Publications by authors named "Yoon-Seok Chang"

336 Publications

Health risk assessment of exposure to organochlorine pesticides in the general population in Seoul, Korea over 12 years: A cross-sectional epidemiological study.

J Hazard Mater 2021 Sep 30;424(Pt B):127381. Epub 2021 Sep 30.

Division of Environmental Science and Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Republic of Korea. Electronic address:

This study evaluated the 12-year trends in serum levels of 28 organochlorine pesticides (OCPs) in 880 adults living in Seoul, Korea. The OCP levels decreased from 2006 to 2017, and p,p'-dichlorodiphenyldichloroethylene was a predominant compound. OCP levels were higher in females than in males, and showed positive associations with BMI and age. The OCP concentrations had inverted U-shaped associations with low-density lipoprotein cholesterol and total cholesterol. Concentrations of β-hexachlorocyclohexane were significantly higher in patients with hypertension than in participants that were normotensive. OCP levels showed positive associations with uric acid, creatinine, and thyroid-stimulating hormone, but negative associations with free thyroxine. Participants with diabetes had significantly higher OCP levels than those without it. Principal component analysis suggested possible differences in disease manifestation depending on the composition of OCPs. These results suggest that OCPs might disturb renal transport and thyroid homeostasis. To our knowledge, the inverted U-shaped associations of heptachlor epoxide and endosulfan with cholesterol, the epidemiological associations of trans-nonachlor and endosulfan with thyroid hormones, and the association of p,p'-DDE with hyperuricemia have not been previously reported in general population. This is the first long-term study to show trends of 28 OCPs in serum and associations with various health indicators in Korea.
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http://dx.doi.org/10.1016/j.jhazmat.2021.127381DOI Listing
September 2021

Electrochemical activation of hydrogen peroxide, persulfate, and free chlorine using sacrificial iron anodes for decentralized wastewater treatment.

J Hazard Mater 2021 Aug 28;423(Pt A):127068. Epub 2021 Aug 28.

Division of Environmental Science and Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Republic of Korea. Electronic address:

Increasing contamination of groundwater by heavy metals could potentially hamper the basic sanitation based on septic system in developing countries. Therefore, this paper evaluated wastewater treatment by electrochemical activation of hydrogen peroxide (EAHP), persulfate (EAP), and free chlorine (EAFC) to simultaneously eliminate aqueous organic matter and heavy metals. Sacrificial iron anodes under galvanostatic regime activated the batch-injected oxidants under uncontrolled pH, to avoid extra cost of control in decentralized processes (e.g., household use) to treat domestic wastewater. Response surface methodology (RSM) was used to determine the optimized conditions for EAP ([persulfate] = 25 mM, 24.4 mA/cm), EAFC ([free chlorine] = 35.5 mM, 44.4 mA/cm), and EAHP ([HO] = 91.1 mM, 45 mA/cm) towards total organic carbon (TOC) removal. Treatment of real wastewater under optimum conditions significantly reduced chemical oxygen demand (COD) and TOC in all treatments, complying with lenient effluent standards as well as the added benefit of complete As(V) and Cr(VI) removal. Although EAP and EAFC provided superior removal of TOC (70-75%) and COD (73-100%) within 3 h, respectively, effluent toxicity and operation cost (76-85 USD/m) were relatively high. EAHP was the best available option to secure non-toxic effluent with the least cost (63 USD/m).
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http://dx.doi.org/10.1016/j.jhazmat.2021.127068DOI Listing
August 2021

Association of asthma comorbidity with poor prognosis of coronavirus disease 2019.

World Allergy Organ J 2021 Aug 16;14(8):100576. Epub 2021 Aug 16.

Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.

Background: While global health agencies have listed asthma as a vulnerability for severe cases of coronavirus disease 2019 (COVID-19), the evidence supporting this is scarce.

Methods: A nationwide cohort study was conducted using the validated Korean national health insurance claim data of patients diagnosed with COVID-19 between January 1 and April 8, 2020. Asthma comorbidity was determined using a diagnosis code assigned by the physician and the prescription of asthma-related medications. The clinical course of COVID-19 was classified into 3 severity grades according to the requirements for oxygen supply and mechanical ventilation. We also evaluated the association of asthma with overall and in-hospital mortality of COVID-19.

Results: Asthma morbidity was a significant risk factor for severe COVID-19 (grade 2 requiring oxygen supply) (adjusted odds ratio [aOR] = 1.341, 95% confidence interval [CI], 1.051-1.711, P = 0.018) and grade 3 requiring mechanical ventilation or leading to death (aOR = 1.723, 95% CI: 1.230-2.412, P = 0.002) multinomial logistic regression adjusting co-risk factors. Asthma was also significantly associated with mortality of COVID-19 (aOR = 1.453, 95% CI: 1.015-2.080, P = 0.041) and was revealed to have a shorter time to in-hospital mortality of COVID-19 (P < 0.001). Patients with recent asthma exacerbation showed more severe COVID-19 of grade 3 (OR = 7.371, 95% CI: 2.018-26.924, P = 0.003) and higher mortality (OR = 9.208, 95% CI: 2.597-32.646, P < 0.001) in univariable analysis, but the statistical significance was not found in multivariable analysis.

Conclusion: Asthma morbidity was associated with severity and mortality of COVID-19. Patients with asthma should pay more attention to avoid worsening of COVID-19.
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http://dx.doi.org/10.1016/j.waojou.2021.100576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8364802PMC
August 2021

Stepping down for mild asthma and disadvantages of the 'as-needed' strategy-Perspectives from a developing country.

