Outcome of percutaneous transluminal angioplasty in diabetic patients with critical limb ischaemia

OBJECTIVE

We investigated the clinical outcome of percutaneous transluminal angioplasty (PTA) which has not been fully established in diabetic patients with critical limb Ischaemia (CLI) compared with non-diabetics.

DESIGN AND PATIENTS

A total of 73 limbs of 52 patients (50 limbs of 34 diabetic patients and 23 limbs of 18 non-diabetics) who underwent PTA for CLI (Rutherford-Becker category 4, 5 or 6) were enrolled. Rates of amputation and restenosis, and ankle brachial index (ABI), were assessed before and after PTA during a 36-month follow-up period.

RESULTS

Diabetic patients had a higher rate of major amputations after PTA (10 vs. 0%, P<0.05); however, total amputation (12.0 vs. 8.7%, P=0.62) and restenosis rates (4.0 vs. 8.7%, P=0.38) were not significantly different compared with non-diabetic patients. ABI at 3 months after PTA was significantly improved in both diabetic and non-diabetic patients (0.70±0.20 vs. 0.93±0.19, P<0.01 in diabetic patients; 0.69±0.25 vs. 0.92±0.17, P<0.01 in non-diabetics). Improved ABI was maintained for 36 months in both groups and did not show a significant difference (0.88±0.21 vs. 0.89±0.20, P=0.89).

CONCLUSION

Our results, showing that the outcome of PTA in diabetic patients is not inferior to that in non-diabetics, suggest the potential benefit of primary PTA, instead of bypass surgery, for CLI in diabetic patients who are at high risk of perioperative complications.

A Fas-associated via death domain promoter polymorphism (rs10898853, -16C/T) as a risk factor for papillary thyroid cancer

PURPOSE

To determine whether a Fas-associated via death domain (FADD) promoter single-nucleotide polymorphism (SNP) is associated with susceptibility to papillary thyroid cancer (PTC) and clinicopathological features of PTC.

METHODS

To identify a possible association with PTC, 94 patients with PTC and 346 healthy controls were recruited. One promoter SNP (rs10898853, -16C/T) was analyzed by direct sequencing. Multiple logistic regression models (co-dominant, dominant, recessive, and log-additive models) were applied, and odds ratios (ORs), 95% confidence intervals (CIs), and p values were calculated.

RESULTS

The genotype of the promoter SNP (rs10898853) of FADD was found to be significantly associated with PTC in the co-dominant model 2 (T/T vs. C/C; p = 0.002, OR = 2.80, 95% CI = 1.39-5.65), the recessive model (p = 0.003, OR = 2.21, 95% CI = 1.31-3.71), and the log-additive model (p = 0.002, OR = 1.71, 95% CI = 1.20-2.44). Allele frequency analysis showed that the C allele of rs10898853 was significantly associated with an increased risk of PTC (p = 0.002, OR = 1.67, 95% CI = 1.21-2.32).

CONCLUSIONS

Our results suggest that the FADD promoter polymorphism is associated with susceptibility to PTC.

Acute basilar artery occlusion: outcome of mechanical thrombectomy with Solitaire stent within 8 hours of stroke onset

BACKGROUND AND PURPOSE

Mechanical thrombectomy with a stent retriever applied shortly after symptom onset could increase good functional outcomes and improve survival in patients with acute basilar artery occlusion, but this has not yet been studied. This study evaluated the efficacy and safety of mechanical thrombectomy with a Solitaire stent within 8 hours of stroke onset in patients with acute basilar artery occlusion.

MATERIALS AND METHODS

We analyzed 25 consecutive patients with acute basilar artery occlusion who were treated with mechanical thrombectomy by use of the Solitaire stent within 8 hours of stroke symptom onset. Successful recanalization was defined as TICI grade 2b or 3. Good outcome was defined as mRS score of 0-2 at 3 months. Clinical and radiologic data in patients with good outcomes were compared with those with poor outcomes.

