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Lim, Hyungryul,Choi, Jonghyuk,Kim, Jong-Hun,Cheong, Hae-Kwan,Ha, Mina The Korean Academy of Medical Sciences 2018 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.33 No.29
<P><B>Background</B></P><P>Radiation exposure from medical procedures has been rapidly increasing. We purposed to estimate the fraction of cancer incidence and mortality attributed to diagnostic medical radiation exposure in Korea.</P><P><B>Methods</B></P><P>Using information on diagnostic medical radiation exposure from various sources including national health examination (National Health Insurance Service), private health examination, and conscription health examination; the annual mean exposed organ dose (mGy) from all diagnostic medical radiation use, grouped by sex and 5-year age ranges up to 80 years, was calculated. Cancer incidence and mortality lifetime attributable risks (LARs) up to 85 years using estimated exposed organ doses and biological effects of ionizing radiation (BEIR) VII model (excess relative risk and excess absolute risk) were estimated. Using background cancer incidence and mortality risk based on the national database, along with estimated LARs, we finally estimated population attributable fraction (PAF) of cancer incidence and mortality.</P><P><B>Results</B></P><P>The PAF for diagnostic medical radiation exposure among all cancers of Koreans was 0.9% for incidence and mortality, resulting 1,915 cancer cases and 637 cancer deaths a year. The PAF in females was higher than those in males: 1.2% and 1.7% (incidence and mortality) versus 0.6% (same in incidence and mortality), respectively.</P><P><B>Conclusion</B></P><P>The estimated PAF for diagnostic medical radiation in Korea in 2013 was higher than those reported in the UK in 2004. Optimized management of diagnostic medical radiation use is important in Korea.</P>
Hyungryul Lim,Ji-ae Lim,Jong Hyuk Choi,Ho-jang Kwon,Mina Ha,Heon Kim,Jung-duck Park 한국독성학회 2016 Toxicological Research Vol.32 No.1
Recently several studies reported that the renal toxicity of lead (Pb) and cadmium (Cd) may exist in even a low level exposure. In terms of the deterioration of tubular function, it affects the loss of divalent metals and leads to other complications, so renal tubular effect of heavy metals should be well managed. Considering the exposure to heavy metals in reality, it is hard to find the case that human is exposed to only one heavy metal. We designed a cross-sectional study using Korean Research Project on the Integrated Exposure Assessment (KRIEFS) data to investigate the renal effects of multiple metal exposure in general population. We used blood Pb and urinary Cd as exposure measures, and urinary N-acetyl-β-D-glucosaminidase (NAG) and β2-microglobulin (β2-MG) as renal tubular impairment outcome. We conducted linear regression to identify the association between each heavy metal and urinary NAG and β2-MG. And then, we conducted linear regression including the interaction term. Of 1953 adults in KRIEFS (2010~2011), the geometric mean of blood Pb and urinary Cd concentration was 2.21 μg/dL (geometric SD = 1.49 μg/dL) and 1.08 μg/g cr (geometric SD = 1.98 μg/g cr), respectively. In urinary Cd, the strength of the association was also high after adjusting (urinary NAG: β = 0.44, p < 0.001; urinary β2-MG: β = 0.13, p = 0.002). Finally, we identified the positive interactions for the two renal biomarkers. The interaction effect of the two heavy metals of β2-MG was greater than that of NAG. It is very important in public health perspective if the low level exposure to multiple heavy metals has an interaction effect on kidney. More epidemiological studies for the interaction and toxicological studies on the mechanism are needed.
Lim, Hyungryul,Lim, Ji-ae,Choi, Jong Hyuk,Kwon, Ho-jang,Ha, Mina,Kim, Heon,Park, Jung-duck Korean Society of ToxicologyKorea Environmental Mu 2016 Toxicological Research Vol.32 No.1
Recently several studies reported that the renal toxicity of lead (Pb) and cadmium (Cd) may exist in even a low level exposure. In terms of the deterioration of tubular function, it affects the loss of divalent metals and leads to other complications, so renal tubular effect of heavy metals should be well managed. Considering the exposure to heavy metals in reality, it is hard to find the case that human is exposed to only one heavy metal. We designed a cross-sectional study using Korean Research Project on the Integrated Exposure Assessment (KRIEFS) data to investigate the renal effects of multiple metal exposure in general population. We used blood Pb and urinary Cd as exposure measures, and urinary N-acetyl-${\beta}$-D-glucosaminidase (NAG) and ${\beta}_2$-microglobulin (${\beta}_2$-MG) as renal tubular impairment outcome. We conducted linear regression to identify the association between each heavy metal and urinary NAG and ${\beta}_2$-MG. And then, we conducted linear regression including the interaction term. Of 1953 adults in KRIEFS (2010~2011), the geometric mean of blood Pb and urinary Cd concentration was $2.21{\mu}g/dL$ (geometric $SD=1.49{\mu}g/dL$) and $1.08{\mu}g/g\;cr$ (geometric $SD=1.98{\mu}g/g\;cr$), respectively. In urinary Cd, the strength of the association was also high after adjusting (urinary NAG: ${\beta}=0.44$, p < 0.001; urinary ${\beta}_2$-MG: ${\beta}=0.13$, p = 0.002). Finally, we identified the positive interactions for the two renal biomarkers. The interaction effect of the two heavy metals of ${\beta}_2$-MG was greater than that of NAG. It is very important in public health perspective if the low level exposure to multiple heavy metals has an interaction effect on kidney. More epidemiological studies for the interaction and toxicological studies on the mechanism are needed.