Respirology 2021 10 3;26(10):917-919. Epub 2021 Aug 3.

Department of Respiratory Functional Exploration, University Medical Center HCMC, Ho Chi Minh City, Vietnam.

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http://dx.doi.org/10.1111/resp.14130DOI Listing
October 2021

The Role of Upper Airway Microbiome in the Development of Adult Asthma.

Immune Netw 2021 Jun 29;21(3):e19. Epub 2021 Jun 29.

Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Clinical and molecular phenotypes of asthma are complex. The main phenotypes of adult asthma are characterized by eosinophil and/or neutrophil cell dominant airway inflammation that represent distinct clinical features. Upper and lower airways constitute a unique system and their interaction shows functional complementarity. Although human upper airway contains various indigenous commensals and opportunistic pathogenic microbiome, imbalance of this interactions lead to pathogen overgrowth and increased inflammation and airway remodeling. Competition for epithelial cell attachment, different susceptibilities to host defense molecules and antimicrobial peptides, and the production of proinflammatory cytokine and pattern recognition receptors possibly determine the pattern of this inflammation. Exposure to environmental factors, including infection, air pollution, smoking is commonly associated with asthma comorbidity, severity, exacerbation and resistance to anti-microbial and steroid treatment, and these effects may also be modulated by host and microbial genetics. Administration of probiotic, antibiotic and corticosteroid treatment for asthma may modify the composition of resident microbiota and clinical features. This review summarizes the effect of some environmental factors on the upper respiratory microbiome, the interaction between host-microbiome, and potential impact of asthma treatment on the composition of the upper airway microbiome.
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http://dx.doi.org/10.4110/in.2021.21.e19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8263217PMC
June 2021

Pharmacological prevention of delayed hypersensitivity reactions caused by iodinated contrast media.

World Allergy Organ J 2021 Jul 1;14(7):100561. Epub 2021 Jul 1.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.

Background: Delayed hypersensitivity reactions (DHRs) to radiocontrast media (RCM) occur in approximately 0.5-23.0% of patients and are thought to be caused by T cell-mediated mechanisms. However, an optimal pharmacological preventive strategy is not yet established in patients with histories of delayed reactions to RCM.

Objective: We aimed to evaluate the efficacy of pharmacological prevention in patients with histories of delayed reactions to non-ionic low-osmolar RCM when re-exposed to RCM.

Methods: A retrospective review of electronic medical records of 117 patients with previous histories of DHRs to RCM who visited an allergy clinic for the prevention of reactions after the re-exposure to RCM was conducted. The effects of pharmacological prevention were compared according to the symptom scores of previous reactions based on their intensities and durations with electronic medical records (EMRs).

Results: Of the 117 patients who experienced DHRs after RCM injection, we confirmed the outcomes of RCM re-exposure in 101 patients. For pharmacological prevention, 92 patients (91.1%) received steroids before RCM injection and among them, 50 patients (49.5%) received additional steroids after RCM injection. With this pharmacological prevention, patients of symptoms improved or no recurrence, recurrence of similar previous symptoms, and recurrence of worse symptoms were 98 (97.0%), 2 (2.0%), and 1 (1.0%), respectively. The proportions of no recurrence after pharmacological prevention were lower in patients with severe reactions and higher symptom scores.

Conclusion: Pharmacological prevention showed a beneficial effect in most patients with delayed hypersensitivity to RCM. Further investigations are needed to establish an effective protocol for the prevention of delayed reactions to RCM.
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http://dx.doi.org/10.1016/j.waojou.2021.100561DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8256281PMC
July 2021

COVID-19 Vaccine-associated Anaphylaxis and Allergic Reactions: Consensus Statements of the KAAACI Urticaria/Angioedema/Anaphylaxis Working Group.

Allergy Asthma Immunol Res 2021 Jul;13(4):526-544

Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital,Seoul National University College of Medicine, Seongnam, Korea.

In the era of novel coronavirus epidemics, vaccines against coronavirus disease 2019 (COVID-19) have been recognized as the most effective public health interventions to control the pandemic. An adverse event following immunization (AEFI) is defined as any untoward occurrence following immunization, and the majority of AEFIs are caused by protective immune responses stimulated by vaccines. Most of the reported AEFIs are not serious, and many are not immunologically mediated or even reproducible on re-exposure. However, uncommon severe allergic adverse reactions, such as anaphylaxis or other allergic reactions, can occur after vaccinations. Confirmed allergic reactions to vaccines may be caused by residual non-human protein, preservatives, or stabilizers in the vaccine formulation (also known as excipients). There are 2 main potential allergenic/immunogenic excipients in COVID-19 vaccines, polyethylene glycol (PEG) and polysorbate 80. PEG, also known as macrogol, is an ingredient in various laxatives and injectable formulations, such as depot steroids. Polysorbate 80 is present in various medical products, creams, ointments, lotions, and medication tablets. Contraindications to the administration of COVID-19 vaccines include a previous history of severe allergic reactions to the first dose of COVID-19 vaccine or proven hypersensitivity to a vaccine component, such as PEG or polysorbate 80. Anaphylaxis or other allergic reactions following immunization can cause fear and loss of confidence in the safety of vaccines among the public. A better understanding of these events is thought to help alleviate concerns about the current COVID-19 vaccines and provide reassurance to the general population by analyzing the exact incidence of anaphylaxis and potential risk factors. COVID-19 vaccine-associated anaphylaxis could be prevented and managed by risk stratification based on our local and global experience.
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http://dx.doi.org/10.4168/aair.2021.13.4.526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255352PMC
July 2021

Asthma and pulmonary tuberculosis: misdiagnosis or coexistence.