RESULTS

Successful recanalization was achieved in 96% (24/25) of patients, and 48% (12/25) of patients had good outcomes. Eighty-eight percent (22/25) of patients survived to 3 months. The median NIHSS score on admission was significantly lower in patients with good outcomes than in those with poor outcomes (9.5 versus 14, P = .005). Procedure-related complications occurred in 2 patients (8%). No symptomatic intracerebral hemorrhages occurred.

CONCLUSIONS

The current study suggests that mechanical thrombectomy by use of a Solitaire stent within 8 hours of stroke onset increases good outcomes and improves survival in patients with acute basilar artery occlusion.

An initial measurement of a fast neutral spectrum for ion cyclotron range of frequency heated plasma using two-channel compact neutral particle analyzers in KSTAR

The accurate measurement of fast neutral particles from high energy ion tails is very important since it is a measure of ion cyclotron range of frequency (ICRF) or neutral beam (NB) ion heating. In KSTAR, fast neutral measurements have been carried out using a compact neutral particle analyzer based on the silicon photo diode since 2010. As a result, the fast neutral spectrum was observed consistent with the ion temperature, diamagnetic energy, and neutron flux in 2011. However, there was fast neutral count beyond the injected neutral beam energy in NB-only heating. Since it is difficult to expect the count unless the temperature is high enough to diffuse the fast ions beyond the beam energy it was required to identify what it is. During the 2012 campaign, the two-channel diode detectors with and without a particle stopper were used to distinguish fast neutral counts and other counts by a hard X-ray or neutrons. As a result, it was confirmed that the high energy component beyond the beam energy originated from a hard X-ray or neutrons. Finally, it was observed that faster neutrals are generated by ICRF heating and enhanced by electron cyclotron heating compared to NB-only heating.

Validation of a scoring tool to predict drug-resistant pathogens in hospitalised pneumonia patients

BACKGROUND

Health care-associated pneumonia (HCAP) affects a heterogeneous group of patients in frequent contact with health care systems. However, HCAP criteria poorly predict infection with drug-resistant (DR) pathogens.

OBJECTIVE

To validate our previously reported risk-scoring model (predictive of DR pathogen infection) in patients admitted to hospital with pneumonia.

DESIGN

We evaluated 580 patients admitted with culture-positive bacterial pneumonia. We identified risk factors, evaluated the risk-scoring model's capacity to predict infection by DR pathogens and compared the model's diagnostic accuracy with that of current HCAP criteria.

RESULTS

DR pathogens were observed in 227/580 patients (39.1%). Of 269 HCAP patients, 153 (56.9%) were infected with DR pathogens. Overtreatment was more common in HCAP than in community-acquired pneumonia (58.7% vs. 41.2%, P < 0.001). Recent hospitalisation, admission from a long-term care facility, recent antibiotic treatment and tube feeding were independently associated with DR pathogens. For pathogen prediction, the risk-scoring model showed better diagnostic accuracy than HCAP criteria (area under receiver operating-characteristic curve = 0.723 vs. 0.673, P < 0.001).

CONCLUSION

According to current HCAP criteria, half of the HCAP patients were treated unnecessarily with broad-spectrum antibiotics. Risk scoring by stratifying risk factors could improve the identification of patients likely to be infected with DR pathogens.

Interleukin 22 polymorphisms and papillary thyroid cancer

BACKGROUND

IL22RA1 (Interleukin 22 receptor-alpha 1), a member of the class II cytokine receptor family, mediates diverse biologic activities and appears to be important in pathogen defense, wound healing, and tissue reorganization. Polymorphisms in genes encoding inflammatory cytokines are associated with increased cancer risk.

AIM

The aim of this study was to evaluate the association between the single nucleotide polymorphisms (SNP) in the IL22 and IL22RA1 and papillary thyroid cancer (PTC), and to assess the relationship between the SNP in the IL22 and IL22RA1 and the clinical parameters of PTC.

