• Korean Journal of Radiology
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• 제23권11호
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• pp.1055-1066
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• 2022

Objective: The clinical relevance of myosteatosis has not been well evaluated in patients with pancreatic ductal adenocarcinoma (PDAC), although sarcopenia has been extensively researched. Therefore, we evaluated the prognostic value of muscle quality, including myosteatosis, in patients with resectable PDAC treated surgically. Materials and Methods: We retrospectively evaluated 347 patients with resectable PDAC who underwent curative surgery (mean age ± standard deviation, 63.6 ± 9.6 years; 202 male). Automatic muscle segmentation was performed on preoperative computed tomography (CT) images using an artificial intelligence program. A single axial image of the portal phase at the inferior endplate level of the L3 vertebra was used for analysis in each patient. Sarcopenia was evaluated using the skeletal muscle index, calculated as the skeletal muscle area (SMA) divided by the height squared. The mean SMA attenuation was used to evaluate myosteatosis. Diagnostic cutoff values for sarcopenia and myosteatosis were devised using the Contal and O'Quigley methods, and patients were classified according to normal (nMT), sarcopenic (sMT), myosteatotic (mMT), or combined (cMT) muscle quality types. Multivariable Cox regression analyses were conducted to assess the effects of muscle type on the overall survival (OS) and recurrence-free survival (RFS) after surgery. Results: Eighty-four (24.2%), 73 (21.0%), 75 (21.6%), and 115 (33.1%) patients were classified as having nMT, sMT, mMT, and cMT, respectively. Compared to nMT, mMT and cMT were significantly associated with poorer OS, with hazard ratios (HRs) of 1.49 (95% confidence interval, 1.00-2.22) and 1.68 (1.16-2.43), respectively, while sMT was not (HR of 1.40 [0.94-2.10]). Only mMT was significantly associated with poorer RFS, with an HR of 1.59 (1.07-2.35), while sMT and cMT were not. Conclusion: Myosteatosis was associated with poor OS and RFS in patients with resectable PDAC who underwent curative surgery.

• Annals of Occupational and Environmental Medicine
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• 제35권
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• pp.48.1-48.13
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• 2023

Background: This study was conducted to identify the success rate for smoking cessation over time after participation in a therapeutic smoking cessation camp, and to identify how participant characteristics, including a supportive workplace environment for smoking cessation (SWESC), affect the success rate for smoking cessation. Methods: In all, 296 participants at smoking cessation camps in Ulsan between 2015 and 2020 were investigated. The success rates of smoking cessation after weeks 4, 6, 12, and 24 at camp were investigated. The participants were grouped as workers with an SWESC, and workers without an SWESC, and variables (age, education, household income, marital status, drinking, exercise, body mass index, morbidity, job, number of counseling sessions, cigarettes smoked per day and smoking initiation age) were investigated. Multiple logistic regression analysis was conducted at each time point. In addition, Cox regression analysis was performed to evaluate the variables affecting the success rate for smoking cessation over time. Results: The smoking cessation success rate of workers with an SWESC at week 24 (90.7%) was higher than that for workers without an SWESC (60.5%). Multiple logistic regression was performed to determine the relationship between each variable and the success rates for smoking cessation at week 6, 12, and 24. SWESC was confirmed as significant (p < 0.05) variables for increased success rate for smoking cessation at all 3 time points. After adjusting for all variables, the Cox proportional hazards survival analysis showed a hazard ratio of 6.17 for SWESC (p < 0.001,; 95% confidence interval: 3.08-12.38). Conclusions: At a professional treatment smoking cessation camp, participants with an SWESC showed a significantly higher success rate for smoking cessation. Supportive workplace environment for workers' health is expected to be an important factor for smoking cessation projects as well as other health promotion projects at workplace.

