Sex differences between Helicobacter pylori infection and cholesterol levels in an adult health checkup program.

BACKGROUND: Helicobacter pylori (H pylori) infection is suggested to be a risk factor of metabolic syndrome (MS) and lipid abnormalities. The aim of this study was to investigate the influence of H pylori infection on MS and lipid abnormalities according to sex differences. MATERIALS AND METHODS: We analyzed a total of 4551 adults who received health checkups from January 2016 to May 2017. We enrolled participants who did not have a history of hypertension, diabetes, hyperlipidemia, or cancer among those who underwent endoscopy with a rapid urease test. RESULTS: We included a total of 1065 participants, and 663 patients (62.3%) were H pylori-positive. The H pylori infection rate was 59.3% (426/719) in males and 68.5% (237/346) in females. The mean level of total cholesterol (P = .003), low-density lipoprotein (LDL) cholesterol (P = .046), and triglycerides (P = .029) were statistically higher in H pylori-infected males. The mean level of high-density lipoprotein (HDL) cholesterol was statistically lower in H pylori-infected females (P = .032). Multivariate analysis showed that total cholesterol in males (odds ratio [OR], 1.007; 95% confidence interval [CI], 1.002-1.011) and HDL cholesterol in females (OR, 0.983; 95% CI, 0.968-0.998) were associated with active H pylori infection. The prevalence of MS was higher in both male and female H pylori-infected groups; however, there was no statistical significance. CONCLUSIONS: H pylori infection is significantly related to increased total cholesterol in males and to decreased HDL cholesterol in females, which suggests that H pylori could affect lipid profiles and may be different by sex.

Effect of 7-day Bismuth Quadruple Therapy versus 14-day Moxifloxacin Triple Therapy for Second-line Helicobacter pylori Eradication Therapy.

BACKGROUND/AIMS: Both bismuth-containing quadruple therapy and moxifloxacin-containing triple therapy have been suggested as second-line eradication therapy for Helicobacter pylori (H. pylori) infection. We aimed to evaluate the efficacy of 14-day moxifloxacin-containing triple therapy (14-EAM) in second-line H. pylori eradication in comparison to 7-day bismuth-containing quadruple therapy (7-RBMT). METHODS: From January 2011 to December 2015, a total of 569 patients who failed to respond to first-line triple therapy and who subsequently received second-line 7-RBMT or 14-EAM were retrospectively enrolled. The eradication rates were identified using per-protocol (PP) analysis. H. pylori eradication was confirmed by a ¹³C-urea breath test (UBiT-IR300®; Otsuka Electronics, Co., Ltd., Osaka, Japan) or a rapid urease test (CLOtest® Delta West, Bentley, Australia) at least 4 weeks after completion of eradication therapy. RESULTS: A total of 487 and 82 patients received 7-RBMT and 14-EAM, respectively. PP eradication rates were 93.6% (366/391; 95% CI, 91.0-95.9%) with 7-RBMT and 73.8% (48/65; 95% CI, 63.1-84.6%) with14-EAM (p<0.001). Therefore, the eradication rates with 7-RBMT were significantly higher than with 14-EAM according to the PP analysis. The adverse event rate was 17.1% (67/391) with 7-RBMT and 7.7% (5/65) with 14-EAM (p=0.065). In terms of risk factors, multivariate analysis revealed that 14-EAM (OR, 5.47; 95% CI, 2.74-10.93) was related to H. pylori eradication failure. CONCLUSIONS: 7-RBMT may be an effective second-line therapy in patients who failed to respond to first-line triple therapy in Korea, where there is a high prevalence of H. pylori infection.

Relationship between patterns of calcification in thyroid nodules and histopathologic findings.

Various patterns of calcification have been detected in benign and malignant thyroid nodules on ultrasonography (US). Microcalcification has been found to be highly associated with papillary thyroid carcinoma. However, other patterns of calcification have unclear clinical significance. The aim of this study was to evaluate which pattern of calcification could be predictive of malignancy. A total of 1,431 thyroid nodules of 1,078 patients who received preoperative ultrasound examinations and subsequently underwent thyroidectomy were retrospectively reviewed. The types of calcification were defined as follows: microcalcification, annular-like peripheral calcification, crescent-like peripheral calcification, intranodular coarse calcification, and calcified spot. Of these 1,431 nodules, 1,305 (91.1%) were thyroid carcinomas and 126 (8.9%) were benign nodules. Calcifications were detected in 38.6% (552/1,431) of all nodules. Calcifications were found in 40.2% (524/1,305) of malignant nodules and 22.2% (28/126) of benign nodules. Of the 524 malignant nodules with calcification, microcalcification was the most common pattern, occurring in 42.9% (225/524), and annular type was the least common pattern, occurring in 5.9% (31/524). Among the calcification types, only microcalcification and intranodular had a significant association with malignancy (p = 0.001, 0.035), with OR values of 3.5 (95% CI, 1.6-7.7) and 2.4 (95% CI, 1.1-5.6). Though using the patterns of calcification alone for predicting malignancy had limitation, microcalcification and intranodular calcification were significantly associated with malignancy.

The impacts of C-reactive protein and atrial fibrillation on carotid atherosclerosis and ischemic stroke in patients with suspected ischemic cerebrovascular disease: a single-center retrospective observational cohort study.

BACKGROUND AND OBJECTIVES: Carotid intima-media thickness (IMT) is associated with chronic inflammation, and C-reactive protein (CRP) level is elevated in patients with atrial fibrillation (AF). We investigated the impacts of CRP and AF on carotid atherosclerosis and ischemic stroke in patients with suspected ischemic cerebrovascular disease. SUBJECTS AND METHODS: One-hundred forty patients (78 males) with suspected ischemic cerebrovascular disease underwent carotid ultrasonography. The mean common carotid artery IMT, mean internal carotid artery (ICA) IMT, and plaque score were measured. Patients were divided into four groups according to the presence of AF and elevated CRP level {n=46 for AF(-)CRP(-), n=38 for AF(-)CRP(+), n=43 for AF(+)CRP(-), and n=13 for AF(+)CRP(+)}. RESULTS: Common carotid artery IMT was significantly higher in the AF(-)CRP(+) (0.98±0.51 mm) and AF(+)CRP(+) (0.96±0.27 mm) groups compared to the AF(-)CRP(-) (0.80±0.32 mm) and AF(+)CRP(-) (0.77±0.19 mm) groups (p=0.027). Although there was no significant difference in mean ICA IMT among the groups, plaque score was the highest in the AF(+)CRP(+) (4.18±3.84 mm) group, followed by AF(-)CRP(+) (3.87±2.78 mm), AF(+)CRP(-) (1.34±2.61 mm), and AF(-)CRP(-) (1.17±2.02 mm) (p<0.001). The AF(+)CRP(+) group showed significantly higher incidence of ischemic stroke than the other groups (all p<0.05). Binary logistic regression analysis showed that age {odds ratio (OR)=1.033, p=0.001}, elevated CRP (OR=3.884, p=0.001), and the presence of AF (OR=1.375, p=0.018) were significantly correlated with incidence of ischemic stroke. CONCLUSION: Elevated plasma CRP concentration may be a reliable surrogate marker for predicting carotid atherosclerosis in patients with AF, which may be related to increased risk of ischemic stroke.