MATERIAL AND METHODS

Study enrolled experimental group of 94 PTC patients and 213 controls. PTC patients were grouped and compared for clinical PTC parameters. One promoter SNP of IL22, -429C/T (rs2227485), and one SNP of IL22RA1, Arg518Gly (rs3795299) were analyzed using direct sequencing. Genetic data were analyzed using Helixtree, SNPAnalyzer Pro, SNPStats, and Haploview.

RESULTS

A SNP in IL22 (rs2227485) was significantly associated with PTC (codominant2 model [C/C vs T/T], odds ratio (OR) 2.39, 95% confidence interval (CI) 1.21-4.71, p=0.012; dominant model, OR 1.89, 95% CI 1.08-3.31, p=0.022). The allele T frequency of rs2227485 in IL22 was also associated with PTC (OR 1.59, 95% CI 1.13-2.25, p=0.009). According to clinical parameters, rs2227485 of IL22 was associated with number of cancers (dominant model, OR 3.03, 95% CI 1.02-9.01, p=0.035). By haplotype analysis, TG was associated with PTC (codominant model, OR 1.52, 95% CI 1.07-2.16, p=0.019; dominant model, OR 1.91, 95% CI 1.13- 3.24, p=0.015). Genotype and allele analysis of rs3795299 in IL22RA1 showed no significant differences between PTC patients and controls.

CONCLUSION

The rs2227485 SNP in IL22 might be associated with the risk and the multifocality of PTC.

Transient thyrotoxicosis from thyroiditis induced by sibutramine overdose

Sibutramine is an antiobesity drug that inhibits the reuptake of serotonin and noradrenalin in the hypothalamus. A 37-year-old Korean man presented to the emergency room for the oral intake of 280 mg of sibutramine. The patient was in thyrotoxic state. The 99mTechnetium-pertechnetate thyroid scan showed irregular uptake of radioisotope and thyroid-stimulating hormone receptor antibody and thyroperoxidase antibody were negative. Thyroid function normalized after that. The patient had transient thyrotoxicosis with thyroiditis. We report a case of thyrotoxicosis accompanied by thyroiditis resulting from the intentional overdose of sibutramine.

Ultra-low gamma-ray measurement system for neutrinoless double beta decay

An experiment for the detection of 0νβ(+)/EC and 0νEC/EC in 92Mo nuclei has been carried out with a scintillating crystal, CaMoO4, in coincidence with the HPGe detector. We study the background events inside the event selection window for 0ν β(+)/EC decays of CaMoO4 detector. For 51.2 days of data taking period, we didn't observe any event in the neutrinoless EC/EC decay event window. The (92)Mo 0νβ(+)/EC decay half-life limit was set to 0.61×10(20) years with a 90% confidence by method of Feldman and Cousins. This ultra-low gamma ray measurement utilizing coincidence technique can be used for the resonant EC/EC decay process of some nuclei which is potentially important for neutrinoless double beta decay process.

Search for an H-dibaryon with a mass near 2mΛ in Υ(1S) and Υ(2S) decays

We report the results of a high-statistics search for H dibaryon production in inclusive Υ(1S) and Υ(2S) decays. No indication of an H dibaryon with a mass near the M(H)=2m(Λ) threshold is seen in either the H→Λpπ(-) or ΛΛ decay channels and 90% confidence level branching-fraction upper limits are set that are between one and two orders of magnitude below the measured branching fractions for inclusive Υ(1S) and Υ(2S) decays to antideuterons. Since Υ(1S,2S) decays produce flavor-SU(3)-symmetric final states, these results put stringent constraints on H dibaryon properties. The results are based on analyses of 102 million Υ(1S) and 158 million Υ(2S) events collected with the Belle detector at the KEKB e(+)e(-) collider.