Respirol Case Rep 2021 Jul 3;9(7):e00797. Epub 2021 Jun 3.

Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital Seoul National University College of Medicine Seongnam South Korea.

Asthma and pulmonary tuberculosis (PTB) are disease entities with different pathogenesis. However, endobronchial tuberculosis (EBTB), a peculiar form of PTB, can mimic the symptoms of asthma. Although uncommon, the coexistence of asthma and PTB can appear. We report three cases of PTB. The first two cases with EBTB were misdiagnosed as asthma and the third case with asthma developed PTB four months after high-dose inhaled corticosteroid (ICS) therapy. The first two cases presented with chronic cough up mucopurulent/purulent sputum and localized wheezing which revealed diagnostic clues. The third case presented with dry cough and showed a positive bronchodilator response and the right pulmonary apical fibrosis which could be associated with quiescent tuberculous infection. EBTB should be included in the differential diagnosis of asthma. Although rare, physicians should be aware that PTB can also be developed during the treatment course of asthma.
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http://dx.doi.org/10.1002/rcr2.797DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173453PMC
July 2021

Genetic variants in the TLR-related pathway and smoking exposure alter the upper airway microbiota in adult asthmatic patients.

Allergy 2021 10 29;76(10):3217-3220. Epub 2021 Jun 29.

Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

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http://dx.doi.org/10.1111/all.14970DOI Listing
October 2021

Cough, coronavirus disease 2019, the vaccines, and allergy.

Authors:
Yoon-Seok Chang

Asia Pac Allergy 2021 Apr 30;11(2):e23. Epub 2021 Apr 30.

Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

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http://dx.doi.org/10.5415/apallergy.2021.11.e23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103005PMC
April 2021

Carbon-nitride-based micromotor driven by chromate-hydrogen peroxide redox system: Application for removal of sulfamethaxazole.

J Colloid Interface Sci 2021 Sep 1;597:94-103. Epub 2021 Apr 1.

Division of Environmental Science and Engineering, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang 37673, Republic of Korea. Electronic address:

In this study, a Janus Fe/CN micromotor driven by a chromate-hydrogen peroxide (Cr(VI)/HO) redox system was developed and its movement was analyzed. The motion of the micromotor was tracked via nanoparticle tracking analysis (NTA) and the corresponding diffusion coefficients (D) were determined. The NTA results revealed that D = 0 in water in the absence of additives (Cr(VI) or HO). The addition of HO resulted in an increase in D from 0 to 12 × 10 nm s, which further increased to 20 × 10, 26.5 × 10, 29 × 10, and 44 × 10 nm s with the addition of 0.5, 1, 2, and 5 ppm of Cr(VI), respectively. Cr(VI) alone did not efficiently propel the Fe/CN-based micromotor. Therefore, it was proposed that the Cr(VI)/HO redox system generates O, which plays a major role in the movement of the CN-based micromotor. In addition, the formation of reactive species, such as OH and O, was confirmed through electron spin resonance experiments. The reactive species efficiently degraded sulfamethaxazole (SMX), an organic pollutant, as demonstrated through degradation studies and product analyses. The effects of various parameters, such as HO concentration, Cr(VI) concentration, and initial pH on the movement of micromotor and degradation of SMX were also documented.
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http://dx.doi.org/10.1016/j.jcis.2021.03.164DOI Listing
September 2021

Discontinuation of inhaled corticosteroids in patients with controlled asthma: The DISCO (Discontinuation of Inhaled Steroid in Controlled asthmatics Over 6 months) study.

Ann Allergy Asthma Immunol 2021 07 2;127(1):123-130.e1. Epub 2021 Apr 2.

Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address:

Background: Although inhaled corticosteroids (ICSs) are the recommended first-line therapy for asthma, determining whether to continue or discontinue ICS treatment in patients with mild asthma remains challenging for clinicians. Several studies have revealed that patients with mild-persistent asthma maintained a well-controlled state after ICS withdrawal. However, the long-term outcomes of ICS withdrawal have not yet been determined.

Objective: To determine the possible clinical outcomes of the discontinuation of ICS in patients with well-controlled mild asthma.

Methods: We investigated the clinical outcomes of discontinuing ICSs in patients with well-controlled mild asthma and compared the time to loss of control (LOC) between patients who stopped ICS treatment (ICS withdrawal group, IWG) and those who continued treatment for 3 years (continuous ICS group, CIG).

Results: A significant difference in the time to LOC was observed between the IWG and CIG (hazard ratio, 2.56; 95% confidence interval, 1.52-4.33; P < .001). Increasing fractional exhaled nitric oxide levels (P = 0.008) and sputum eosinophil counts (%) (P = 0.015) revealed a weak but significant association with LOC risk in the CIG. The sputum eosinophil counts (P = 0.039) and serum total immunoglobulin E levels (P = 0.014) were significantly higher in the LOC group than in the non-LOC group of the CIG.