• 한국환경보건학회지
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• 제50권2호
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• pp.146-156
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• 2024

Background: Children who use playground facilities are exposed to potential risks due to the high concentration of heavy metals contained in the finishing materials of facilities in children's playgrounds. Objectives: The purpose of this study was to investigate the concentration of heavy metals in the finishing materials of outdoor children's playgrounds where harmful heavy metals exist in Gwangju and to conduct human risk assessment for children and adults by age to find the risks and limitations. Methods: The bottom and top layers of double-painted paint were peeled off and collected together from the finishing materials of children's play facilities such as slides, swings, and seesaws in 147 children's parks in Gwangju. Heavy metals were analyzed using ICP-OES, etc., and human risk assessment was performed using the concentrations of heavy metals. Results: Based on 1.0E-04, which requires legal regulation, CTE was found to pose a carcinogenic risk for preschool children and no carcinogenic risk for the rest of the age groups. However, RME showed that both men and women of all ages had a carcinogenic risk. For reference, when the carcinogenic risk was based on 1.0E-06, CTE was found to pose a carcinogenic risk from infants to elementary school students, and RME was found to have a carcinogenic risk in all age groups. It was judged that there is a non-carcinogenic risk if the non-carcinogenic risk exceeds 1 based on the hazard index (HI) 1. In CTE, there was no non-carcinogenic risk, and RME for preschooler males (1.49E+00) and females (1.56E+00) were found to have non-carcinogenic risk. Conclusions: This study was meaningful in that it examines the differences in the current management of heavy metals concentration standards and potential carcinogenic and non-carcinogenic risks to the human body and discusses the relationship between heavy metals and human health effects.

• Korean Circulation Journal
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• 제52권3호
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• pp.205-217
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• 2022

Background and Objectives: The prognostic value of left atrial (LA) function in terms of long-term clinical outcomes after mitral regurgitation (MR) surgery remains unclear. Therefore, we investigated the impact of preoperative LA global longitudinal strain (LAGLS) on the long-term postoperative clinical outcomes in chronic severe MR patients who underwent mitral valve (MV) repair surgery. Methods: From January 2012 to December 2017, we analyzed 338 patients (mean age, 51.9±12.5 years; 218 males [64.5%]) treated with MV repair surgery for severe MR. The primary outcome was cardiovascular events, defined as the composite of all-cause death, newly developed atrial fibrillation (AF), and re-hospitalization for cardiovascular causes. Results: During a median follow-up of 45 months (interquartile range, 26-65), 30 (8.9%) cardiovascular events, 5 (1.5%) all-cause death, 8 (2.4%) newly developed AF, and 26 (7.7%) re-hospitalizations occurred. On multivariable analysis, baseline LAGLS was an independent predictor of cardiovascular events (adjusted hazard ratio [HR], 0.91; 95% confidential interval [CI], 0.85-0.97; p=0.004) and re-hospitalization (adjusted HR, 0.93; 95% CI, 0.86-1.00; p=0.037). According to the optimal cutoff value of LAGLS, patients with low LAGLS (<23.6%) had a significantly higher risk of cardiovascular events (adjusted HR, 2.70; 95% CI, 1.04-7.00; p=0.041) than those with high LAGLS (≥23.6%). In a subgroup analysis, patients with high LAGLS had better clinical outcomes regardless of whether the patient had a LA volume index <60 mL/m². Conclusions: In patients with chronic severe MR who received successful MV repair surgery, preoperative LAGLS is an independent predictor of long-term postoperative outcomes.

• Annals of Occupational and Environmental Medicine
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• 제34권
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• pp.15.1-15.9
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• 2022

