An updated review of case–control studies of lung cancer and indoor radon-Is indoor radon the risk factor for lung cancer?

Sheen, Seungsoo,Lee, Keu Sung,Chung, Wou Young,Nam, Saeil,Kang, Dae Ryong BioMed Central 2016 Annals of occupational and environmental medicine Vol.28 No.1

<P>Lung cancer is a leading cause of cancer-related death in the world. Smoking is definitely the most important risk factor for lung cancer. Radon (<SUP>222</SUP>Rn) is a natural gas produced from radium (<SUP>226</SUP>Ra) in the decay series of uranium (<SUP>238</SUP>U). Radon exposure is the second most common cause of lung cancer and the first risk factor for lung cancer in never-smokers.</P><P>Case–control studies have provided epidemiological evidence of the causative relationship between indoor radon exposure and lung cancer. Twenty-four case–control study papers were found by our search strategy from the PubMed database. Among them, seven studies showed that indoor radon has a statistically significant association with lung cancer. The studies performed in radon-prone areas showed a more positive association between radon and lung cancer. Reviewed papers had inconsistent results on the dose–response relationship between indoor radon and lung cancer risk.</P><P>Further refined case–control studies will be required to evaluate the relationship between radon and lung cancer. Sufficient study sample size, proper interview methods, valid and precise indoor radon measurement, wide range of indoor radon, and appropriate control of confounders such as smoking status should be considered in further case–control studies.</P>

An updated review of case-control studies of lung cancer and indoor radon-Is indoor radon the risk factor for lung cancer?

Seungsoo Sheen,Keu Sung Lee,Wou Young Chung,Saeil Nam,Dae Ryong Kang 대한직업환경의학회 2016 대한직업환경의학회지 Vol.28 No.-

Lung cancer is a leading cause of cancer-related death in the world. Smoking is definitely the most important risk factor for lung cancer. Radon (<SUP>222</SUP>Rn) is a natural gas produced from radium (<SUP>226</SUP>Ra) in the decay series of uranium (<SUP>238</SUP>U). Radon exposure is the second most common cause of lung cancer and the first risk factor for lung cancer in never-smokers. Case–control studies have provided epidemiological evidence of the causative relationship between indoor radon exposure and lung cancer. Twenty-four case–control study papers were found by our search strategy from the PubMed database. Among them, seven studies showed that indoor radon has a statistically significant association with lung cancer. The studies performed in radon-prone areas showed a more positive association between radon and lung cancer. Reviewed papers had inconsistent results on the dose–response relationship between indoor radon and lung cancer risk. Further refined case–control studies will be required to evaluate the relationship between radon and lung cancer. Sufficient study sample size, proper interview methods, valid and precise indoor radon measurement, wide range of indoor radon, and appropriate control of confounders such as smoking status should be considered in further case–control studies.

임상진료지침의 개발

신승수 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

A comprehensive study of deaths due to exposure to humidifier disinfectant in Korea: focusing on medical records, assessment of exposure to humidifier disinfectants, and causes of death

Yeong Jun Ju,Seungho Lee,Seungsoo Sheen,Dong-Woo Choi,Jong-Han Leem,Soon Young Lee 한국역학회 2021 Epidemiology and Health Vol.43 No.-

OBJECTIVES: We aimed to determine the characteristics of the deceased victims of deaths caused by exposure to humidifier disinfectants, and present the distribution of the victims’ data submitted for damage application, demographic characteristics, imaging findings, characteristics of humidifier disinfectant exposure, and distribution of the causes of death. METHODS: An integrated database of victims was established using the medical records data of 1,413 victims submitted during the application for death damage caused by exposure to humidifier disinfectants, and the demographic characteristics, medical records, imaging findings, exposure characteristics, and cause of death were examined. RESULTS: The average numbers of data submissions of each applicant for death damage were 3.0 medical use records. A total of 608 (43.0%) victims had more than one finding of acute, subacute, or chronic interstitial lung diseases. The average daily and cumulative use times of the victims were 14.40 and 24,645.81 hours, respectively, indicating greater exposure in this group than in the survivors. The humidifier disinfectants’ components comprised polyhexamethylene guanidine (72.8%), chloromethylisothiazolinone/methylisothiazolinone (10.5%), other components (15.0%), and oligo-[2-(2-ethoxy)-ethoxyethyl] guanidine chloride (1.5%). The components’ distribution was 67.8% for single-component use, which was higher than that in the survivors (59.8%). The distribution of the causes of death were: respiratory diseases (54.4%), neoplasms (16.8%), and circulatory diseases (6.3%). Other interstitial lung diseases (65.5%) were the most common cause of death among those who died due to respiratory diseases. CONCLUSIONS: Careful discussions of appropriate remedies should be conducted based on a comprehensive understanding of the characteristics of the deceased victims, considering their specificities and limitations.

