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Humidifier disinfectant lung injury, how do we approach the issues?
Choi, Jihyun Emma,Hong, Sang-Bum,Do, Kyung-Hyun,Kim, Hwa Jung,Chung, Seockhoon,Lee, Eun,Choi, Jihyun,Hong, Soo-Jong The Korean Society of Environmental Toxicology 2016 환경독성보건학회지 Vol.31 No.-
A large portion of the Korean population has been exposed to toxic humidifier disinfectants (HDs), and considering that the majority of the victims are infants, the magnitude of the damage is expected to be considerably larger than what has currently been revealed. The current victims are voicing problems caused by various diseases, including but not limited to lung, upper respiratory tract, cardiovascular, kidney, musculoskeletal, eye, and skin diseases, etc. However, there has been difficulty in gaining validation for these health problems and identifying causal relationships due to lack of evidence proving that toxic HD is the specific causes of extrapulmonary diseases such as allergic rhinitis. Furthermore, the victims and bereaved families of the HD case have not received any support for psychological distress such as post-traumatic stress disorder, depression, feelings of injustice, and anger caused by the trauma. In addition, because the underlying mechanisms of the toxic materials within the HDs such as polyhexamethylene guanidine phosphate, poly(oxyalkylene guanidine) hydrochloride, chloromethylisothiazolinone /methylisothiazolinone have yet to be determined, the demand for information regarding the HD issue is growing. The victims of the HD cases require support that goes beyond financial aid for medical costs and living expenses. There is a desperate need for government-led integrated support centers that provide individualized support through health screenings; in other words, we need an integrated facility that provides the appropriate social support to allow the victims to recover their physical and mental health, so as to well prepare them to return to a normal life. The implementation of such a plan requires not only the close cooperation between those departments already directly involved such as the Ministry of Environment and the Ministry of Health and Welfare, but also active support on a national scale from pan-governmental consultative bodies.
Humidifier disinfectant lung injury, how do we approach the issues?
Jihyun Emma Choi,Sang-Bum Hong,Kyung-Hyun Do,Hwa Jung Kim,Seockhoon Chung,Eun Lee,Jihyun Choi,Soo-Jong Hong 환경독성보건학회 2016 환경독성보건학회지 Vol.31 No.-
A large portion of the Korean population has been exposed to toxic humidifier disinfectants (HDs), and considering that the majority of the victims are infants, the magnitude of the damage is expected to be considerably larger than what has currently been revealed. The current victims are voicing problems caused by various diseases, including but not limited to lung, upper respiratory tract, cardiovascular, kidney, musculoskeletal, eye, and skin diseases, etc. However, there has been difficulty in gaining validation for these health problems and identifying causal relationships due to lack of evidence proving that toxic HD is the specific causes of extrapulmonary diseases such as allergic rhinitis. Furthermore, the victims and bereaved families of the HD case have not received any support for psychological distress such as post-traumatic stress disorder, depression, feelings of injustice, and anger caused by the trauma. In addition, because the underlying mechanisms of the toxic materials within the HDs such as polyhexamethylene guanidine phosphate, poly(oxyalkylene guanidine) hydrochloride, chloromethylisothiazolinone /methylisothiazolinone have yet to be determined, the demand for information regarding the HD issue is growing. The victims of the HD cases require support that goes beyond financial aid for medical costs and living expenses. There is a desperate need for government-led integrated support centers that provide individualized support through health screenings; in other words, we need an integrated facility that provides the appropriate social support to allow the victims to recover their physical and mental health, so as to well prepare them to return to a normal life. The implementation of such a plan requires not only the close cooperation between those departments already directly involved such as the Ministry of Environment and the Ministry of Health and Welfare, but also active support on a national scale from pan-governmental consultative bodies.