Background: Most previous longitudinal studies on lifestyle and gastroesophageal reflux disease (GERD) have focused on physical activity rather than sitting time. The main purpose of this study was to investigate the relationship between prolonged sitting time and the development of erosive esophagitis (EE). Methods: A self-report questionnaire was used for measuring sitting time in the Kangbuk Samsung Health Study. Sitting time was categorized into four groups: ≤ 6, 7-8, 9-10, and ≥ 11 hours/day. Esophagogastroduodenoscopy (EGD) was performed by experienced endoscopists who were unawared of the aims of this study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the development of EE were estimated using Cox proportional hazards analyses with ≤ 6 hours/day sitting time as the reference. Results: There were 6,524 participants included in the study. During a mean follow-up of 3.14 years, 2,048 incident cases developed EE. In age- and sex-adjusted models, the HR in the group sitting ≥ 11 hours per day compared ≤ 6 hours per day was 0.88 (95% CI: 0.76-0.99). After further adjusting for alcohol intake, smoking status, educational level, history of diabetes, and history of dyslipidemia, sitting time was still significantly related to the risk of EE (HR, 0.87; 95% CI: 0.76-0.98). After further adjustment for exercise frequency, this association persisted (HR, 0.86; 95% CI: 0.76-0.98). In subgroup analysis by obesity, the relationship between sitting time and EE was only significant among participants with body mass index < 25 kg/m² (HR, 0.82; 95% CI: 0.71-0.95). Conclusions: Generally, prolonged sitting time is harmful to health, but with regard to EE, it is difficult to conclude that this is the case.

• Korean Journal of Radiology
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• 제21권7호
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• pp.880-890
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• 2020

Objective: Patients with chronic obstructive pulmonary disease (COPD) are known to be at risk of osteoporosis. The purpose of this study was to evaluate the association between thoracic vertebral bone density measured on chest CT (D_Thorax) and clinical variables, including survival, in patients with COPD. Materials and Methods: A total of 322 patients with COPD were selected from the Korean Obstructive Lung Disease (KOLD) cohort. D_Thorax was measured by averaging the CT values of three consecutive vertebral bodies at the level of the left main coronary artery with a round region of interest as large as possible within the anterior column of each vertebral body using an in-house software. Associations between D_Thorax and clinical variables, including survival, pulmonary function test (PFT) results, and CT densitometry, were evaluated. Results: The median follow-up time was 7.3 years (range: 0.1-12.4 years). Fifty-six patients (17.4%) died. D_Thorax differed significantly between the different Global Initiative for Chronic Obstructive Lung Disease stages. D_Thorax correlated positively with body mass index (BMI), some PFT results, and the six-minute walk distance, and correlated negatively with the emphysema index (EI) (all p < 0.05). In the univariate Cox analysis, older age (hazard ratio [HR], 3.617; 95% confidence interval [CI], 2.119-6.173, p < 0.001), lower BMI (HR, 3.589; 95% CI, 2.122-6.071, p < 0.001), lower forced expiratory volume in one second (FEV₁) (HR, 2.975; 95% CI, 1.682-5.262, p < 0.001), lower diffusing capacity of the lung for carbon monoxide corrected with hemoglobin (DL_CO) (HR, 4.595; 95% CI, 2.665-7.924, p < 0.001), higher EI (HR, 3.722; 95% CI, 2.192-6.319, p < 0.001), presence of vertebral fractures (HR, 2.062; 95% CI, 1.154-3.683, p = 0.015), and lower D_Thorax (HR, 2.773; 95% CI, 1.620-4.746, p < 0.001) were significantly associated with all-cause mortality and lung-related mortality. In the multivariate Cox analysis, lower D_Thorax (HR, 1.957; 95% CI, 1.075-3.563, p = 0.028) along with older age, lower BMI, lower FEV₁, and lower DL_CO were independent predictors of all-cause mortality. Conclusion: The thoracic vertebral bone density measured on chest CT demonstrated significant associations with the patients' mortality and clinical variables of disease severity in the COPD patients included in KOLD cohort.

