)geBe,and there Wag significant difference between the SMA severity(type I to typeⅢ)and SMN2 copy humber(P<0.05).of the 31 parents 29(93.5%)had 1 copy of SMNI,2(6.5%)had 2 copies of SMN1.Of the 50 healthy individuals.1(2.0%)had 1 copy of SMN1,48(96.O%)had 2 copies of SMN1,and 1(2.0%)had 3 copies.The SMN1 copy humber of the parents was significantly higher than that of the healthy individuals (P<0.01).Two of the 10 feruses had homozygous deletion of SMN1.Conclusion The MLPA technique has proved to be an accurate and reliable tool for the molecular diagnosis of SMA.both in patients and in healthy carriers.

Objective To verify the sensitivity and reliability of methylation-specific multiplex ligation-dependent probe amplification(MS-MLPA)and to develop a simple,accurate,reliability method of genetic diagnosis for AS and PWS.Methods Pefipherai blood samples were collected from 4 suspected AS patients,2 suspected PWS patients,2 normal persons,and 2 molecular biologically proven positive controls (1 AS patient and l PWS patient).DNA was extracted and purified.MS-MLPA wag used to detect the methylation of the CpG dinucleotide and the copy number in the 15q.q13 region.The results of MS-MLPA were confirmed by MSP.Results Three cages with matemal deletion on 15q11-q13 region and one case with paternal uniparental disomy(UPD)or imprinting center defect in 15q11-q13 region were found in the 4 suspected AS patients.One PWS cage was found to be with paternal deletion in 15q11-q13 region and the other with paternal deletion in 15q11-q13 region or UPD or imprinting center defect in 15q11-q13 region.Conclusion MS-MLPA is a simple.rapid,accurate, and reliable method of genetic test.

objetqive To investigate the characteristics of mitochondrial DNA mutations and genotype-phenotype correlations in mitochondrial encephalomyopathies.Methods Biopsy of skeletal muscle and collection of peripheraI blood samples were conducted among 97 patients with mitochondrial encephalomyopathies.Southern blotting,PCR-RFLP and direct sequencing of PCR products were performed to search large scale deletions.and common and uncommon pathological point mutations in the muscle and/ or blood mtDNA.Results Seventy-seven patients were identified to be with mitochondrial DNA mutations. including single large deletion(n=21),multiple large-scale deletions(n=4),A3243G point mutation (n=43),A8344G point mutation(n=6),T8993G mutation(n=1),T8993C mutation(n=1),and 1r3271C mutation(n=1).Total mtDNA sequencing revealed 4 difierent noveI point mutations in four unrelated patients with isolated mitochondrial myopathy.Conclusion The type and frequency of mtDNA mutations in this series of Chinese mitochondrial encephalopathies are consistent with those reported abroad, Ahhough there is some association between the genotype and phenotype,heterogeneity in phenotype and genotype iS also a prominent feature seen in this series of patients.especially those with A3243G mutation.

objeetive To identify a better non.invasive method to detect the carrier of mitochondrial A3243G mutation,a cause of mitochondfial encephalopathy-lactic acidosis.stroke like episode (MELAS)syndrome.Methotis DNA was extracted from the peripheral blood,urine,hair follicle,and saliva of 25 MELAS syndrome patients carrying A3243G mutation and their mothers and other maternal relatives,33 persons in number,and the muscle tissues from 5 patients obtained by biopsy.A3243G mutation was detected by PCR-RFLP method,and the A3243G mutation ratio was identified by measuring the density of each band and calculation with the software AlphaEase 5.0.Results A3243G mutations were detected in all tissues of the 25 MELAS patients.The A3243G mutation ratio in urine was 62%±9%. significantly higher than that in the blood [(36%±10%),t=-11.13,P<0.01 ].A3243G mutations were detected in at least one tissue of the 28 maternal relatives.The A3243G mutation rates in their urine samples was 33.O%(5.O%.70.4%),significantly higher than that in their blood samples[8.O%(0-33.3%).x=-4.197.P<0.01].There was no significant difference in A3243G mutation ratio among the samples of hair follicle,saliva,and blood.Conclusion The A3243G mutation ratio in urine is significantly higher than those in blood samples of the patients and their maternal relatives.A noninvasive method,A3243G mutation ratio analysis of urine is superior to that in blood.