Biallelic expression of the L-arginine:glycine amidinotransferase gene with different methylation status between male and female primordial germ cells in chickens

The basic functions of DNA methylation include in gene silencing by methylation of specific gene promoters, defense of the host genome from retrovirus, and transcriptional suppression of transgenes. In addition, genomic imprinting, by which certain genes are expressed in a parent-of-origin-specific manner, has been observed in a wide range of plants and animals and has been associated with differential methylation. However, imprinting phenomena of DNA methylation effects have not been revealed in chickens. To analyze whether genomic imprinting occurs in chickens, methyl-DNA immunoprecipitation array analysis was applied across the entire genome of germ cells in early chick embryos. A differentially methylated region (DMR) was detected in the eighth intron of the l-arginine:glycine amidinotransferase (GATM) gene. When the DMR in GATM was analyzed by bisulfite sequencing, the methylation in male primordial germ cells (PGC) of 6-d-old embryos was higher than that in female PGC (57.5 vs. 35.0%). At 8 d, the DMR methylation of GATM in male PGC was 3.7-fold higher than that in female PGC (65.0 vs. 17.5%). Subsequently, to investigate mono- or biallelic expression of the GATM gene during embryo development, we found 2 indel sequences (GTTTAATGC and CAAAAA) within the GATM 3'-untranslated region in Korean Oge (KO) and White Leghorn (WL) chickens. When individual WL and KO chickens were genotyped for indel sequences, 3 allele combinations (homozygous insertion, homozygous deletion, and heterozygotes) were detected in both breeds using a gel shift assay and high-resolution melt assay. The deletion allele was predominant in KO, whereas the insertion allele was predominant in WL. Heterozygous animals were evenly distributed in both breeds (P < 0.01). Despite the different methylation status between male and female PGC, the GATM gene conclusively displayed biallelic expression in PGC as well as somatic embryonic, extraembryonic, and adult chicken tissues.

Hypopigmented keratosis: is it a hyperkeratotic variant of idiopathic guttate hypomelanosis?

We have occasionally seen patients with acquired well-demarcated, scattered hypopigmented papules. In this study, we investigated the clinical and histopathological characteristics of such lesions. Biopsies were taken from the lesional and perilesional normal skin from 10 of 13 patients, which were compared with 10 idiopathic guttate hypomelanosis (IGH) samples. The lesions were scattered, well-circumscribed, flat-topped, hypopigmented papules. There was no age or gender predilection. Marked hyperkeratosis was present, with clear-cut margins distinguishable from the adjacent normal epidermis. The melanin content was decreased in the lesional epidermis, which was associated with a decrease in expression of melanogenesis-associated markers such as tyrosinase and NKI/beteb (marker of gp100) and reduction in the number of melanocytes. These histological findings were similar to those of IGH except for the additional finding of a thicker stratum corneum in this case seem to represent a 'hyperkeratotic' variant of IGH.

The responses of multiple cytokines following incubation of whole blood from TB patients, latently infected individuals and controls with the TB antigens ESAT-6, CFP-10 and TB7.7

The development of clinically relevant biomarkers is important for diagnosing latent tuberculosis infection (LTBI) and active tuberculosis (TB) and predicting their prognoses. This study examined whether the responses of multiple cytokines can be used as a biomarker to distinguish the TB infection status and mycobacterial load. We analysed the responses of multiple cytokines (IFN-γ, IL-2, IL-10, IL-13, IL-17 and TNF-α) in the supernatant from the QuantiFERON-TB Gold In-Tube assay following stimulation of whole blood from the TB group (n = 32), LTBI group (n = 19) and healthy controls (n = 30) with TB antigens (ESAT-6, CFP-10 and TB7.7). The median responses of IFN-γ, IL-2, IL-10 and IL-13 were higher in the LTBI and active TB groups than in the non-TB control group (IFN-γ, P < 0.001; IL-2, P < 0.001; IL-10, P = 0.012; IL-13, P < 0.001). The median IL-2/IFN-γ ratio of the LTBI group was higher than that of the active TB group (P = 0.014) and differed significantly between patients with LTBI, patients with smear-negative TB and patients with smear-positive TB (P = 0.027). This difference was especially evident between the patients with LTBI and patients with smear-positive TB (P = 0.047). In conclusion, IFN-γ, IL-2, IL-10 and IL-13 can serve as biomarkers for distinguishing TB infection. In addition, the IL-2/IFN-γ ratio appears to be a biomarker for diagnosing LTBI and may be useful as a prognostic factor and for evaluating treatment responses.