안구돌출과 요붕증으로 나타난 Langerhans 세포 조직구증에 대한 증례 보고

김선신,박준성,신승수,김효철,전미선,박광화 아주대학교 의과학연구소 1999 아주의학 Vol.4 No.1

The authors experienced a case of Langerhans cell histiocytosis who presented with severe exophtalmus and central diabetes insipidus. A 26 year old female patient had exophthalmus on her left side due to Langerhans cell histiocytosis infiltrating the left petrosal and orbital bone demonstrated by MRI. Water deprivation test revealed diabetes insipidus of central type due to Langerhas cell histiocytosis involving the pituitary gland. Exophtalmus improved significantly with VP-16 150 ㎎/㎡/weekly for 6 weeks, vinblastin 6 ㎎/㎡ weekly for 6 weeks, and prednisolone 40 ㎎/㎡/daily for 4 weeks, while diabetes insipidus was controlled by nasal spray of DDAVP.

Evaluation report on the causal association between humidifier disinfectants and lung injury

Mina Ha,Soon Young Lee,Seung-sik Hwang,Hyesook Park,Seungsoo Sheen,Hae Kwan Cheong,Bo Youl Choi 한국역학회 2016 Epidemiology and Health Vol.38 No.-

OBJECTIVES: As of November 2011, the Korean government recalled and banned humidifier disinfectants (HDs) from the market, because four case-control studies and one retrospective epidemiological study proved the association between HDs and lung injury of unknown cause. The report reviewed the causal role of HDs in lung injury based on scientific evidences. METHODS: A careful examination on the association between the HDs and lung injury was based on the criteria of causality inference by Hill and the US Surgeon General Expert Committee. RESULTS: We found that all the evidences on the causality fulfilled the criteria (strength of association, consistency, specificity, temporality, biologic gradient, plausibility, coherence, experiment, analogy, consideration of alternative explanations, and cessation of exposure), which proved the unknown cause lung injury reported in 2011 was caused by the HDs. In particular, there was no single reported case of lung injury since the ban in selling HDs in November 2011 as well as before the HDs were sold in markets. CONCLUSIONS: Although only a few epidemiological studies in Korea have evaluated the association between lung injury and the use of HDs, those studies contributed to proving the strong association between the use of the HDs and lung injury, based on scientific evidence.

Poster Session : PS-1544 ; COPD : Effectiveness of Bronchoscopic Lung Volume Reduction Using Unilateral Endobronchial Valve: A Systematic Review and Meta-Analysis

( Miyoung Choi ),( Worl Suk Lee ),( Min Lee ),( Kyeongman Jeon ),( Seungsoo Sheen ),( Sanghoon Jheon ),( Young Sam Kim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Bronchoscopic lung volume reduction (BLVR) can be suggested as an alternative for surgical lung volume reduction surgery for severe emphysema patients. This article intends to evaluate the safety and effectiveness of BLVR using one-way endobronchial valve by systematic review. Methods: A systematic search of electronic databases including MEDLINE, EMBASE, and Cochrane Library, as well as eight domestic databases up to December 2013 was performed. Two reviewers independently screened all references according to selection criteria. The Scottish Intercollegiate Guidelines Network (SIGN) criterion was used to assess quality of literature. Data from randomized controlled trials (RCTs) were combined and meta-analysis was performed. Results: This review included 15 studies. The forced expiratory volume in one second (FEV1) improved in the intervention group compared to the control group (MD=6.71, 95% CI: 3.31 to 10.11). Six minute walking distance (MD=15.66, 95% CI : 1.69 to 29.64) and cycle workload (MD= 4.43, 95% CI: 1.80- to7.07) also improved. In addition, the St. George`s Respiratory Questionnaire (SGRQ) score decreased (MD -4.29, 95% CI: -6.87 to -1.71) in the intervention group. In a subgroup analysis of patients with complete fissure, the FEV1 change from baseline was higher in the BLVR group than the control group for both 6 month (MD=14.75, p <.001) and 12 months (MD=17.43, p <.001) whereas patients with incomplete fissure the FEV1 and 6MWD showed no change. One year follow-up randomized controlled trials reported deaths although the cause of death was not related to BLVR. Respiratory failure and pneumothorax incidence rate was relatively higher in the BLVR group but the difference was not significant. Conclusions: Bronchoscopic lung volume reduction may be an effective and safe procedure for the treatment of severe COPD patients with emphysema based on existing studies.