Objective To analyze the pathogenic mutation of an X-linked ichthyosis(XLI)family, and identify the genetic diagnosis of three probable female carriers in this family.To evaluate the availability of different detect methods fer steroid sulfatase(STS)gene mutation.Methods Peripheral blood samples were collected from the family,including the proband,proband's mother,younger sister,and younger female cousin,and 10 males and 10 females as controls.Ordinary PCR was used to detect whether there Was STS gene deletion in the male proband.Then.multiplex quantitative fluorescent PC8(QF-PCR)was used to detect the STS gene in the proband and his 3 female family members.Fluorescence in situ hybridization (FISH)was used to authenticate the results of multiplex OF-PCR method.Results No amplified product of the exons 1～10 of STS gene deletion was detected by ordinary PCR in the proband.The proband's mother Was diagnosed a8 a carrier,but his sister and cousin were diagnosed as normal fcmales by multiplex Qr-PCR.FISH confirmed the results of multiplex OF-PCR.Conclusion Both multiplex QF-PCR and FISH are effective to detect the complete deletion mutation of STS gene and identify the female carrier,and multiplex QF-PCR is more convenient and automatic compared with FISH.

Objective To investigate the presence and severity of depression before and after operation in patients undergoing coronary artery bypass grafting(CABG)and the effect thereof on the quality of life.Methods A validated Chinese version of Beck Depression Inventory(BDI)Wag used in 138 CABG patients that were divided into 2 groups according the fact if depression was present.1 week before and 1,3, and 6 months after operation,and SF-36 scale Wag used to evaluate the quality of life(QOL)one week before operation and 1 and 6 months after operation.Results Depressive disorders occurred in 42.7%of the patients preoperatively and in 23.1%of the patients 6 months after the operation.There were no significant difierences in all the dimensions of the SF-36 scale before operation between the depression and non-depression groups.All the scores of the 36-f dimensions were improved 1 and 6 months after the operation.However,the SF-36 social functioning(SF),mental health(M H),role emotional(RE),and bodily pain f BP)subscale scores 6 months after operation of the depression group were alIlower than those in the non-depressive groups(all P<0.05).Conclusion Depression symptoms at different degrees exist before CABG and can be impmved post-operatively.The improvement of QOL of the depressive patients after operation is not 80 marked compared to the non-depressive patients,especially in SF,MH,RE,and BP dimensions.

Objective To investigate expression of cyclooxygenase-2(COX-2)and urokinase plasminogen activator(uPA)in gastric carcinoma and the clinical significance thereof.Methods Strepavidin-peroxidase method was used to detect the expression of COX-2 and uPA in 192 specimens of gastric carcinoma,56 specimens of paracancer tissues obtained during operation.Immunohistochemical double staining was used to detect the microvessel density(MVD)and microlymphatic density(MLD). Thirty specimens of normal gastric mucosa obtained during gastroscopy were used as controls.Results The positive rates of COX-2 in the gastric carcinoma and paracancer tissues were 67.7%and 62.5% respectively,both significantly higher than that of the control group(40.O%,both P<0.05).The positive expression of COX-2 in gastric carcinoma was significantly related with the depth of invasion and MVD (both P<0.05).The positive rates of uPA in the gastric carcinoma.paracancer tissue were 78.1%and 44.6% respectively,both significantly higher than that of the control tissues(6.7%,both P<0.01)and there was a significant difference in the positive rates of uPA between the first 2 groups too(P<0.01).The positive expression of uPA jn gastric carcinoma was significantly related with lymph node metastasis.depth of invasion,Lauren typing,differentiation,MVD,and MLD(P<0.05,P<0.01).COX-2 expression was positively linked with uPA expression(r=0.167,P=0.021).The survival time of the uPA positive group was(38±4)months,significantly shorter than that of the negative group[(54±6)months,P<0.05]. The survival time of the group positive in both COX-2 and uPA was(27±3)months,significantly shorter than that of the single positive or double negative groups[both(58±4)months,both P<0.01).Conclusion COX-2 and uPA are highly expressed in gastric carcinoma.COX-2 expression is positively linked with uPA expression.COX-2 and uPA in the gastric carcinoma participate in the development of gastric cancer in the early process.uPA is significantly related with the survival time.