Modular instrument mounting system for variable environment in operando X-ray experiments

In the growing field of in operando and in situ X-ray experiments, there exists a large disparity in the types of environments and equipment to control them. This situation makes it challenging to conduct multiple experiments with a single mechanical interface to the diffractometer. Here, we describe the design and implementation of a modular instrument mounting system that can be installed on a standard six-circle diffractometer (e.g., 5021 Huber GmbH). This new system allows for the rapid changeover of different chambers and sample heaters and permits accurate sample positioning (x, y, z, and azimuthal rotation) without rigid coupling to the chamber body. Isolation of the sample motion from the chamber enclosure is accomplished through a combination of custom rotary seals and bellows. Control of the pressure and temperature has been demonstrated in the ranges of 10(-6)-10(3) Torr and 25°C-900°C, respectively. We have utilized the system with several different modular instruments. As an example, we provide in situ sputtering results, where the growth dynamics of epitaxial LaGaO3 thin films on (001) SrTiO3 substrates were investigated.

Abstract P1-10-01: Curcumin suppresses MMP-9 expression via inhibition of PKCα/MAPKs and NF-κB/AP-1 activation in MCF-7 cells

Background: Curcumin is a polyphenol derived from the plant turmeric (Curcuma longa), which is commonly used as a spice. It was recently reported for its anticancer effect on several types of cancer cells in vitro, however the molecular mechanisms of this anticancer effect are not fully understood. In the present study, we investigated the effect of curcumin on 12-O-tetradecanoylphorbol-13-acetate(TPA)-induced matrix metalloproteinase-9(MMP-9) expression and cell invasion in MCF-7 breast cancer cells.

Materials and Methods: The effect of curcumin on MCF-7 cell viability was determined using MTT assay. The cells invasion was demonstrated by the Matrigel-coated transwell assay. Western blot analysis was performed to detect the effect of curcumin on the expression of MMP-9. MMP-9 mRNA levels were analyzed by real-time PCR. NF-κB and AP-1 DNA binding was analyzed by EMSA.

Results: Our results showed that curcumin inhibits TPA-induced MMP-9 expression and cell invasion through suppressing NF-κB and AP-1 activation. Curcumin strongly repressed the TPA-induced phosphorylation of p38 and JNK and also inhibited TPA-induced translocation of PKCa from the cytosol to the membrane, but did not affect the translocation of PKCδ.

Conclusion: It is concluded that curcumin inhibits the TPA-induced MMP-9 expression and cell invasion through the suppression of the PKCα/MAPK/NF-kB/AP-1 pathway in MCF-7 breast cancer cells. Accordingly, curcumin may have the therapeutic potential in restricting breast cancer metastasis.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-10-01.

Association of CXCL1 promoter polymorphism with ischaemic stroke in Korean population

This is a pilot study analysing association of chemokine gene polymorphisms (CXCL1, rs3117604; CXCL2, rs3806792; CCL2, rs2857656 and rs3760396; CCL5, rs2107538) in Korean patients with ischemic stroke (IS) (n = 120) and age-matched controls (n = 267). The CXCL1 gene and particularly T allele of rs3117604 was associated with IS.