Conclusion: Our results suggest that the maintenance of ICS treatment may help keep patients' asthma under control. Furthermore, patients with LOC had significantly higher sputum eosinophil counts in the CIG than those in the non-LOC group. Therefore, continuous ICS use by patients with mild, well-controlled asthma could be associated with good clinical outcomes.

Trial Registration: ClinicalTrials.gov Identifier: KCT0002234.
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http://dx.doi.org/10.1016/j.anai.2021.03.031DOI Listing
July 2021

Gyeonggi-do Atopy · Asthma Education Information Center in Korea: a key partner in the Korean Asthma Allergy Program.

Authors:
Yoon-Seok Chang

Asia Pac Allergy 2021 Jan 30;11(1):e12. Epub 2021 Jan 30.

Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Allergic diseases such as asthma, allergic rhinitis, and atopic dermatitis are common and cause high socioeconomic burden. Allergic disease is a matter of not just for a patient, but also for a family and the society. The Korean government, the Korean Disease Control and Prevention Agency, started the nationwide asthma and atopic disease prevention and management plan in collaborations with the opinion leaders from the Korean Academy of Asthma, Allergy, and Clinical Immunology, and the Korea Asthma Allergy Foundation since 2007. Seoul Atopy · Asthma Education Information Center was established in 2008 by the Korean Disease Control and Prevention Agency and the Seoul metropolitan government to provide the reliable and accurate information on asthma and allergic diseases. In 2011, Gyeonggi-do Atopy ∙ Asthma Education Information Center was established by the Korean Disease Control and Prevention Agency and the Gyeonggi-do provincial government. The activities of the center are as follows: (1) atopy ∙ asthma-friendly school program, (2) development/distribution of the educational materials, (3) open lectures for the community, patients, their caregivers, older people, nurses, pharmacists, and doctors, (4) collaborations with the Korean Disease Control and Prevention Agency, the Gyeonggi-do provincial government, the office of education, and the public health centers, (5) collaborations with the Gyeonggi-do fire services to educate 119 rescue teams on the allergic emergency conditions, (6) international collaborations. In this article, 10 years of experience and achievement from the Gyeonggi-do Atopy ∙ Asthma Education Information Center were described, especially on the atopy ∙ asthma-friendly school program.
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http://dx.doi.org/10.5415/apallergy.2021.11.e12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870373PMC
January 2021

Thymic stromal lymphopoietin production in DN32.D3 invariant natural killer T (iNKT) cell line and primary mouse liver iNKT cells.

Asia Pac Allergy 2021 Jan 28;11(1):e10. Epub 2021 Jan 28.

Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Background: Invariant natural killer T (iNKT) cells are known as the fast responder in allergic inflammation and the source of interleukin (IL)-4, IL-13, and interferon-gamma. Absence of iNKT cells down-regulated thymic stromal lymphopoietin (TSLP) production at the early stage of type 2 immune responses in the airway. However, it has not been reported whether iNKT cells are able to produce TSLP via stimulation of T-cell receptor (TCR).

Objective: We aimed to evaluate TSLP production from iNKT cells by TCR specific stimulations with anti-CD3/CD28 antibodies and α-galactoceramide (α-GalCer).

Methods: DN32.D3 iNKT cell line was stimulated with anti-CD3/CD28 antibodies, and TSLP production was measured in culture supernatants. Next, to confirm the TSLP production in primary mouse iNKT cells, the cells were sorted using α-GalCer-CD1d tetramer from mouse liver, and stimulated with anti-CD3/CD28 antibodies and α-GalCer. Then, cytokine productions were evaluated by enzyme-linked immunosorbent assay and quantitative polymerase chain reaction.

Results: TCR specific stimulation in DN32.D3 cells induced TSLP production as well as signature cytokines of iNKT cells. On the other hand, isolated primary mouse iNKT cells from liver did not show any induction of TSLP by TCR specific stimulations including anti-CD3/CD28 antibodies and α-GalCer, on the contrary to other cytokines.

Conclusion: This study suggested the possibility of TSLP production in iNKT cells, especially from DN32.D3 although primary mouse liver iNKT cells showed a different result.
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http://dx.doi.org/10.5415/apallergy.2021.11.e10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870374PMC
January 2021

Allergy and coronavirus disease (COVID-19) international survey: Real-life data from the allergy community during the pandemic.

World Allergy Organ J 2021 Feb 31;14(2):100515. Epub 2021 Jan 31.

Department of Medicine, Allergy Asthma and Clinical Immunology Section, University Hospital of Verona, Verona Italy.

Background: The COVID-19 outbreak brought an unprecedented challenge to the world. Knowledge in the field has been increasing exponentially and the main allergy societies have produced guidance documents for better management of allergic patients during this period. However, few publications so far have provided real-life data from the allergy community concerning allergy practice during the COVID-19 outbreak. Therefore, we proposed an international survey on the management of allergic patients during the current pandemic.

Methods: We performed an online survey undertaken to reach out the worldwide allergy community by e-mail and social media. The web-based questionnaire contained 24 questions covering demographic data from the participants, clinical practice during this period, and questions related to the new international classification and coding tools addressed for COVID-19. It was circulated for 8 weeks and had anonymous and volunteer context.

Results: Data are presented for 635 participants from 78 countries of all continents. Allergists with long-term professional experience were the main audience. As expected, we received many responses as "I have no data" or "I don't know" to the questions of the survey. However, most with more experience on managing allergic patients during the pandemic agreed that patients suffering from allergic or hypersensitivity conditions have no increased risk of contracting COVID-19 or developing SARS CoV-2. Also, participants mentioned that none of the allergy treatments (inhaled corticosteroids, allergen immunotherapy, biological agents) increased the risk of contracting COVID-19 infection including severe presentations.

