Cost-effectiveness and short-term clinical outcomes of argon plasma coagulation compared with endoscopic submucosal dissection in the treatment of gastric low-grade dysplasia.

Endoscopic treatment such as endoscopic submucosal dissection (ESD) or argon plasma coagulation (APC) is widely performed to treat gastric low-grade dysplasia (LGD). We aimed to evaluate the clinical efficacy of APC versus ESD for gastric LGD in terms of cost-effectiveness. This was a retrospective review of patients with gastric LGD who were treated with endoscopic intervention (APC or ESD) between March 2011 to December 2015. Fifty-nine patients treated with APC and 124 patients treated with ESD were included. Patients in the APC group were significantly older (mean age, 67.68 vs 63.90 years, respectively, P < .01), had an increased rate of Helicobacter pylori infection (27.1 vs 10.5%, respectively, P < .01), and had a higher mean Charlson Comorbidity Index score (2.32 vs 0.38, respectively, P < .01) than those in the ESD group. The 2 groups did not differ in tumor size, location, macroscopic morphology, or surface configuration. The procedure time (11.31 vs56.44 minutes, respectively, P < .01), and hospital stay (3.2 vs 5.6 days, respectively, P < .01) were significantly, shorter in the APC group than in the ESD group. Additionally, the cost incurred was significantly, lower in the APC group than in the ESD group (962.03 vs 2,534.80 dollars, respectively, P < .01). APC has many advantages related to safety, and cost-effectiveness compared with ESD. Therefore, APC can be considered an alternative treatment option for gastric LGD.

Abdominal fat distribution measured using computed tomography is associated with an increased risk of colorectal adenoma in men.

A few studies have shown inconsistent results regarding the association between the visceral fat proportion and colorectal adenomas. We aimed to investigate the association between abdominal fat distribution measured by computed tomography (CT) and colon adenoma.A total of 336 participants underwent physical examination, blood tests, colonoscopy, and abdominal computed tomography at Chung-Ang University Hospital. The associations between the obesity indicies (body mass index, visceral fat area (VFA), subcutaneous fat area (SFA), VFA-to-SFA ratio (VFA/SFA), and colorectal adenomas were evaluated.Of 309 subjects, 119 patients (38.5%) had colorectal adenoma. Mean age and fasting plasma glucose were higher in the patients with colorectal adenoma (P < .05, respectively). The mean VFA (153.3 cm vs 131.4 cm, P < .01) and VFA/SFA (1.07 vs 0.92, P < .05) were higher in the adenoma group than in the nonadenoma group. Males had higher mean VFA and VFA/SFA (P < .001). The mean VFA, SFA, and VFA/SFA were not associated with the location, size, number, and advancement of colorectal adenoma. In multivariate analysis, colorectal adenoma was significantly associated with VFA rather than VFA/SFA. In addition, colorectal adenoma was significantly associated with VFA rather than VFA/SFA in the men. The VFA, SFA, and VFA/SFA were not associated with colorectal adenoma in the women.The VFA measured by using a CT scan was positively associated with the presence of colorectal adenoma, especially in men. Furthermore, average risk men with large visceral fat volume should be examined carefully in screening colonoscopy.

Seasonal factors influencing exercise-induced asthma.

PURPOSE: Exercise-induced bronchoconstriction (EIB) in patients with asthma occurs more frequently in winter than in summer. The concentration of house dust mite (HDM) allergens in beds also shows seasonal variation. This study examined the relationship between seasonal differences in the prevalence of EIB and sensitization to HDMs in patients with asthma. METHODS: The medical records of 74 young adult male patients with asthma-like symptoms who underwent bronchial challenge with methacholine, 4.5% saline and exercise, and allergen skin prick tests, were reviewed. The subjects were divided into summer (n=27), spring/fall (n=26) and winter (n=21) groups according to the season during which they underwent testing. RESULTS: The positive responses to exercise differed according to season (48.1% in summer, 73.1% in spring/fall, and 90.5% in winter; P<0.01). In addition, the prevalence of positive responses to HDM (70.4%, 88.5%, and 95.2%, respectively; P<0.05) and pollen skin tests (37.0%, 19.2%, and 0%, respectively; P<0.01) also showed significant seasonal differences. Severe responses to 4.5% saline showed a similar trend, although it was not statistically significant (44.4%, 50.0%, and 71.4%, respectively; P=0.07). Skin test reactivity to HDMs was significantly related to maximal fall in forced expiratory volume in one second (FEV1) following exercise (r=0.302, P<0.01) and the index of airway hyperresponsiveness (AHR) to 4.5% saline (r=-0.232, P<0.05), but not methacholine (r=-0.125, P>0.05). CONCLUSIONS: Positive skin test reactions to HDMs and EIB occurred in winter, spring/fall, and summer in decreasing order of frequency. Seasonal variation in the prevalence of EIB may be related to seasonal variation in sensitization to HDMs, accompanied by differences in indirect, but not direct, AHR.

Very Late Stent Thrombosis in a Drug-Eluting Stent due to Interruption of Anti-Platelet Agents in Patients With Acute Myocardial Infarction and Thrombocytosis.

Stent thrombosis is a fatal complication in patients who have undergone percutaneous coronary intervention, and discontinuation of anti-platelet agent is a major risk factor of stent thrombosis. We report a rare case of very late stent thrombosis (VLST) following discontinuation of anti-platelet agents in a patient who experienced acute myocardial infarction and essential thrombocytosis. She had undergone implantation of a drug eluting stent (DES) and a bare metal stent (BMS) two and half years prior to her presentation. VLST developed in DES, not in BMS, following interruption of anti-platelet therapy.

Personal Factors Affecting Therapeutic Responses to BCG Vaccination in Asthmatics.

PURPOSE: Bacille Calmette-Guérin (BCG) vaccination has been reported to be an effective treatment for asthma in several animal models. This study investigated whether the response to BCG treatment in asthma depends on subject clinical characteristics. METHODS: Stable asthma patients were vaccinated with BCG. One month later, alterations in pulmonary function after vaccination and their relationships with subject clinical characteristics were determined. RESULTS: Of 149 patients with asthma, 54 (36.2%) showed a good or fair response to BCG. The ΔFEV1 after vaccination was significantly related to age (r=-0.348, P<0.001), peripheral blood eosinophil counts (r=0.315, P<0.001) and baseline FEV1, expressed as % personal best value (r=-0.474, P<0.001), but not to FEV1 % predicted value (r=-0.066, P>0.05). A good/fair response was highly prevalent in atopic females compared with atopic males, especially among those aged ≤50 years (90.9% vs. 40.0%, P=0.024). Age (P<0.001, odds ratios (OR)=0.92, confidence interval (CI)=0.88-0.96) and atopy (P<0.01, OR=4.95, CI=1.70-14.44) were significant predictors for a good/fair response in females. However, blood eosinophil counts (P<0.05, OR=1.18, CI=1.01-1.39) and FEV1 % best (P<0.001, OR=0.86, CI=0.79-0.94), but not age or atopy, were significant predictors in males. Approximately three-quarters of the males were smokers. CONCLUSIONS: The therapeutic effect of BCG in asthma may differ according to patient clinical characteristics. The greatest benefit occurred in young atopic females. Asthma activity indices, such as eosinophilia and FEV1 % best, were more predictive of a good/fair response in males; this may have been related to cigarette smoking.