• 자원환경지질
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• 제37권1호
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• pp.73-86
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• 2004

본 연구에서는 폐금속광산인 도곡 Au-Ag-Cu 광산과 화천 Au-Ag-Pb-Zn 광산을 대상으로 광산주변 광미, 토양, 자연수 및 농작물 시료를 채취하여 독성 중금속원소들의 오염수준을 규명하고, 토양에 대한 SBET분석을 통해 인체의 위에서 흡수되는 중금속들의 흡수비를 평가하고자 하였다. 또한 이들 지역 주민에 대한 인체 노출경로를 파악하여 독성 중금속들에 노출된 주민들의 건강에 미치는 악영향(독성 및 발암성)을 정량적으로 산출하는 위해성평가를 수행하고자 하였다. 도곡광산의 광미내 중금속의 평균함량은 218 As mg/kg, 90.2 Cd mg/kg, 3,053 Cu mg/kg, 9,473 Pb mg/kg, 14,500 Zn mg/kg 으로 매우 높은 함량을 나타내었다. 화천광산의 광미의 경우, 그 평균함량은 72 As mg/kg, 12.4 Cd mg/kg, 34 Cu mg/kg, 578 Pb mg/kg, 1,304 Zn mg/kg 으로 나타나, Cu를 제외한 원소들이 높은 함량을 나타내고 있다. 따라서 As 및 중금속을 다량 함유하고 있는 이들 광산의 광미들이 강우나 바람에 의해 하류로 유실됨으로써 주변 토양과 수계를 오염시키고 있다. SBET분석결과에 의하면, 화천광산의 논토양내 As, Cd, Zn의 인체흡수도는 각각 55.4%, 20.8%, 26.4%로 나타났으며, 도곡광산의 밭토양의 경우는 각각 40.8%, 37.6%, 33.0%로 나타나 As의 인체흡수도가 가장 높은 것으로 판단된다. 독성(비발암성)위해도 평가 결과, 화친광산에서는 As의 HI 지수가 5.38로, 도곡광산에서는 Cd처 Hl 지수가 3.257.1 이상으로 나타나 이 지역에 거주하는 주민들이 지속적으로 오염된 농작물(쌀알), 지하수, 토양을 섭취한다면 As 및 Cd에 대한 독성위해도가 발생할 가능성이 큼을 시사하고 있다. 발암위해도 평가 결과, 화천광산 지역의 쌀알 및 지하수(식수) 섭취를 통한 As의 초과 발암위해도가 각각 만명중의 8명 및 1명으로 높게 나타났다. 이는 US-EPA에서 제시한 허용발암위해도보다도 크므로 이 지역 주민들이 As에 의해 오염된 쌀알이나 지하수를 식수로 계속적으로 장기간 섭취하게 된다면 As의 발암성 확률이 크다고 판단된다.

• 농약과학회지
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• 제17권2호
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• pp.117-125
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• 2013

경기도내 유통 농산물 중 잔류농약 모니터링(2006~2010)결과 chlorothalonil, chlorpyrifos, dicofol, endosulfan, EPN, ethoprophos, fenitrothion, methidathion, phenthoate와 tebupirimfos 등 농약10종에 대하여 확률론적 노출평가를 실시하였다. 몬테 카를로 시뮬레이션을 활용하였고, 농도와 섭취량의 분포는 모수인 평균과 표준편차를 입력하여 lognormal로 가정하였다. 농약별 평균과 95백분위수의 위해도는 결정론적 노출평가결과에 비해 대체로 낮게 나타났다. 위해도(%ADI)는 전국민 대상에 농도 불검출 데이터에 LOD = 0 mg/kg을 적용한 경우 평균과 95백분위수에서 각각 0.05~0.70%와 0.11~1.94%로 나타났다. LOD = 0.005 mg/kg을 적용한 경우는 평균과 95백분위수에서 각각 0.41~4.42%와 0.98~13.81%로 나타났다. 섭취자군 대상에 농도 불검출 데이터에 LOD = 0 mg/kg을 적용한 경우 평균과 95백분위수에서 각각 1.24~10.16%와 3.72~33.81%로 나타났다. LOD = 0.005 mg/kg을 적용한 경우 평균과 95백분위수는 각각 3.43~18.26%과 9.45~54.99%로 나타났다. 섭취자군에서는 LOD = 0과 LOD = 0.005를 적용한 위해도 평균과 95백분위수는 모두 methidathion이 가장 높게 나타났다. 경기도내 유통 농산물의 잔류농약에 대한 확률론적 노출위해도는 100미만으로 모두 안전한 것으로 나타났다.