Conclusion: The data presented are a starting point in the process of getting feedback on all the recommendations provided by the allergy societies; it could also be the basis of new strategies to support health professionals while new COVID-19 specific treatments and vaccines are being explored. The information here presented intends to be helpful to the community but represents a course of action in a highly specific situation due to the state of emergency, and it should be helpful to health systems.
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http://dx.doi.org/10.1016/j.waojou.2021.100515DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847410PMC
February 2021

Urinary bisphenol A concentrations and the risk of obesity in Korean adults.

Sci Rep 2021 01 15;11(1):1603. Epub 2021 Jan 15.

Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, 1342, Dongilro, Nowon-gu, Seoul, 01757, Korea.

This study was aimed to evaluate the association between urinary bisphenol A (BPA) levels and risk of obesity in Korean adults. We analyzed data from the Korean National Environmental Health Survey (KoNEHS) Cycle 2 (2012-2014) and Cycle 3 (2015-2017). A total of 10,021 participants aged ≥ 19 years were included. Urine dilution was corrected by the covariate-adjusted standardization (CAS) method. We performed meta-analysis, logistic regression analysis by matching all covariates with a 1:1 propensity score, and a 4-knot restricted cubic spline plot model to calculate the odds ratios (ORs) for obesity according to natural log-transformed BPA levels. Mean urinary BPA concentration was 1.12 µg/L in KoNEHS Cycle 2 and 1.32 µg/L in Cycle 3. BPA levels were significantly higher among obese adults than among non-obese adults in both KoNEHS Cycles 2 and 3. In pooled data of KoNEHS Cycles 2 and 3, BPA showed significant positive associations with ORs for obesity in both sexes, which were more prominent in females (linear) than in males (non-linear). These associations were confirmed in spline analyses. CAS-applied BPA concentrations were positively associated with obesity in nationwide representative samples of Korean adults. Further studies are warranted to confirm and elucidate the underlying mechanism.
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http://dx.doi.org/10.1038/s41598-021-80980-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811011PMC
January 2021

Assessment of working postures and physical loading in advanced order picking tasks: A case study of human interaction with automated warehouse goods-to-picker systems.

Work 2020 ;67(4):855-866

Department of Industrial Engineering & Management Systems, University of Central Florida, Florida, USA.

Background: Order picking activities are the most labor-intensive processes in retail warehouses. Although various automated order picking technologies have been developed recently, human intervention continues to be required. Most advanced order picking systems can be classified into automated storage and retrieval system (AS/RS) and moving robot types. Both types of goods-to-picker systems aim to reduce the picker's travel time required to determine product locations and to move these products to meet customer requests.

Objective: Many studies on the efficiency and effectiveness of automated order picking systems have focused solely on system performance. Since human operators play an essential part in order picking systems from both the effectiveness and efficiency point of view, the work-related risk factors for the workers interacting with these systems should also be evaluated. In this paper, we assess the ergonomic design features of two system types, a moving robot (MR) and automated storage and retrieval system (AS/RS), focusing on the assessment of the risk factors for work-related postural stresses.

Methods: We compare the performance factors of two order picking systems, i.e. MR and AS/RS, by applying a digital human modeling and simulation, and assessing the total average physical activity exhibited by human operators on a given order picking task.

Results: The AS/RS type order picking system exhibited a lower risk for task-related postural stresses for warehouse workers.

Conclusions: The picking station for moving robot (MR) order picking system requires design changes in order to reduce postural stresses during human operator's interaction with such a system.
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http://dx.doi.org/10.3233/WOR-203337DOI Listing
June 2021

Factors associated with partitioning behavior of persistent organic pollutants in a feto-maternal system: A multiple linear regression approach.

Chemosphere 2021 Jan 4;263:128247. Epub 2020 Sep 4.

Division of Environmental Science and Engineering, Pohang University of Science and Technology (POSTECH), San 31, Hyoja-dong, Nam-gu, Pohang, 37673, Republic of Korea. Electronic address:

Prenatal exposure to persistent organic pollutants (POPs) has been a matter of particular concern because such exposure can severely affect the health of the fetus. The mechanistic understanding of the partitioning behavior of POPs in the feto-maternal system and the associated factors, however, have rarely been studied. Here, we employed a new approach based on multiple linear regression (MLR) analysis to predict the feto-maternal ratio (FM-ratio) of POPs and to assess the factors associated with feto-maternal partitioning behavior. Two preliminary exploratory MLR models were built using physiological conditions of the participants, and molecular descriptors were calculated with a computational model. The FM-ratio was calculated from the concentrations of polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs), and polybrominated diphenyl ethers (PBDEs) in 20 pairs of maternal and cord blood. The models showed that the lipids and cholesterols in the maternal and cord blood and the placenta significantly influence the partitioning of POPs. The body mass index (BMI) change during pregnancy was also related to the FM-ratio. The physicochemical properties associated with lipophilicity and molecular size were also related to the FM-ratio. Even though the results should be interpreted with caution, the preliminary MLR models illustrate that feto-maternal partitioning is governed by transplacental transporting mechanisms, toxicokinetics, and the molecular physicochemical properties of POPs. Overall, the new approach used in this study can improve our understanding of the partitioning behavior in the feto-maternal system.
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http://dx.doi.org/10.1016/j.chemosphere.2020.128247DOI Listing
January 2021

The way we communicate in allergy.

