Staphylococcal enterotoxin sensitization in a community-based population: a potential role in adult-onset asthma.

BACKGROUND: Recent studies suggest that Staphylococcus aureus enterotoxin sensitization is a risk factor for asthma. However, there is a paucity of epidemiologic evidence on adult-onset asthma in community-based populations. OBJECTIVE: We sought to evaluate the epidemiology and the clinical significance of staphylococcal enterotoxin sensitization in community-based adult populations. METHODS: The present analyses were performed using the baseline data set of Korean adult population surveys, consisting of 1080 adults (mean age = 60.2 years) recruited from an urban and a rural community. Questionnaires, methacholine challenge tests, and allergen skin tests were performed for defining clinical phenotypes. Sera were analysed for total IgE and enterotoxin-specific IgE using ImmunoCAP. RESULTS: Staphylococcal enterotoxin sensitization (≥ 0.35 kU/L) had a prevalence of 27.0%. Risk factors were identified as male sex, current smoking, advanced age (≥ 61 years), and inhalant allergen sensitization. Current asthma was mostly adult onset (≥ 18 years old) and showed independent associations with high enterotoxin-specific IgE levels in multivariate logistic regression tests. In multivariate linear regressions, staphylococcal enterotoxin-specific IgE level was identified as the major determinant factor for total IgE level. CONCLUSIONS AND CLINICAL RELEVANCE: Staphylococcal enterotoxin sensitization was independently associated with adult-onset asthma in adult community populations. Strong correlations between the enterotoxin-specific IgE and total IgE levels support the clinical significance. The present findings warrant further studies for the precise roles of staphylococcal enterotoxin sensitization in the asthma pathogenesis.

Clonorchis sinensis infection is positively associated with atopy in endemic area.

BACKGROUND: Epidemiologic studies have suggested that helminth infections play a protective role against allergy; this inverse association, however, has not been consistent. Clonorchis sinensis, the liver fluke of human, is prevalent in the Far East. The association between C. sinensis infection and allergy has not yet been reported. OBJECTIVE: We evaluated the association between clonorchiasis and atopy or allergic diseases in adults in endemic areas of clonorchiasis. METHODS: A total of 1116 subjects (males 419, females 697; age range, 30-86; mean age=61 years) were recruited from two endemic areas of C. sinensis in Korea. Clonorchiasis was confirmed by stool examination. Allergic symptoms were evaluated with a modified ISAAC questionnaire, and atopy was defined by skin prick test for common inhalant allergens. Total serum IgE and C. sinensis-specific IgE level was measured by ELISA and methacholine bronchial provocation test was performed to evaluate airway hyperresponsiveness (AHR). RESULTS: Clonorchiasis was positively associated with atopy [odds ratio (OR), 1.856; 95% confidence interval (CI), 1.199-2.873] and high levels of total serum IgE (OR, 1.455; 95% CI, 1.050-2.016). Higher association with clonorchiasis was shown in subjects who showed both atopy and high total serum IgE levels (OR, 2.540; 95% CI, 1.448-4.455). Clonorchiasis had no association with wheezing, AHR, asthma or allergic rhinitis. CONCLUSION AND CLINICAL RELEVANCE: Clonorchiasis was positively associated with atopy in adults in endemic area.

Combined effect of socioeconomic status, viral hepatitis, and lifestyles on hepatocelluar carcinoma risk in Korea.

BACKGROUND: The independent and combined effects of socioeconomic status (SES), viral hepatitis, and other lifestyle factors on hepatocellular carcinoma (HCC) risk have not been investigated among Koreans. METHODS: From the National Cancer Center Hospital, 207 HCC cases and 828 age- and gender-matched controls aged 30 years or older were recruited. Socio-demographic and behavioural risk factors were ascertained through personal interview, and infection with hepatitis B and C viruses was determined by their serologic markers. Multivariate logistic regression and synergy index methods were applied for statistical analysis. RESULTS: HB surface antigen (HbsAg) and anti-HCV-positive rates were 149.3 and 185.1 times higher in cases than controls, respectively. Lifetime alcohol consumption (odds ratio: 2.96, 95% CI: 1.29-6.79), cigarette smoking (OR: 3.53, 95% CI: 1.31-9.52), and family income (OR: 17.07, 95% CI: 4.27-68.25) were independently associated with the risk of HCC in subjects with or without viral hepatitis. Synergistic interaction on HCC risk was observed between low income and HBsAg positivity (SI: 3.12, 95% CI: 1.51-6.47) and between low income and heavy alcohol intake (SI: 2.93, 95% CI: 1.24-6.89). CONCLUSION: The inverse association with SES suggests SES as an independent and synergistic predictor of HCC. Heavy alcohol intake also showed a combined effect with low SES on HCC risk.

Recurrence after percutaneous ethanol ablation of simple hepatic, renal, and splenic cysts: is it true recurrence requiring an additional treatment?

BACKGROUND: Recurrence after percutaneous ethanol ablation (PEA) of benign hepatic and renal cysts has been common, resulting in re-treatment or additional surgery. However, in recent years, a few cases of spontaneous regression of recurrent cysts following PEA have been experienced, which led to the design of this study to evaluate cyst recurrence after PEA and the necessity of additional treatment. PURPOSE: To evaluate whether the initial recurrence after PEA of benign hepatic, renal, and splenic cysts is true recurrence, and to decide whether additional treatment is needed. MATERIAL AND METHODS: Thirty-nine benign cysts (21 hepatic, 17 renal, and one splenic) were treated with PEA. PEA was performed with injection of 13-900 ml (40-50% of the volume of aspirated fluid) of absolute ethanol into the cysts. For cysts larger than 100 ml, two or more PEAs were given in one session. Ultrasonography was then performed during a period of 12 months with 1-2-month intervals. RESULTS: Two months after PEA, eight cysts (20.5%) regressed completely; another 31 cysts recurred with decreased size. After 6 months, 10 of the recurrent cysts had regressed spontaneously. Another four recurrent cysts regressed after 8 months, and three regressed after 12 months. Hence, 25 out of 39 (64.1%) cysts regressed within 12 months after PEA. The mean regression time of the 25 recurrent cysts was 6.3 months. All recurrent cysts, including the 14 that were lost to complete follow-up, showed gradual decrease overtime. There were no major complications associated with PEA. CONCLUSION: Initial relapse of a cyst following PEA does not signify true recurrence, but transient, reactive, or inflammatory fluid collections which eventually disappear within several months, and thus does not necessitate additional treatment.

Pneumothorax size: correlation of supine anteroposterior with erect posteroanterior chest radiographs.

Findings in 30 consecutive patients with pneumothorax were prospectively analyzed. All patients underwent supine anteroposterior (AP) and erect posteroanterior (PA) chest radiography. The interpleural distances were measured at three locations. Average interpleural distances on supine AP and erect PA radiographs were analyzed by means of correlation and linear regression analysis. The authors developed a formula that can be used to estimate the size of a pneumothorax on a supine AP chest radiograph.