Objective To seek a best therapeutic protocol for sinail eell neucroendocrine carcinoma of head and neck.Methods The clinical data of 34 patients with small cell neucroendocfine carcinoma of head and neck,21 males and 13 females,aged 53(17-71),were retrospectively analyzed.The therapeutic protocols that had been used for the patients included surgery alone(in 5 patients),radiotherapy alone(in 7 patients),combined therapy with surgery and radiotherapy(in 7 patients),combined therapy with surgery and chemotherapy(for 3 patients),combined therapy with radiotherapy and chemotherapy(for 10 patients),and combined therapy with surgery,radiotherapy and chemotherapy(for 2 patients).The follow-up ended on August 1 2007.Results The prognosis of the patient with small cell neuroendoerine carcinoma of skin was the best.Local recurrence occurred in 7 patients,of which 2 underwent surgery alone,2 combined therapy with surgery and radiotherapy,1 combined therapy with surgery and chemotherapy,and 2 combined therapy with radiotherapy and chemotherapy.Recurrence in neck occurred in 1 patient that had undergone combined therapy with surgery and radiotherapy.Neck lymph node metastasis was found in 4 patients of whom 2 had undergone surgery alone,1 had undergone combined therapy with surgery and chemotherapy,and 1 combined therapy with radiotherapy and chemotherapy.Distant metastasis was found in 1 1 patients of whom 2 had undergone surgery alone,2 radiotherapy alone,3 combined therapy with surgery and radiotherapy,and 3 combined therapy with radiotherapy and chemotherapy.The median survival time was 24 months.and the overall 3-year and 5-year cumulative survival rates were 65.37%and 35.95%respectively.Conclusion The prognosis of the patient with small cell neuroendocrine carcinoma of head and neck was poor.Small cell neuroendoerine carcinoma cases with the lesions at different sites differ in prognosis and needed different therapeutic fashions. Combined therapy with radiotherapy and chemotherapy is recommended for small cell neuroendocrine carcinoma of head and neck,and surgery serves as a salvage therapeutic measure.

Objective To study the correlation between the expression of caveolin-1 in hepatitis Brelated hepatocellular carcinoma(HCC)and the relationship thereof with the invasive and metastatic ability of HCC.Methods Real-time pCR and immunohistochemistry were used to detect the expression of caveolin-1 in 123 specimens of HCC tissues obtained during operation.Human HCC cells of the lines MHCC-97L and MHCC-97 H were cultured.and Western-blotting was used to detect the caveolin-1 expression in these cells.Results The expression level of caveolin-1 in the HCC tissues was significantlylower than that of the adjacent noncancerous tissues(P=0.026).The caveolin-1 mRNA expression in theHBV-related HCC cells was negatively correlated with the tumor size.expression of AFP,major venous invasion,being single or multiple,pTNM staging,and HBx expression level,factors closed to the prognosis of HCC.The caveolin-1 protein expression of the MHCC-97H ceils was significantly lower than that of the MHCC-97L cells.Conclusion Caveolin-1 expression is associated with the invasive and metastatic ability of HCC.low expression of caveolin-1 shows poor prognosis of HCC.and caveolin-1 is probably downregulated bv HBx protein.