Authors:
Yoon-Seok Chang

Asia Pac Allergy 2020 Oct 30;10(4):e45. Epub 2020 Oct 30.

Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea.

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http://dx.doi.org/10.5415/apallergy.2020.10.e45DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7610085PMC
October 2020

Diagnostic procedures & practices in drug allergy/hypersensitivity: a survey of 13 Asian countries.

Asia Pac Allergy 2020 Oct 15;10(4):e36. Epub 2020 Oct 15.

Department of Pediatrics, Nippon Medical School, Tokyo, Japan.

Background: The issues and challenges in the diagnosis of drug allergy/hypersensitivity among children and adults in Asia are likely to be different from non-Asian countries.

Objective: To study the diagnostic modalities used in the evaluation and management of drug allergy/drug hypersensitivity reactions (DHRs) among member societies of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI).

Methods: A questionnaire comprising 41 questions was circulated electronically to member societies and individual members of APAAACI between January 23, 2020 and March 6, 2020.

Results: Twenty-six respondents from 15 member societies and 1 individual member responded. European DHR guidelines were most commonly used. Skin prick and intradermal testing was used by 100%, with only 60% having access to commercial penicillin skin test reagents. -specific IgE tests were used by 75%, and basophil activation test by 56.3% for immediate DHR. Patch tests were used by 75% in contrast to lymphocyte transformation tests by 25% for nonimmediate DHR. Drug provocation tests were used by 68.8%, the most common indication being to exclude hypersensitivity where history/symptoms were not suggestive of drug hypersensitivity/allergy (93.3%). Human leukocyte antigen (HLA) genotype testing was mandatory among 25% respondents before new carbamazepine prescriptions, and 8.3% for allopurinol prescriptions.

Conclusions: There was increased use of skin testing for iodinated contrast media hypersensitivity and patch testing for nonimmediate DHR. HLA genotype testing prior to new carbamazepine, allopurinol and abacavir prescriptions remain variable despite strong associations for severe cutaneous adverse reactions with Asian ethnicity. Results of this survey form a useful framework for developing educational and training needs and for improving access to drug allergy diagnostic and treatment modalities across APAAACI member societies.
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http://dx.doi.org/10.5415/apallergy.2020.10.e36DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7610088PMC
October 2020

Biological treatments in allergy: prescribing patterns and management of hypersensitivity reactions.

J Allergy Clin Immunol Pract 2021 03 5;9(3):1396-1399.e2. Epub 2020 Nov 5.

Division of Allergy, Département de Pneumologie et Addictologie, University Hospital of Montpellier, Montpellier, France; Sorbonne Université, INSERM UMR-S 1136, IPLESP, Equipe EPAR, Paris, France; WHO Collaborating Centre on Scientific Classification Support, Montpellier, France. Electronic address:

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http://dx.doi.org/10.1016/j.jaip.2020.10.044DOI Listing
March 2021

Occurrence, distribution, and bioaccumulation of new and legacy persistent organic pollutants in an ecosystem on King George Island, maritime Antarctica.

J Hazard Mater 2021 03 1;405:124141. Epub 2020 Oct 1.

Pohang University of Science and Technology (POSTECH), San 31, Hyoja-dong, Nam-gu, Pohang 37673, South Korea. Electronic address:

The occurrence and bioaccumulation of new and legacy persistent organic pollutants (POPs), organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), polychlorinated naphthalenes (PCNs), hexabromocyclododecanes (HBCDs), and Dechlorane Plus (DPs) and their related compounds (Dechloranes) in an ecosystem on King George Island, Antarctica are investigated. The new and legacy POPs were widely detected in the animal samples collected from Antarctica, which included Limpet, Antarctic cod, Amphipods, Antarctic icefish, Gentoo and Chinstrap penguins, Kelp gull, and South polar skua. The trophic magnification factors indicated that the levels of PCNs and HBCDs, as well as the legacy POPs, were magnified through the food web, whereas DPs might be diluted through the trophic levels contradicting the classification of Dechloranes as POPs. This is one of the first extensive surveys on PCNs, HBCDs, and Dechloranes, which provides unique information on the distribution and trophic biomagnification potential of the new and legacy POPs in the Antarctic region.
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http://dx.doi.org/10.1016/j.jhazmat.2020.124141DOI Listing
March 2021

Twenty-year trends and exposure assessment of polychlorinated dibenzodioxins and dibenzofurans in human serum from the Seoul citizens.

Chemosphere 2021 Jun 7;273:128558. Epub 2020 Oct 7.