The Korean Academy of Tuberculosis and Respiratory Diseases : Slide Session ; OS-041 : COPD ; Clinical Effi cacy and Adverse Events Between Indacaterol and Tiotropium in COPD: Meta-Analysis of Randomized Controlled Trials

( Jung Soo Kim ),( Hye Yun Park ),( Yeon Mok Oh ),( Kwang Ha Yoo ),( Yong Bum Park ),( Seungsoo Sheen ),( Jin Kyeong Park ),( Ji Ye Jung ),( Seong Yong Lim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Current guidelines recommend the use of inhaled long-acting bronchodilators as the fi rst-line therapy in patients with stable chronic obstructive pulmonary disease (COPD). In Korea, nationally, two, once daily inhaled bronchodilator are available: the beta2 agonist indacaterol and the anticholinergic tiotropium. We aimed to compare the clinical effi cacy and safety between indacaterol and tiotropium. Methods: Data sources were Medline, EMBASE, Cochrane Central Register of Controlled Trials (to July, 2014). Randomized prospective trials that compared tiotropium with indacaterol in COPD for more than 12 weeks were included. The primary outcome was trough FEV1 at 12th week, and secondary outcomes included trough FEV1 at 26th week, St. George`s Respiratory Questionnaire (SGRQ) total score at 26th week, and adverse events. Results: Four RCTs were eligible for inclusion. Trough FEV1 at 12th and 26th week were not significantly different between tiotropium and indacaterol by a standard deviation mean difference (SMD) of 0.00 (95% CI: -0.01, 0.02, I2 =12%) and 0.02 (95% CI: -0.07, 0.12,I2 = 0%), respectively. Regarding to quality of life, indacaterol and tiotropium showed similar SGRQ total score at 26th week (SMD of -0.01, 95% CI: -0.07, 0.08, I2 = 50%). Adverse events such as cardiovascular event and nasopharyngitis, and serious adverse events were similar between indacaterol and tiotropium, while cough was more common in indacaterol than tiotropium (OR: 1.65, 95% CI 1.33, 2.06).Conclusions: The evidence is equivocal as to clinical efficacy and serious adverse events between tiotropium and indacaterol, while patients with indacaterol had complained for cough more than those with tiotropium.

The Prognostic Value of Residual Volume/Total Lung Capacity in Patients with Chronic Obstructive Pulmonary Disease

Shin, Tae Rim,Oh, Yeon-Mok,Park, Joo Hun,Lee, Keu Sung,Oh, Sunghee,Kang, Dae Ryoung,Sheen, Seungsoo,Seo, Joon Beom,Yoo, Kwang Ha,Lee, Ji-Hyun,Kim, Tae-Hyung,Lim, Seong Yong,Yoon, Ho Il,Rhee, Chin Kook The Korean Academy of Medical Sciences 2015 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.30 No.10

Indoor radon exposure increases tumor mutation burden in never-smoker patients with lung adenocarcinoma

Lim, Sun Min,Choi, Jae Woo,Hong, Min Hee,Jung, Dongmin,Lee, Chang Young,Park, Seong Yong,Shim, Hyo Sup,Sheen, Seungsoo,Kwak, Kyeong Im,Kang, Dae Ryong,Cho, Byoung Chul,Kim, Hye Ryun Elsevier 2019 Lung cancer Vol.131 No.-

<P><B>Abstract</B></P> <P><B>Objectives</B></P> <P>Radon, a natural radiation, is the leading environmental cause of lung cancer in never-smokers. However, the radon exposure impact on the mutational landscape and tumor mutation burden (TMB) of lung cancer in never-smokers has not been explored. The aim of this study was to investigate the mutational landscape of lung adenocarcinoma in never-smokers who were exposed to various degrees of residential radon.</P> <P><B>Materials and methods</B></P> <P>To investigate the effect of indoor radon exposure, we estimated the cumulative exposure to indoor radon in each house of patients with lung cancer with a never-smoking history. Patients with at least 2 year-duration of residence before the diagnosis of lung adenocarcinoma were included. Patients were subgrouped based on the median radon exposure level (48 Bq/m<SUP>3</SUP>): radon-high <I>vs.</I> radon-low and targeted sequencing of tumor and matched blood were performed in all patients.</P> <P><B>Results</B></P> <P>Among 41 patients with lung adenocarcinoma, the TMB was significantly higher in the radon-high group than it was in the radon-low group (mean 4.94 <I>vs</I>. 2.6 mutations/Mb, <I>P</I> = 0.01). The recurrence rates between radon-high and radon-low group did not differ significantly. Mutational signatures of radon-high tumors showed features associated with inactivity of the base excision repair and DNA replication machineries. The analysis of tumor evolutionary trajectories also suggested a series of mutagenesis induced by radon exposure. In addition, radon-high tumors revealed a significant protein-protein interaction of genes involved in DNA damage and repair (<I>P</I> < 0.001).</P> <P><B>Conclusions</B></P> <P>Indoor radon exposure increased the TMB in never-smoker patients with lung adenocarcinoma and their mutational signature was associated with defective DNA mismatch repair.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Radon is the leading environmental cause of lung cancer in never-smokers. </LI> <LI> We investigated the mutational landscape in never-smokers who were exposed to residential radon. </LI> <LI> Indoor radon exposure increased tumor mutation burden. </LI> </UL> </P>