CCR5-mediated Recruitment of NK Cells to the Kidney Is a Critical Step for Host Defense to Systemic Candida albicans Infection

C-C chemokine receptor type 5 (CCR5) regulates the trafficking of various immune cells to sites of infection. In this study, we showed that expression of CCR5 and its ligands was rapidly increased in the kidney after systemic Candida albicans infection, and infected CCR5−/−mice exhibited increased mortality and morbidity, indicating that CCR5 contributes to an effective defense mechanism against systemic C. albicans infection. The susceptibility of CCR5−/− mice to C. albicans infection was due to impaired fungal clearance, which in turn resulted in exacerbated renal inflammation and damage. CCR5-mediated recruitment of NK cells to the kidney in response to C. albicans infection was necessary for the anti-microbial activity of neutrophils, the main fungicidal effector cells. Mechanistically, C. albicans induced expression of IL-23 by CD11c+ dendritic cells (DCs). IL-23 in turn augmented the fungicidal activity of neutrophils through GM-CSF production by NK cells. As GM-CSF potentiated production of IL-23 in response to C. albicans, a positive feedback loop formed between NK cells and DCs seemed to function as an amplification point for host defense. Taken together, our results suggest that CCR5-mediated recruitment of NK cells to the site of fungal infection is an important step that underlies innate resistance to systemic C. albicans infection.

CCR5-mediated Recruitment of NK Cells to the Kidney Is a Critical Step for Host Defense to Systemic Candida albicans Infection

C-C chemokine receptor type 5 (CCR5) regulates the trafficking of various immune cells to sites of infection. In this study, we showed that expression of CCR5 and its ligands was rapidly increased in the kidney after systemic Candida albicans infection, and infected CCR5−/−mice exhibited increased mortality and morbidity, indicating that CCR5 contributes to an effective defense mechanism against systemic C. albicans infection. The susceptibility of CCR5−/− mice to C. albicans infection was due to impaired fungal clearance, which in turn resulted in exacerbated renal inflammation and damage. CCR5-mediated recruitment of NK cells to the kidney in response to C. albicans infection was necessary for the anti-microbial activity of neutrophils, the main fungicidal effector cells. Mechanistically, C. albicans induced expression of IL-23 by CD11c+ dendritic cells (DCs). IL-23 in turn augmented the fungicidal activity of neutrophils through GM-CSF production by NK cells. As GM-CSF potentiated production of IL-23 in response to C. albicans, a positive feedback loop formed between NK cells and DCs seemed to function as an amplification point for host defense. Taken together, our results suggest that CCR5-mediated recruitment of NK cells to the site of fungal infection is an important step that underlies innate resistance to systemic C. albicans infection.

Gastric and rectal cancers in workers exposed to asbestos: a case series

Gastric and rectal cancers in workers exposed to asbestos: a case series

BACKGROUND@#The Occupational Safety and Health Research Institute (OSHRI) of the Korea had not recognized gastrointestinal cancer as work-related disease during their evaluation. However, in 2018 OSHRI recognized gastric and rectal cancers as work-related disease in asbestos-exposed workers. We present 2 such cases along supportive evidence of causation.CASE PRESENTATION: Patient A: A 57-year-old man had worked for about 40 years since 1978 as an oxygen cutter at workplaces that dismantle ships, buildings, boilers, and thermal power plants. In November 2016, endoscopy and biopsy confirmed the diagnosis of advanced gastric cancer, for which he underwent subtotal gastrectomy and chemotherapy; however, he later died of the cancer. Patient B: A 71-year-old man had worked in shipbuilding and repair workplaces for approximately 49 years, being employed in pipe laying, asbestos insulation installation, grinding, and other ship repair work. In 2003, he was diagnosed of rectal cancer by abdominal computed tomography. He accordingly underwent surgical removal of the cancer. Based on the occupational history of the 2 patients and our review of the relevant literature addressing the occupational environment, we concluded that both patients had continuous exposure to high levels of asbestos while performing their jobs for 40 and 49 years, respectively.@*CONCLUSION@#Both patients had a history of smoking and drinking (non-occupational personal risk factors). However, the possibility of an increased risk of gastric and rectal cancers from asbestos exposure cannot be excluded. Therefore, we considered that occupational exposure to asbestos had contributed to the cancer diagnosis in these cases. Workers exposed to asbestos should be made aware of the possibility of gastric or rectal cancer, and should undergo monitoring and medical examinations. Appropriate compensation for gastric and rectal cancers that occur in workers exposed to asbestos are anticipated in future.