Lim, Hyungryul,Kwon, Ho-Jang,Lim, Ji-Ae,Choi, Jong Hyuk,Ha, Mina,Hwang, Seung-sik,Choi, Won-Jun The Korean Society for Preventive Medicine 2016 Journal of Preventive Medicine and Public Health Vol.49 No.4
Objectives: No children-specified review and meta-analysis paper about the short-term effect of fine particulate matter ($PM_{2.5}$) on hospital admissions and emergency department visits for asthma has been published. We calculated more precise pooled effect estimates on this topic and evaluated the variation in effect size according to the differences in study characteristics not considered in previous studies. Methods: Two authors each independently searched PubMed and EMBASE for relevant studies in March, 2016. We conducted random effect meta-analyses and mixed-effect meta-regression analyses using retrieved summary effect estimates and 95% confidence intervals (CIs) and some characteristics of selected studies. The Egger's test and funnel plot were used to check publication bias. All analyses were done using R version 3.1.3. Results: We ultimately retrieved 26 time-series and case-crossover design studies about the short-term effect of $PM_{2.5}$ on children's hospital admissions and emergency department visits for asthma. In the primary meta-analysis, children's hospital admissions and emergency department visits for asthma were positively associated with a short-term $10{\mu}g/m^3$ increase in $PM_{2.5}$ (relative risk, 1.048; 95% CI, 1.028 to 1.067; $I^2=95.7%$). We also found different effect coefficients by region; the value in Asia was estimated to be lower than in North America or Europe. Conclusions: We strengthened the evidence on the short-term effect of $PM_{2.5}$ on children's hospital admissions and emergency department visits for asthma. Further studies from other regions outside North America and Europe regions are needed for more generalizable evidence.
Mercury Exposure in Association With Decrease of Liver Function in Adults: A Longitudinal Study
Choi, Jonghyuk,Bae, Sanghyuk,Lim, Hyungryul,Lim, Ji-Ae,Lee, Yong-Han,Ha, Mina,Kwon, Ho-Jang The Korean Society for Preventive Medicine 2017 Journal of Preventive Medicine and Public Health Vol.50 No.6
Objectives: Although mercury (Hg) exposure is known to be neurotoxic in humans, its effects on liver function have been less often reported. The aim of this study was to investigate whether total Hg exposure in Korean adults was associated with elevated serum levels of the liver enzymes aspartate aminotransferase (AST), alanine transaminase (ALT), and gamma-glutamyltransferase (GGT). Methods: We repeatedly examined the levels of total Hg and liver enzymes in the blood of 508 adults during 2010-2011 and 2014-2015. Cross-sectional associations between levels of blood Hg and liver enzymes were analyzed using a generalized linear model, and nonlinear relationships were analyzed using a generalized additive mixed model. Generalized estimating equations were applied to examine longitudinal associations, considering the correlations of individuals measured repeatedly. Results: GGT increased by 11.0% (95% confidence interval [CI], 4.5 to 18.0%) in women and 8.1% (95% CI, -0.5 to 17.4%) in men per doubling of Hg levels, but AST and ALT were not significantly associated with Hg in either men or women. In women who drank more than 2 or 3 times per week, AST, ALT, and GGT levels increased by 10.6% (95% CI, 4.2 to 17.5%), 7.7% (95% CI, 1.1 to 14.7%), and 37.5% (95% CI,15.2 to 64.3%) per doubling of Hg levels, respectively, showing an interaction between blood Hg levels and drinking. Conclusions: Hg exposure was associated with an elevated serum concentration of GGT. Especially in women who were frequent drinkers, AST, ALT, and GGT showed a significant increase, with a significant synergistic effect of Hg and alcohol consumption.