Division of Environmental Science and Engineering, Pohang University of Science and Technology (POSTECH), Pohang, 37673, Republic of Korea; National Institute of Environmental Research, Hwangyong-ro 42, Seo-gu, Incheon, 22689, Republic of Korea. Electronic address:

This study investigated polychlorinated dibenzodioxins and dibenzofurans (PCDD/Fs) in air (n = 108) and human serum (n = 1802) samples collected over 20 years to evaluate the long-term exposure to PCDD/Fs and health effects on the Korean general population. The serum PCDD/F levels were higher in males than in females and were significantly correlated with age, body mass index, and manifestation of diabetes mellitus. From 2000 to 2019, the PCDD/F levels declined by 96% in the air, but only by 36% in the serum, because PCDD/Fs are relatively stable in the human body and are exposed to humans after PCDD/Fs are distributed and migrated in various environmental matrices. The PCDD/F levels in other environmental matrices have also decreased at rates that differed among the matrices due to the different retention times and changes in continuous input of contaminants. As PCDD/Fs migrate from environmental matrices to the human body, the fraction of PCDDs increased whereas that of PCDFs decreased because of their relatively short half-lives. This study provides a concrete evidence that PCDD/F emissions by national regulations can achieve long-term reduction in human exposure. To the best of our knowledge, this is the longest and largest study to evaluate the long-term trends and annual changes of PCDD/Fs in the atmosphere and human serum, simultaneously.
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http://dx.doi.org/10.1016/j.chemosphere.2020.128558DOI Listing
June 2021

A Proposal from the Montpellier World Health Organization Collaborating Centre for Better Management and Prevention of Anaphylaxis.

J Allergy Clin Immunol Pract 2021 02 13;9(2):676-683.e1. Epub 2020 Oct 13.

Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, France; Sorbonne Université, INSERM UMR-S 1136, IPLESP, Equipe EPAR, Paris, France; WHO Collaborating Centre on Scientific Classification Support, Montpellier, France.

Since the first description of anaphylaxis in 1902, its clinical importance as an emergency condition has been recognized worldwide. Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction characterized by rapid onset and the potential to endanger life through respiratory or circulatory compromise. It is usually, although not always, associated with skin and mucosal changes. Although the academic/scientific communities have advocated to promote greater awareness and protocols for the management of anaphylaxis based on best evidence, there are few efforts documenting feedback as to the success of these efforts. In this article, we review the key unmet needs related to the diagnosis and management of anaphylaxis, and propose a public health initiative for prevention measures and a timetable action plan that intends to strengthen the collaboration among health professionals and especially primary care physicians dealing with anaphylaxis, which can encourage enhanced quality of care of patients with anaphylaxis. More than calling for a harmonized action for the best management of anaphylaxis to prevent undue morbidity and mortality, the Montpellier World Health Organization Collaborating Centre here proposes an action plan as a baseline for a global initiative against anaphylaxis. We strongly believe that these collaborative efforts are a strong public health and societal priority that is consistent with the overarching goals of providing optimal care of allergic patients and best practices of allergology.
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http://dx.doi.org/10.1016/j.jaip.2020.09.062DOI Listing
February 2021

Retinol-binding protein-4 was associated with sensitization to inhalant allergens in the elderly population.

Korean J Intern Med 2021 03 13;36(2):447-455. Epub 2020 Oct 13.

Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Background/aims: Recent evidence suggests an association between allergic sensitization and metabolic markers. However, this association has rarely been examined in the elderly. Retinol-binding protein-4 (RBP-4) is a recently identified adipokine that acts on the muscle and liver affecting insulin sensitivity. We evaluated the association between metabolic parameters and allergic sensitization in the elderly.

Methods: We analysed the database of the Korean Longitudinal Study on Health and Aging cohort study conducted during 2005 to 2006. Atopy was identified by inhalant allergen skin prick test. Metabolic conditions were assessed using anthropometric indices and serum biomarkers such as fasting glucose, lipid, adiponectin, and RBP-4.

Results: Among the 854 elderly subjects, 17.2% had atopy. Plasma RBP-4 levels were significantly higher in the atopic elderly than nonatopic elderly (p = 0.003). When RBP-4 percentiles were categorized as under three groups, the prevalence of atopy and current rhinitis increased significantly with percentiles of RBP-4 levels (p = 0.019 and p = 0.007, respectively). Log RBP-4 was associated with atopy (odds ratio [OR], 4.10; p = 0.009) and current rhinitis (OR, 2.73; p = 0.014), but not with current asthma (OR, 1.17; p = 0.824). Higher RBP-4 level in atopic elderly was also observed in current rhinitis patients. Atopy, but not current rhinitis, showed significant relationships with log RBP-4 levels in multivariate analyses adjusted for other metabolic markers including body mass index.

Conclusion: RBP-4 positively associated with atopy in the general elderly population irrespective of other metabolic markers.
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http://dx.doi.org/10.3904/kjim.2019.348DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969066PMC
March 2021

Internal distribution and fate of persistent organic contaminants (PCDD/Fs, DL-PCBs, HBCDs, TBBPA, and PFASs) in a Bos Taurus.

Environ Pollut 2020 Dec 11;267:115306. Epub 2020 Aug 11.

Division of Environmental Science and Engineering, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang, 37673, Republic of Korea. Electronic address:

While terrestrial organisms such as livestock are consumed regularly, studies of internal distribution and bioaccumulation of persistent organic pollutants (POPs) have been focused more on aquatic organisms. In this study, we have assessed the internal distribution and fate of legacy (PCDD/Fs and PCBs) and emerging POPs (HBCDs and PFASs), and TBBPA in 42 tissues of a Bos Taurus. PCDD/Fs, DL-PCBs, and HBCDs were found 3, 4, and 4-fold higher in the lipid-rich organs (subcutaneous fat, visceral fat, large intestine) compared to the remaining organs and muscles, owing to their hydrophobic properties. The TBBPA concentration in the excrement was 36-fold higher compared to the average tissues, suggesting a short internal half-life of TBBPA. Among PFASs, PFUnDA displayed 98% contribution from all ionic PFASs in the tissues due to its strong binding affinity, high exposure via feed and water, and increasing emergence of PFUnDA and its precursors in the Southeast Asian countries. While our study suggests that, at the moment, there is no significant health risks to the general Korean population, the future changes in environmental exposure as well as the internal dynamics and fate of various POPs species should be kept in mind when consuming various parts of livestock.
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http://dx.doi.org/10.1016/j.envpol.2020.115306DOI Listing
December 2020

A multicenter anaphylaxis registry in Korea: Clinical characteristics and acute treatment details from infants to older adults.