Gastric and rectal cancers in workers exposed to asbestos: a case series

BACKGROUND@#The Occupational Safety and Health Research Institute (OSHRI) of the Korea had not recognized gastrointestinal cancer as work-related disease during their evaluation. However, in 2018 OSHRI recognized gastric and rectal cancers as work-related disease in asbestos-exposed workers. We present 2 such cases along supportive evidence of causation.CASE PRESENTATION: Patient A: A 57-year-old man had worked for about 40 years since 1978 as an oxygen cutter at workplaces that dismantle ships, buildings, boilers, and thermal power plants. In November 2016, endoscopy and biopsy confirmed the diagnosis of advanced gastric cancer, for which he underwent subtotal gastrectomy and chemotherapy; however, he later died of the cancer. Patient B: A 71-year-old man had worked in shipbuilding and repair workplaces for approximately 49 years, being employed in pipe laying, asbestos insulation installation, grinding, and other ship repair work. In 2003, he was diagnosed of rectal cancer by abdominal computed tomography. He accordingly underwent surgical removal of the cancer. Based on the occupational history of the 2 patients and our review of the relevant literature addressing the occupational environment, we concluded that both patients had continuous exposure to high levels of asbestos while performing their jobs for 40 and 49 years, respectively.@*CONCLUSION@#Both patients had a history of smoking and drinking (non-occupational personal risk factors). However, the possibility of an increased risk of gastric and rectal cancers from asbestos exposure cannot be excluded. Therefore, we considered that occupational exposure to asbestos had contributed to the cancer diagnosis in these cases. Workers exposed to asbestos should be made aware of the possibility of gastric or rectal cancer, and should undergo monitoring and medical examinations. Appropriate compensation for gastric and rectal cancers that occur in workers exposed to asbestos are anticipated in future.

Effects of an Online Imagery-Based Treatment Program in Patients with Workplace-Related Posttraumatic Stress Disorder: A Pilot Study

OBJECTIVE: We developed easily accessible imagery-based treatment program for patients with post-traumatic stress disorder (PTSD) related to workplace accidents and investigated the effects of the program on various PTSD related symptoms. METHODS: The program was based on an online platform and consisted of eight 15-min sessions that included script-guided imagery and supportive music. Thirty-five patients with workplace-related PTSD participated in this program 4 days per week for 4 weeks. Its effects were examined using self-report questionnaires before and after the take-home online treatment sessions. RESULTS: After completing the 4-week treatment program, patients showed significant improvements in depressed mood (t=3.642, p=0.001) based on the Patient Health Questionnaire-9 (PHQ-9), anxiety (t=3.198, p=0.003) based on the Generalized Anxiety Disorder seven-item (GAD-7) scale, and PTSD symptoms (t=5.363, p < 0.001) based on the Posttraumatic Stress Disorder Check List (PCL). In particular, patients with adverse childhood experiences exhibited a greater degree of relief related to anxiety and PTSD symptoms than those without adverse childhood experiences. CONCLUSION: The present results demonstrated that the relatively short online imagery-based treatment program developed for this study had beneficial effects for patients with workplace-related PTSD.

Erratum to: Practice status of specialized agencies for occupational health management of small- to medium-size enterprises and the factors improving their performance: a cross-sectional survey study

After publication of the original article the authors found that the following affiliation was incorrect at the time of publication.

Practice status of specialized agencies for occupational health management of small- to medium-size enterprises and the factors improving their performance: a cross-sectional survey study

BACKGROUND: We examined the current status of specialized agencies for occupational health management (SAs) and their workforce. Furthermore, we aimed to clarify the current practice status of SA healthcare professionals and factors that influence their performance. METHODS: To examine the current SA workforce, we analyzed data from the 2014 Survey of Current Status of SA and their Workforce from the Ministry of Employment and Labor (MOEL). Furthermore, we mailed out an original questionnaire to SA professionals to determine their current health management status and factors that affect their performance. Data from the respondents (N = 384) were analyzed. RESULTS: In 2014, the workforce performing health management in SAs comprised 232 physicians, 507 nurses, and 312 occupational hygienists, with no significant regional differences in the distribution of physicians and nurses. According to the findings of the questionnaire, the average daily number of worker consultations by physicians and nurses was 22.8, while the average time taken for health management ranged from 74.3 to 104.3 min, depending on the size of the firm. Most of the respondents (41.5%) answered that they were following-up on more than 80% of individuals with illnesses. Among health management tasks, performance scores of “consultations for general diseases” and “consultations for lifestyle habits” were relatively high, whereas health promotion activities at workplaces were relatively low. There was a significant correlation between the utilization of general and special health examination results and task performance. CONCLUSION: Among health management tasks, follow-up management of individuals with illnesses and consultations for disease/lifestyle habits were relatively well performed, whereas health promotion activities at workplaces were not performed well. Among factors that positively influenced SA performance at workplaces, only the utilization of health examination results had significant effects. Therefore, to accomplish health management goals and perform effective health management at workplaces, there is a need to establish a comprehensive system of occupational health service outsourcing integrating health examinations and health management services. Furthermore, the current task system, which focuses on follow-up management, should be expanded to incorporate preventive and health promotion functions—the fundamental functions of occupational health services (OHS).