( Jihyun An ),( Ju Hyun Shim ),( Ha Il Kim ),( Seheon Chang ),( Sangyoung Yi ),( Jonggi Choi ),( Gwang Hyeon Choi ),( Danbi Lee ),( Kang Mo Kim ),( Young-suk Lim ),( Han Chu Lee ),( Young-hwa Chung ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Evidence-based guidelines recommend radiofrequency ablation (RFA) as a non-transplant option in treating patients with multiple hepatocellular carcinomas (HCCs) meeting the Milan criteria. Previous comparative studies have reported that local recurrence rate is higher in patients experiencing RFA than surgery. The purpose of this study is to compare the efficacy of RFA versus surgical resection in patients with operable HCCs within the Milan criteria. Methods: Between 2007 and 2011, 650 asymptomatic patients with HCC fulfilling the Milan criteria were initially treated with RFA or surgery at our hospital. Among these, 129 patients with Child-Pugh A liver function who had more than one tumor were included in this study: RFA and resection were performed in 48 (37.2%) and 81 (62.8%), respectively. The patient median age was 56 years, 79.1% were males, and 83.7% were HBV-positive. Overall and recurrence- free survivals were compared between the two treatment groups. Clinical variables affecting survival or recurrence were also identified. Results: The mean size of the largest tumor was 1.8±0.5 and 2.1±0.5 cm, respectively in the RFA and resection groups (P<0.05). Signs of portal hypertension were noted in 24 (50%) and 18 (22.2%) patients, respectively in the corresponding groups (P<0.05). During a median observation of 6.5 years, 34 (70.8%) and 50 (61.7%) recurrences; and 15 (31.3%) and 16 (19.8%) deaths occurred in the RFA and resection groups, respectively. The 5-year cumulative rates of recurrence-free- and overall survivals were 31.6% versus 32.7%; and 72.9% versus 85.2%, respectively in the corresponding groups (Ps=NS). Multivariate Cox analysis adjusted for significant confounders showed that no significant difference in the risk of recurrence or death was observed according to treatment method (Ps=NS). Conclusions: Our data indicate that surgical resection may be not preferred over RFA in patients with multifocal HCCs at BCLC A stage, as recommended by current guidelines.
( Jihyun An ),( Ju Hyun Shim ),( Ha Il Kim ),( Seheon Chang ),( Sangyoung Yi ),( Jonggi Choi ),( Gwang Hyeon Choi ),( Danbi Lee ),( Kang Mo Kim ),( Young-suk Lim ),( Han Chu Lee ),( Young-hwa Chung ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: A cut-off point of 5 cm for classifying a single hepatocellular carcinoma (HCC) as BCLC stage A is no longer used in the updated BCLC guidelines. However, there is a continuing debate about the need for size criteria for a single A stage tumor. We aimed to assess whether such size limit was necessary based on survival outcomes of patients receiving treatment recommended by the guidelines. Methods: This study included 301 patients with solitary BCLC-A HCC >5 cm and normal portal hypertension who initially underwent resection (n=238; standard A group) or transarterial chemoembolization (TACE) (n=63; non-standard A group); and 385 with BCLC-B HCC undergoing TACE (standard B group). All patients had Child-Pugh A liver function. Overall survival was compared between the standard and non-standard treatment groups at different stages. We also examined an independent effect of each treatment modality on survival. Results: The mean size of tumor was similar between the standard and non-standard A groups (8.8±3.2 vs. 8.9±3.4cm; P=NS). During the median follow-up of 5.5 years, the 5-year survival rate was 69.7% in the standard A group; and 34.9% in the non-standard A group (P<0.05). Compared with TACE, surgical resection had a multivariate hazard ratio (HR) of 0.34 for survival (95% CI, 0.24-0.50; P<0.05). The 5-year survival rate was significantly higher in the standard A group than in the standard B group (69.7% vs. 32.6%; P<0.05). This trend persisted after adjustment for confounding covariates with an adjusted HR of 0.27 in the standard A group (95% CI, 0.20-0.35; P<0.05). However, there was no significant difference in the 5-year survival outcome between the non-standard A and standard B groups (34.9% vs. 32.2%; P=NS). Conclusions: Our between-group comparison data on survival support that defining all single HCCs of any size as stage A is a reasonable classification in the BCLC staging system ultimately guiding treatment decisions.