Objective To instigate the values of 64 row spiral cT in pre-operative assessment of the occlusion and intra-operative guidance in pereutaneous coronary intervention for chronic total occlusion (CTO)in coronary heart disease.Methods Fifteen coronary disease patients planned to receive percutaneous coronary intervention underwent 64-row spiral CT-coronary angiography and coronary angiography(CAG).The diagnostic effects of these 2 techniques were compared.Results Seventeen CTO lesions were confirmed.MSCT succeeded to show the lengths of the 17 CTO lesions with a calcification identification rate of 76.4%,significantly higher than that of the CAG(41.5%).By Cross-section examination,MSCT succeeded to detect the occlusion degree of the calcified lesions,and showed that 3 CTO lesions were occluded at a rate<50%.and 10 lesions at a rate≥50%.Twelve complete occlusion lesions in 11 patients underwent PCT.SUCCESS Was seen in 6 of which and failure in the other 6.Univariate analysis showed that the length of lesion,branching at the proximal site,formation of bridging lateral branch,form of occlusion end.and calcification were all not significantly related to the SUCCESS or failure of intervention.The percentage of the calcification area≥50%in the intervention failure group WS,S 83.3%.significantly higher than that in the intervention success group(16.7%,P=0.05).3-D images of coronary artery could be obtained by MSCrr to show all the complete occlusive lesions.Conclusion 64-MSCT demonstrates a remarkable ability to identify silicified lesions,Can re-establish 3-D images of coronary artery,and effectively guide the intervention therapy.

Objective To investigate the efficacy and safety of valganciclovir in treatment of cytomegalovirus viremia in patients following allogeneic hematopoietic stem cell transplantation(allo HSCT).Methods Nineteen patients following allo-HSCT were diagnosed as with cytomegalovims viremia with the CMV-DNA load of hisher than 6.0×102 copies/ml confirmed by polymerase chain reaction(PCR) took orally valganciclovir at the dose of 900 mg bid for 14 days followed bv 900 mg Qd for another 14 days. Since 4 weeks after the valganciclovir treatment PCR was conducted in the 6th,8th,12th,16th,and 24th weeks later to detect the CMV-DNA level.Results CMV viremia was confirmed 40 days after HSCT on average with a median CMV-DNA load of 3.346×103 copies/ml.The total effective rate of valganciclovir was 94.7%(18/19).The CMV-DNA turned to negative in 7 d in 11 eases with a negative transfer rate of 54.7%.and in 14 d in 16 cases with a negative transfer rate of 84.2%.The mediall CMV DNA load reduction was 0.75 eopies/ml and 0.084 log10 copies/ml/day.Severe adverse effects were not observed and CMV-related disease did not occur.Conclusion Valganeielovir is an attractive and safe alternative for preemptive CMV viremia treatment in allo-HSCT recipients.

Objective To study the relationship between the impedance of paired cocEear implant electrodes and their position in scalae tympani a8 well a8 the relationship between the impedance and the current frequency.Methods REZ-1 electrodes were implanted in 6 fresh human aduh temporal bone specimens.Ahemating electrieal source was used. Al Kohm resistance was in series with the paired electrodes.The voltages of the resistance and the sam voltages of both the paired electrodes and the resistance were recorded.Thus.the impedances of palred electrodes could be calculated.The impedances of neighboring paired electrodes and paired electrodes separated by one electrode were calculated.The frequencies of signals were 2 Hz,10 Hz,100 Hz,1 KHz,and 10 KHz respectively.Results The impedances of neighboring electrodes increased.as the electrodes were closer to the apical turn of the cochlea(1iner regression,F=198.97,P<0.001).11le impedances of paired electrodes separated by one electrode increasod.as the electrodes were closer to the apical turn of the cochlea(1iner regression,F= 126.35.P<0.001).The impedance decreased when the frequency increased.Conclusions The impedances of neighboring electrodes increase,as the electrodes are closer to the apical turn of the eochiea. The impedances of neishboring paired electrodes inerease.as they are closer to the apical turn in the scalae tympani.The impedances of paired electrodes that are separated by one electrode increase.as they are closer tO the apical turn in the scalae tympani.The impedance decreases when the frequency increases.