Conversion rates of an interferon-γ release assay and the tuberculin skin test in the serial monitoring of healthcare workers

PURPOSE

Regular monitoring of latent tuberculosis (TB) infection in healthcare workers (HCWs) is recommended, but the view about the effective method and performance of serial monitoring is controversial. The aim of this study was to determine differences in conversion rates according to TB exposure risk using the tuberculin skin test (TST) and the QuantiFERON-TB Gold In-Tube (QFT-GIT), and to evaluate the reproducibility and within-subject variability of the QFT-GIT in South Korea.

METHODS

Fifty-three HCWs were grouped according to their risk for TB exposure: group 1, high risk (n = 21); group 2, low risk (n = 32). Baseline and follow-up TSTs and QFT-GITs were performed from June 2009 to July 2011. Enzyme-linked immunosorbent assays (ELISAs) were repeated for the second QFT-GIT and a third QFT-GIT was performed after 8 weeks when discordant results of the second TST and QFT-GIT or a conversion or reversion were observed.

RESULTS

No difference in the QFT-GIT conversion rate was evident between the two groups (15.4 vs. 6.5 %, p = 0.57), and no TST conversion was observed. The rate of QFT-GIT positivity was higher in the high-risk group (first QFT-GIT: 38.1 vs. 3.1 %, p = 0.002; second QFT-GIT: 33.3 vs. 9.4 %, p = 0.039). The re-test reproducibility of QFT-GIT results was high (100 %), and the within-subject results of repetitive QFT-GITs were variable.

CONCLUSIONS

Stricter prevention strategies remain necessary in HCWs at high risk of TB exposure, and serial interferon-γ release assays (IGRAs) should be interpreted with caution in HCWs.

Fall detection algorithm for the elderly using acceleration sensors on the shoes

The rate of increase in the number of aging population in Korea is very rapid among OECD-member countries. And fall accident is one of the most common factors that threaten the health of the elderly. Therefore, it is needed to develop a fall detection system for the elderly. Most fall detection systems use accelerometers attached on the torso. And in various studies, it was verified that these systems have high sensitivity and high specificity. However, the elderly would feel uncomfortable when banding a sensor on the chest every day. Therefore, in this study, we attached an accelerometer on the shoes to detect fall in the elderly. This prototype system would be improved as a smaller, low-power system in the next study. Also, applying energy harvesting device to this shoe system is being developed to reduce the weight of battery.

New limits on interactions between weakly interacting massive particles and nucleons obtained with CsI(Tl) crystal detectors

New limits are presented on the cross section for weakly interacting massive particle (WIMP) nucleon scattering in the KIMS CsI(Tℓ) detector array at the Yangyang Underground Laboratory. The exposure used for these results is 24 524.3  kg·days. Nuclei recoiling from WIMP interactions are identified by a pulse shape discrimination method. A low energy background due to alpha emitters on the crystal surfaces is identified and taken into account in the analysis. The detected numbers of nuclear recoils are consistent with zero and 90% confidence level upper limits on the WIMP interaction rates are set for electron equivalent energies from 3 to 11 keV. The 90% upper limit of the nuclear recoil event rate for 3.6-5.8 keV corresponding to 2-4 keV in NaI(Tℓ) is 0.0098 counts/kg/keV/day, which is below the annual modulation amplitude reported by DAMA. This is incompatible with interpretations that enhance the modulation amplitude such as inelastic dark matter models. We establish the most stringent cross section limits on spin-dependent WIMP-proton elastic scattering for the WIMP masses greater than 20  GeV/c2.