Choi, Joon Ho,Byun, Byung Hyun,Lim, Ilhan,Moon, Hansol,Park, Jihyun,Chang, Kyoung Jin,Kim, Byung Il,Choi, Chang Woon,Lim, Sang Moo 대한핵의학회 2018 핵의학 분자영상 Vol.52 No.2
Purpose We aimed to evaluate the prognostic values of radiography, F-18 FDG PET, and I-131 whole body scans in patients with lung-only metastasis from differentiated thyroid carcinoma (DTC). Methods Between 1998 and 2013, we included 31 patients (F: 26, M: 5) with lung-only metastasis from DTC who had been treated with I-131 and underwent PET. Lung metastasis was categorized according to the size (macronodular ${\geq}1.0cm$ vs. micronodular <1.0 cm), FDG avidity (avid vs. non-avid), and I-131 avidity (avid vs. non-avid). Progression-free survival (PFS) was evaluated for each patient. Results Among 31 patients, seven (23%) had macronodular lung metastasis, 26 (84%) had FDG avid lung metastasis, and 16 (52%) had I-131 avid lung metastasis. During the median follow-up period of 9.4 y, median PFS was 6.1 y. Based on Kaplan-Meier analysis, macronodular lung metastasis (p = 0.017) and I-131 non-avid lung metastasis (p = 0.059) were significantly associated with worse outcomes, but FDG avid lung metastasis was not (p = 0.135). Patients with FDG non-avid lung metastasis did not experience disease progression during follow-up, while 11 of 26 patients (42%) experienced disease progression. Based on univariate analysis, the hazard ratio for a poor prognosis was 3.78 (p = 0.029) for macronodular lung metastasis and 3.29 (p = 0.079) for I-131 non-avid lung metastasis. Conclusions Macronodular and I-131 non-avid lung metastasis were associated with a poor prognosis in lung-only metastasis from DTC. Although FDG avid lung metastasis may be associated with a poor prognosis, a larger-scale study is needed.
( Jihyun An ),( Ju Hyun Shim ),( Ha Il Kim ),( Seheon Chang ),( Sangyoung Yi ),( Jonggi Choi ),( Gwang Hyeon Choi ),( Danbi Lee ),( Kang Mo Kim ),( Young-suk Lim ),( Han Chu Lee ),( Young-hwa Chung ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Transarterial chemoembolization (TACE) is usually considered as second-line therapy for patients with non-ablatable and non-transplantable multifocal hepatocellular carcinomas (HCCs) who meet the Milan criteria. However, there are data suggesting that patients with multiple tumors may be suitable for resection in spite of the higher risk of postoperative recurrence. Given the non-curability of TACE, the aim of this study was to evaluate the therapeutic performance of surgery compared with TACE in such cases. Methods: A total of 300 Milan-in subclinical patients who had more than one HCC nodule and ≤3cm in diameter and Child-Pugh A liver function were included. Patients were treated with surgical resection (n=81) or TACE (n=219) as initial treatment. The median age of patients was 57 years; 80.7% was male; and 79.3% was infected by hepatitis B virus. Results: Patients having three nodules or clinical signs of portal hypertension was more frequently observed in the TACE group than in the surgery group (32.4% vs. 6.2%; and 47.0% vs. 22.2%, respectively; Ps<0.05). During the median observation period of 5.6 years, overall and cancer-specific deaths occurred more frequently in the TACE group (57.5% vs. 19.8%; and 37.4% vs. 12.3%, respectively; Ps<0.05). The median overall survival time in the TACE group was 5.2 years with 5-year overall survival rates of 52.5%, which was lower than 6.6 years with 85.2% in the surgery group (P<0.05). Similar trends were observed for cancer-specific mortality data (P<0.05). Multivariate analyses showed that surgical resection provided better outcomes regarding overall and cancer-specific survivals independently of other clinical predictors including tumor factors (HRs [95% CI], 0.28 [0.16-0.48] and 0.24 [0.12-0.48], respectively; Ps<0.05). Conclusions: Taking our findings and non-curability of TACE into account, surgical resectability should be assessed before TACE rescue in patients with multifocal HCCs meeting Milan who are not eligible for local ablation or liver transplantation.