Clinical Characteristics and Metabolic Health Status of Obese Korean Children and Adolescents / 가정의학회지

BACKGROUND: This study aimed to determine the prevalence of metabolically healthy and unhealthy obesity (MHO and MUO, respectively) and examine the demographic, anthropometric, and lifestyle predictors of metabolic health status in Korean children and adolescents. METHODS: This study was based on data collected from the Korean Children-Adolescent Study in 2010. A total of 1,700 children (846 boys and 854 girls) were included in the primary cohort and classified into metabolically healthy and unhealthy groups according to factors related to the metabolic syndrome. Demographic and biochemical features were evaluated in study participants. Logistic regression estimated the odds ratios of having more fat mass among MUO compared with MHO children after adjusting for confounding factors. RESULTS: Mean body mass index was higher in the MUO group than in the MHO group (24.83 vs. 23.02 kg/m2, respectively). The proportion of obese participants was also higher in the MUO group (59.4%) than in the MHO group (20.7%). MHO children were more likely to have parents with better socioeconomic status and a higher fruit and vegetable intake compared with MUO children. Higher fat mass and percent fat was associated with MUO according to multiple logistic regression analysis. CONCLUSION: Fat mass and percent fat are associated with metabolically healthy phenotypes of obesity among children and adolescents.

Time to First Cigarette and Hypertension in Korean Male Smokers / 가정의학회지

BACKGROUND: Morning blood pressure surge affects to cardiovascular disease risk. Short time to first cigarette (TTFC) after waking can enhance morning blood pressure surge, and accelerate atherosclerosis METHODS: We investigated that the relationship between TTFC and blood pressure. The study subjects included male current smokers (n=211) who had health check-up in Hallym University Sacred Heart Hospital from July to September, 2014. We categorized the subjects into 2 groups according to TTFC; early TTFC (TTFC or =30 minutes), and the subjects who were taking antihypertensive medications or had a high blood pressure (>140 mm Hg or 90 mm Hg) were defined as hypertensive group. Multivariate logistic regression was performed to estimate the odds ratio and 95% confidence interval to investigate the association between TTFC and hypertensive group. RESULTS: Compared with late TTFC, early TTFC had higher odds (odds ratio [OR], 3.87; 95% confidence interval [CI], 1.89-7.94) for hypertensive group. After adjusting confounding factors, early TTFC was significantly associated with an increased risk of hypertension (OR, 4.43; 95% CI, 1.84-10.70). CONCLUSION: early TTFC after waking is associated with hypertension. It suggests delaying TTFC might help to control of blood pressure among the current smokers who are not ready to immediately quit smoking.

A case of chronic myeloid leukemia in a diagnostic radiographer

BACKGROUND: Occupational radiation exposure causes certain types of cancer, specifically hematopoietic diseases like leukemia. In Korea, radiation exposure is monitored and recorded by law, and guidelines for compensation of radiation-related diseases were implemented in 2001. However, thus far, no occupation-related disease was approved for compensation under these guidelines. Here, we report the first case of radiation-related disease approved by the compensation committee of the Korea Workers' Compensation and Welfare Service, based on the probability of causation. CASE PRESENTATION: A 45-year-old man complained of chronic fatigue and myalgia for several days. He was diagnosed with chronic myeloid leukemia. The patient was a diagnostic radiographer at a diagnostic radiation department and was exposed to ionizing radiation for 21 years before chronic myeloid leukemia was diagnosed. His job involved taking simple radiographs, computed tomography scans, and measuring bone marrow density. CONCLUSION: To our knowledge, this is the first approved case report using quantitative assessment of radiation. More approved cases are expected based on objective radiation exposure data and the probability of causation. We need to find a resolution to the ongoing demands for appropriate compensation and improvements to the environment at radiation workplaces.