Counting small hypointense spots confounds the quantification of functional islet mass based on islet MRI

Iron-containing fragmented islets or free iron released from dying cells could confound the interpretation of MRI of iron nanoparticle-labeled islets. Exclusion of small hypointense spots could be a useful strategy to avoid such artifact. We investigated whether this strategy could improve the estimation of functioning islet mass after islet transplantation. Using a rat syngeneic intraportal islet transplantation model, we quantitatively assessed the relationships between total area, number of hypointense spots on MRI that belong to each size quartile and glycemic control of the recipients. The total area of hypointense spots on MRI was greater in the recipients that achieved diabetes reversal (p = 0.002), whereas the total number of hypointense spots was not different (p = 0.757). Exclusion of small hypointense spots improved the association between the number of hypointense spots and the blood glucose level of the recipients (p < 0.001). Ex-vivo imaging and histologic study confirmed that some small hypointense spots represent the phagocytosed free iron. Exclusion of small hypointense spots improved the quantification of the functional islet mass based on islet MRI. This would be a useful principle in the development of an algorithm to estimate functioning islet mass based on islet MRI.

Measurement of the CP-violation parameter sin2φ1 with a new tagging method at the Υ(5S) resonance

We report a measurement of the CP-violation parameter sin2φ1 at the Υ(5S) resonance using a new tagging method, called "B-π tagging." In Υ(5S) decays containing a neutral B meson, a charged B, and a charged pion, the neutral B is reconstructed in the J/ψK(S)(0) CP-eigenstate decay channel. The initial flavor of the neutral B meson at the moment of the Υ(5S) decay is opposite to that of the charged B and may thus be inferred from the charge of the pion without reconstructing the charged B. From the asymmetry between B-π(+) and B-π(-) tagged J/ψK(S)(0) yields, we determine sin2φ1=0.57±0.58(stat)±0.06(syst). The results are based on 121 fb(-1) of data recorded by the Belle detector at the KEKB e(+)e(-) collider.

Chronic obstructive pulmonary disease and metabolic syndrome: a nationwide survey in Korea

SETTING

Systemic inflammation has been suggested to be involved in the pathogenesis of chronic obstructive pulmonary disease (COPD) and metabolic syndrome. However, the association between these two conditions is not fully understood.

OBJECTIVE

To evaluate the relationship between COPD and metabolic syndrome.

DESIGN

Among subjects aged ≥40 years from the 2001 Korean National Health and Nutrition Examination Survey, 1215 subjects with two or more acceptable spirometry measurements and complete anthropometric/laboratory examinations were analysed.

RESULTS

A total of 133 subjects (11%, 100 men and 33 women) were newly diagnosed with COPD (forced expiratory volume in 1 second/forced vital capacity ≤ 70%). The prevalence of metabolic syndrome, based on the National Cholesterol Education Program Adult Treatment Panel III, was significantly higher in COPD subjects compared with non-COPD subjects in both sexes (33.0% vs. 22.2% in men and 48.5% vs. 29.6% in women). In men, the risk of COPD was higher in subjects with metabolic syndrome than in those without (OR 2.03, 95%CI 1.08-3.80), after adjusting for potential confounders. There was a borderline significant association between COPD and abdominal obesity among the individual component of metabolic syndrome (OR 1.95, 95%CI 0.93-4.11).

CONCLUSION

In the Republic of Korea, metabolic syndrome was associated with COPD in men.

A switch to endoscopic mucosal resection after precutting following gastric perforation during endoscopic submucosal dissection: a simple and useful technique

Endoscopic submucosal dissection (ESD) is safe and effective, but as the number of patients undergoing ESD has increased, so has the number of iatrogenic perforations. We describe the effectiveness and benefits of endoscopic mucosal resection after precutting (EMR-P) in a series of patients who developed a macroperforation during ESD. This was a retrospective, single-center case series from a prospectively maintained database in an academic tertiary care center. The study involved 16 patients with macroperforation out of 1171 patients who underwent ESD between November 2006 and January 2011. En bloc resection by EMR-P was achieved in 12 out of 16 patients (75%) and piecemeal resection in 4 (25%). All patients were discharged after a mean hospital stay of 6.8 days without further complications. There were no recurrences during the median follow-up period of 11.4 months. Macroperforation during ESD can be managed successfully by endoscopic closure, and EMR-P should then be considered.