• 대한환경공학회지
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• 제34권2호
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• pp.109-118
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• 2012

본 연구는 한국인 산모의 모유 중 PBDEs의 노출수준 및 위해성평가를 위해 서울지역에서 총 22개의 모유시료를 대상으로 분석되었다. PBDEs는 모든 대상 모유시료에서 검출되어, 이러한 화학물질이 서울지역에 거주하는 일반인에게 광범위하게 노출되었음을 시사한다. ${\Sigma}PBDEs$의 잔류수준은 0.84~13.1 ng/g lipid의 범위로 산술평균 농도는 3.56 ng/g lipid, 중앙값은 2.6 ng/g lipid이었다. 모유 중 ${\Sigma}PBDEs$ 농도 수준은 중국, 대만, 유럽국가(스위덴)와 유사하고 몇몇 아시아(베트남, 필리핀, 인도네시아)보다는 다소 높았다. 그러나 세계에서 PBDEs 소비가 가장 많은 북아메리카의 농도 수준보다는 10~100배 낮은 농도였다. 이성질체 기여율은 BDE-47이 가장 높았으며, 다음으로 BDE-153, BDE-100, BDE-99, BDE-28, BDE-183 그리고 BDE-154 순이었다. BDE-47과 BDE-153의 합은 대부분의 시료에서 ${\Sigma}PBDEs$의 약 65% 이상을 차지하였다. 영아의 모유 수유에 따른 ${\Sigma}PBDEs$ 위해성 평가 결과 영아의 모유 수유를 통한 6개월간 평균일일노출량은 16.5 ng/kg bw/day로 산출되었으며, BDE-47의 인체노출에 따른 위해도 지수(95th percentile)는 $1.2{\times}10^{-1}$로 예측되어 6개월간 모유 수유로 인한 영아의 건강유해영향은 나타나지 않을 것으로 평가되었다.

• Journal of Gastric Cancer
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• 제9권4호
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• pp.200-206
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• 2009

목적: 서구에서의 위암은 상부암과 미만형이 증가하고 있는 것으로 알려져 있다. 우리나라도 서구화되어 감에 따라 위암의 임상병리학적 특성과 생존율의 변화가 있는지를 알아보고자 하였다. 대상 및 방법: 위암의 위절제수술 환자 1,638명을 1990년대(1991~1999년)의 987명과 2000년대 초기(2000~2003년)의 651명으로 구분하였다. 두 시기별 임상병리학적 특성의 변화와 생존율의 영향을 미치는 인자에 대해 단변량과 다변량 분석을 하였다. 결과: 60대 이상의 고령환자가 1990년대 42.7%에서 2000년대 초기에는 50.7%로 증가하였다. 과체중(체질량지수$\geq$23)은 31.5%에서 43.2%로 증가하였다. Ia기 29.8%에서 44.5%로 증가하고 IV기는 23.5%에서 11.8%로 감소하였다. WHO 조직학적 분류, Lauren 분류와 병변의 위치는 변화 없었다. 전체 환자의 5년 생존율은 74.4%이고 5년 생존율은 67.7%에서 83.7%로 증가하였다. Cox proportional hazard 모델에서는 TNM, 근치도 여부와 시기의 구분이 생존율의 독립적인 예후 인자이었다. 2000년대 초기에 수술 받은 환자는 1990년대의 수술 환자에 비해 비교위험도 0.715 (95% 신뢰구간; 0.555~0.921)로 생존율이 좋았다. 결론: 본 연구의 결과 서구에서 나타나는 임상병리학적변화는 관찰되지 않았다. 그렇지만 조기위암과 고연령 환자가 증가하였으며 과체중 환자 증가의 특징이 관찰되었다. 또한 위암 수술 환자의 생존율도 1990년대에 비해 증가하였다.