Job Stress and Musculoskeletal Disorder in Seoul City's School Foodservice Employees / 산업간호학회지

PURPOSE: School foodservice employees (SFEs) could be exposed to the risk of musculoskeletal disease and of job stress due to their job characteristics. This study was to evaluate the level of job stress and the prevalence of work-related musculoskeletal symptoms (WRMS) in Seoul city's SFEs, and to determine associations between job stress and WRMS. METHODS: The study design was cross-sectional, and 975 SFEs were recruited. Self-administered questionnaire included the 'Korean occupational stress scale-short form' and the 'KOSHA GUIDE H-9-2012' instrument to evaluate the job stress and WRMS, respectively. SFEs' medians of job stress were compared to the reference values of published study in Korean workers. RESULTS: The participants reported greater levels of job demand and physical environment than the general Korean population. WRMS were reported in 89.0% of participants at any body part, and 41.1% were presumed to need for medical intervention. High levels of job demand and of physical environment were significantly associated with WRMS. CONCLUSION: Subscales of job demand and physical environment were relatively high in SFEs and those were related to the occurrence of WRMS. To reduce the WRMS prevalence, a job stress management program focused on job demand and physical environment may be required.

Job Stress and Musculoskeletal Disorder in Seoul City's School Foodservice Employees / 한국직업건강간호학회지

PURPOSE: School foodservice employees (SFEs) could be exposed to the risk of musculoskeletal disease and of job stress due to their job characteristics. This study was to evaluate the level of job stress and the prevalence of work-related musculoskeletal symptoms (WRMS) in Seoul city's SFEs, and to determine associations between job stress and WRMS. METHODS: The study design was cross-sectional, and 975 SFEs were recruited. Self-administered questionnaire included the 'Korean occupational stress scale-short form' and the 'KOSHA GUIDE H-9-2012' instrument to evaluate the job stress and WRMS, respectively. SFEs' medians of job stress were compared to the reference values of published study in Korean workers. RESULTS: The participants reported greater levels of job demand and physical environment than the general Korean population. WRMS were reported in 89.0% of participants at any body part, and 41.1% were presumed to need for medical intervention. High levels of job demand and of physical environment were significantly associated with WRMS. CONCLUSION: Subscales of job demand and physical environment were relatively high in SFEs and those were related to the occurrence of WRMS. To reduce the WRMS prevalence, a job stress management program focused on job demand and physical environment may be required.

Epidemiological Investigation of an Outbreak of Hepatitis A at a Residential Facility for the Disabled, 2011 / 예방의학회지

OBJECTIVES: An outbreak of hepatitis A occurred at a residential facility for the disabled in July 10, 2011. This investigation was carried out to develop a response plan, and to find the infection source of the disease. METHODS: A field epidemiologist investigated the symptoms, vaccination histories, living environments, and probable infection sources with 51 residents and 31 teachers and staff members. In July 25, 81 subjects were tested for the hepatitis A virus antibody, and specimens of the initial 3 cases and the last case were genetically tested. RESULTS: Three cases occurred July 10 to 14, twelve cases August 3 to 9, and the last case on August 29. Among the teachers and staff, no one was IgM positive (on July 25). The base sequences of the initial 3 and of the last case were identical. The vehicle of the outbreak was believed to be a single person. The initial 3 patients were exposed at the same time and they might have disseminated the infection among the patients who developed symptoms in early August, and the last patient might have, in turn, been infected by the early August cases. CONCLUSIONS: The initial source of infection is not clear, but volunteers could freely come into contact with residents, and an infected volunteer might have been the common infection source of the initial patients. Volunteers' washing their hands only after their activity might be the cause of this outbreak. Although there may be other possible causes, it would be reasonable to ask volunteers to wash their hands both before and after their activities.

Vaccine Storage Practices and the Effects of Education in Some Private Medical Institutions / 예방의학회지

OBJECTIVES: Although vaccination rates have increased, problems still remain in the storage and handling of vaccines. This study focused on inspecting actual vaccine storage status and awareness, and comparing them before and after education was provided. METHODS: In the primary inspection, a status survey checklist was completed by visual inspection. A questionnaire on the awareness of proper vaccine storage and handling was also administered to vaccine administrators in private medical institutions in 4 regions in Gyeongsangbuk-province. One-on-one education was then carried out, and our self-produced manual on safe vaccine storage and management methods was provided. In the secondary inspection, the investigators visited the same medical institutions and used the same questionnaire and checklist used during the primary inspection. The results before and after education were compared, by treating each appropriate answer as 1 point. RESULTS: The average checklists score was 9.74 (out of 15 points), which increased significantly after education was provided (by 0.84, p<0.001). The participants demonstrated improved practices in recording storage temperatures (p=0.016), storing vaccines in the center of the refrigerator (p=0.004), storing vaccines with other medication and non-medical items (p=0.031) after education. The average score calculated from the questionnaires was 10.48 (out of 14 points), which increased after education (by 1.03, p<0.001). CONCLUSIONS: This study suggests that vaccine storage practices and awareness are inadequate, but can be partially improved by providing relevant education. Repetitive education and policy-making are required to store vaccines safely because one-off education and unenforced guidelines offer limited efficacy.