World Allergy Organ J 2020 Aug 11;13(8):100449. Epub 2020 Aug 11.

Department of Pediatrics, Ajou University School of Medicine, Suwon, South Korea.

Background: Although the prevalence of anaphylaxis is increasing worldwide, the large-scale studies in Asia evaluating anaphylaxis in all age groups are limited. We aimed to collect more precise and standardized data on anaphylaxis in Korea using the first multicenter web-based registry.

Methods: Twenty-two departments from 16 hospitals participated from November 2016 to December 2018. A web-based case report form, designed by allergy specialists, was used to collect anaphylaxis data.

Results: Within the 2-year period, 558 anaphylaxis cases were registered. The age of registered patients ranged from 2 months to 84 years, and 60% were aged <18 years. In children and adolescents, foods (84.8%) were the most common cause of anaphylaxis, followed by drugs (7.2%); in adults, drugs (58.3%) were the most common cause, followed by foods (28.3%) and insect venom (8.1%). The onset time was ≤10 min in 37.6% of patients. Among the 351 cases registered via the emergency department (ED) of participating hospitals, epinephrine was administered to 63.8% of patients. Among those receiving epinephrine in the ED, 13.8% required 2 or more epinephrine shots. Severe anaphylaxis accounted for 23.5% cases (38.1% in adults; 13.7% in children); patients with drug and insect venom-induced anaphylaxis had higher rates of severe anaphylaxis.

Conclusion: This multicenter registry provides data on anaphylaxis for all age groups for the first time in Asia. The major causes and severity of anaphylaxis were remarkably different according to age group, and the acute treatment features of anaphylaxis in the EDs were examined in detail.
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http://dx.doi.org/10.1016/j.waojou.2020.100449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426446PMC
August 2020

COVID-19 and allergy.

Authors:
Yoon-Seok Chang

Asia Pac Allergy 2020 Jul 30;10(3):e34. Epub 2020 Jul 30.

Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

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http://dx.doi.org/10.5415/apallergy.2020.10.e34DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402948PMC
July 2020

The KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children: Part 2. Management of H1-Antihistamine-Refractory Chronic Urticaria.

Allergy Asthma Immunol Res 2020 Sep;12(5):750-770

Department of Dermatology, School of Medicine, Eulji University, Daejeon, Korea.

Quite a few patients with chronic spontaneous urticaria (CSU) are refractory to H₁-antihistamines, even though the dose of H₁-antihistamines is increased up to 4-fold. CSU that is not controlled with H₁-antihistamines results in increased disease burden. Several immunomodulators have been used to manage these patients. The guidelines reported herein are connected to Part 1 of the KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children, and aimed to provide evidence-based recommendations for the management of H₁-antihistamine-refractory CSU. Part 2 focuses on the more commonly used additional treatment options for refractory CSU, including omalizumab, cyclosporine, leukotriene receptor antagonist, dapsone, methotrexate, and phototherapy. The evidence to support their efficacy, dosing, safety, and selection of these agents is systematically reviewed. To date, for patients with refractory CSU, the methodologically sound data to evaluate the use of omalizumab has been growing; however, the evidence of other immunomodulators and phototherapy is still insufficient. Therefore, an individualized stepwise approach with a goal of achieving complete symptom control and minimizing side effects can be recommended. Larger controlled studies are needed to elevate the level of evidence to select a rational therapeutic agent for patients with refractory CSU.
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http://dx.doi.org/10.4168/aair.2020.12.5.750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7346997PMC
September 2020

In situ chemical oxidation of contaminated groundwater using a sulfidized nanoscale zerovalent iron-persulfate system: Insights from a box-type study.

Chemosphere 2020 Oct 25;257:127117. Epub 2020 May 25.

Division of Environmental Science and Engineering, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang, 37673, Republic of Korea; National Institute of Environmental Research, Seo-gu, Incheon, 22689, Republic of Korea. Electronic address:

We report the potential of a sulfidized nanoscale zerovalent iron-persulfate (S-nZVI-PS) system for in situ chemical oxidation (ISCO) of groundwater pollutants. The study was conducted using a sand-filled rectangular box with a permeable reactive barrier of S-nZVI as a facsimile of the ISCO system. Synthetic water contaminated with a target pollutant (reactive black-5, RB-5) was continuously passed through the box. The injection of PS led to the complete removal of RB-5 and the system remained reactive for approximately 12 days. This system has a benefit that the oxidation products of S-nZVI (i.e., FeO, FeO and FeSO) can further activate PS to retain its reactivity. In a separate trial, this method exploited oxidation, reduction, adsorption and co-precipitation mechanisms that conspired to remove two different groundwater pollutants- arsenite and 1,4-dioxane. These results confirmed the utility of S-nZVI-PS as a mediator of ISCO processes to degrade groundwater pollutants.
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http://dx.doi.org/10.1016/j.chemosphere.2020.127117DOI Listing
October 2020
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