Objective To identify the proteins which play key roles during the formation of cholesterol gallstone.difie.rential analysis was carried out that the proteome of vesicular phase and micellar phase of gallbladder bile from cholesterol gallstone patients.Methods Vesicular and micellar phases were isolated by the density gradient ultracentrifugation method.Total proteins from the two phases were extracted.and the protein expressional profiles were established by two-dimensional electrophoresis respectively.The differentially expressed protein spots analyzed by ImageMaster two-dimensional mass spectrometry(MALDI-TOF-MS).Results The concentrations of proteins from vesicular phase and micellar phase of gallbladder bile from cholesterol gallstone patients were(1.5358 4±0.0682)me,/ml and (7.1222 4±0.2022)mg/ml(P<0.01)respectively.The average matched protein spots were 120±24 and 198±37 in the two groups respectively.There were 72±16 matched spots in the two representative gels maps and the matched rate was 45.30%.Eiisat differentially expressed protein spots were identified from the two cholesterol-carrier phases.Among them,6 were up-regulated with 2 down-regulated in vesicular phase comnared with micellar phase.The abundance difierentiation of RBP and HSA Was Confirmed by immunoblotting.Conclusions The difierential protein profiles of vesicular phase and micellar phase of gallbladder bile from cholesterol gallstone patients were established and 8 difierentiaI protein spots were identified successfully.The data may be a basis for further screening the key regulators of formation of cholesterol gallstone.

Objective To establish a highly sensitive and specific ELISA method for measurement of leptin and further to study the secretion of leptin during human preadipecytes difierentiation and effects of troglitazone.Methods Rabbits Balb/c mice were immunized by recombinant human leptin and Balb/e mice were immunized by human leptin so as to produce rabbit anti-human leptin polyclonal antibodies(PAb) and mouse anti-human leptin monoclonal antibodies(MAb).Combination of the PAb as coating antibody,with a carefully paired biotinylated MAb as detector.and the avidin.horseradish peroxidase as the amplifier of detecting signals,a sandwich method,biotin-avidin ELISA(BA-ELISA)was established.Human omental preadipocytes were cultured,introduced to difierentiate,and treated with 10μmoL/L troglitazone;the leptin secretion in the supernatant was detected by BA-ELISA.Peripheral blood samples were collected from 114 healthy persons and the serum leptin was detected by BA-ELISA.Results The sensitivity of BA-ELISA was 0.03.s/ml with a working range of 0.05-5 ng/ml and a exogenous leptin recovery rate of 97.8%.and the intra-and interassay coefficients of variation(CVs)were less than 7.4%and 9.3% respectively.The assay detected only a single free leptin peak in gel chromatographic fractions from the mixed human sera or adipecytes culture media.The leptin secretion level detect 5ed bv BA-ELISA showed that the leptin secretion of the preadipocytes increased strongly when the cells difierentiated into mature adipocytes.The Deak leptin secretion level of the tmglitazone treated group waft 2 times as that of the control group.The leptin concentration of women was than 7.6 ng/ml,significantly higher than that of the men (3.2 ns/ml,P<0.001),and the serum leptin level was significantly correlated with body mass index both for men(r=0.67,P<0.001)and forwomen(r=0.61,P<0.001).Conclusion A highly sensitive BA-ELISA specific for free leptin has been developed that is especially suited for the accurate measurement of the rather low 1eptin levels of clinical blood specimens and for basic research use.

