Furthermore, low responders to clopidogrel because of a CYP2C19 polymorphism. However, easy, fast, and low-cost laboratory examinations to monitor the effect of APA on an individual patient’s platelets are not readily available. For some patients, a certain dose may not be sufficient to prevent thrombotic events, while for others, that same dose might cause dangerous bleeding complications such as ICH. For low responders to APA, in whom platelet function and coagulation parameters are normal, even when given concomitantly with APA, PLT might induce overcoagulation around the ICH site. Taking drug resistance into consideration, clarification of the effects of PLT on ICH prognosis will require a prospective cohort study with monitoring of the effects of APA. A key limitation in this study was the short duration of observation, because patients were often moved to other institutions within a short period of time following admission, due to limited capacity at our hospital. In addition, we need an increased sample size to evaluate better the PLT effect in the multivariate regression analysis. Another disadvantage in this study was that the decision to give a PLT depended on the resident neurosurgeon. However, the strength of our study was that this was the first to look at the effect of PLT in a population of Asian patients with ICH plus concomitant APA; all three previous studies have dealt mainly with Caucasian patients. As Asian people tend to be APA resistant, PLT seemed to be less necessary compared with Caucasians even in cases of ICH with APA. Finally, as this was a single-institution study, our patients were evaluated using consistent methods and procedures. To evaluate the true effects of PLT on ICH survival, animal models and prospective stratified cohorts taking into account the effects of APAs are necessary. Various beneficial or probiotic effects have been attributed to strains belonging to the genera Bifidobacterium and Lactobacillus. Probiotic bacteria have been used to treat, among others, antibiotic-associated diarrhea, food allergies, atopic eczema, inflammatory bowel disease and arthritis. In addition, several studies have inferred a role for probiotic bacteria as antagonists of pathogenic bacteria. Proposed mechanisms of action include competition for the same attachment sites as pathogenic bacteria, competition for nutrients, production of growth-inhibitory compounds and stimulation of the immune system. Whether probiotics need to adhere to epithelial cells of the human gut in order to exert their beneficial effect is still a matter of debate, but close contact between the two is required at some stage. Bacterial adhesion to the gut epithelium is a complex process in which host, bacterial and environmental factors interact, and it is reasoned that adhesion and associated probiotic activities are regulated by bacterial cell-to-cell communication systems.