Objective To investigate the effect of early insulin therapy on the nuclear factor κB (NF-κB)pathway and inflammatory cytokine responses in skeletal muscle in type 2 diabetes mellitus (DM).Methods SD rats underwent intraperitoneal injection of streptozotoein to establish DM models and then divided into 5 groups:early un-treated group,early gliclazide treated group(receiving gliclazide since the third day after blood glucose increase for 3 weeks for 3 weeks),early insulin treated group(receiving insulin since the third day after blood glucose increase for 3 weeks for 3 weeks),late un-treated group,and late insulin treated group(receiving insulin since the fourth week after blood glucose increase for 3 weeks). By the end of treatment the rats were killed.Homogenate of skeletal muscle wss made.The NF-κB P65 DNA binding was assayed by ELISA.based assay kit.Real time PCR was used to detect the mRNA expression levels of the gene of the cytokines:glucose transporter 4(Glut4),inhibitor κB(IκBα),IL-1β,IL-6,and tumor necrosis factor (TNF)-α.And Glut4and IκBα protein expression Ievels were assayed by Westem blotting.Results The Glut4 mRNA level in the skeletal muscle of the untreated DM rats decreased by 59% and the Glut4 protein level in the muscle cell membrane decreased by 69%.Insulin treatment and glieiazide treatment increased the Glut4 mRNA expression by 17%and 13%respectively,increased the Glut4 protein expression in cell membrane by 23%and 10%respectively.and decreased the Glut4 protein expression in the cytoplasm.In the DM rats the IKBct protein expression in the skeletaI muscle was significantly lower (P<0.05)and the NF-κB P65 DNA binding activity increased,and TNF-α,IL-1β,and IL-6 expression levels Were up-regulated in comparison with the normal control group.Early treatment of insulin and gliciazide increased the IKBa protein expression,decreased the NF-κB P65 DNA binding activity and the TNF-α expression in the skeletal muscle.Conclusion Early insulin treatment inhibits the NFκB activity and inflammatory cytokine responses in skeletal muscle that are involved in the amelioration of insulin resistance in type 2 DM.Such results may be due to indirect antiinflammatery effects of insulin relieving glucotoxicity and lipotoxicity in peripheral tissues.

Many kinds of clinical diseases can lead to skeletal muscle atrophy, such as sepsis, cancer cachexia, severe trauma, burn, cardiopulmonary function, etc. Skeletal muscle atrophy not only affects patients' exercise and rehabilitation, but also easily causes complications such as pulmonary complications, deep vein thrombosis of lower limbs, low immune function, etc.

Blood lipid levels have been widely used clinically to assess the risk of cardiovascular events. Usually, we ask patients to fast for at least 8 h before performing blood lipid test. However, many outpatient patients often overlook this point. How much influence does normal diet have on blood lipid test, and whether its data can be used to assess the risk of cardiovascular events, Professor Nordestgaard of Copenhagen University Hospital, Denmark, et al.<This hypothesis was verified by a cross-sectional Study of more than 40,000 individuals in the Copenhagen General Population Study and the Copenhagen City Heart Study, published in Circulation, 2008, 118: 2047-2056.

The 2008 National Conference on Pediatric Cardiovascular Diseases was held in Jinan, Shandong Province from September 24 to 26, 2008. The conference was presided over by Professor Du Junbao, head of the cardiovascular group of Pediatrics Branch of South China Medical Association and a scholar from the Yangtze River. 222 pediatric clinical workers and researchers from 27 provinces, municipalities and autonomous regions, Hong Kong and Macao Special Administrative Regions participated in the conference. A total of 330 papers were included, including 71 exchanges and 16 special lectures.

Objeetive To evaluate the diagnostic values of double-balloon enteroscopy(DBE)and abdominal computed tomography(CT)in small bowel disease.Methods Seventy eight DBE procedures were carried out in 70 patients,40 males and 30 females;aged 47.7(16-83)with suspected smalI bowel disease,all of whom received gastroscopy,colonoscopy.and abdominal CT examination at the same time. The diagnostic value of DBE was compared with that of CT.Results Seventeen kinds of small bowel Iesions were detected,mainly including Crohn's disease,adenocarcinoma,gastrointestinal stroma tumor,vascular deformity,lymphoma,diverticulum,and polyp.There were no complications and all procedures were tolerated well.The mean duration of procedure was 110 min(30-240 min).Nineteen patients received surgical intervention.The diagnostic yield rate of DBE wag 57.1%(40/70),significantly higher than that of CT(31.4%,22/70,P<0.01).The positive diagnosis rate of DBE combined with CT was 62.9%(44/70).not significant difierent from that of the DBE alone(P>0.05).Conclusion DBE shows a significantly higher diagnostic yield than CT in patients with suspected small bowel disease,and thus should be selected for the initial diagnosis.DBE Combined with CT did not inerease the diagnostic yield.However. CT not only provides direction of jntubation for DBE.but also clearly depicts the small howel wall and extraenteric alterations.DBE and CT compliment each other in examining the patients with suspected small bowel disease.