The International Civil Aviation Organization (ICAO) amended the upper age limit for commercial pilots in 2006 changing from 60 to 65 years old. Due to lack of skilled pilots, there is an increase in the number of senior pilots in active duty worldwide. Safety concerns are increasing as age of airline pilot increases and efforts are being made to determine whether airline pilots over the age of 60 pose a hazard to aviationsafety and whether risk assessment could replace age-based retirement. For aged pilots, incapacitation from medical reasons and gradual performance degradation are the main risk factors decaying safety. Cardiovascular incapacitation, although rare in the cockpit, the risk increases with age, but profiling of risk factor could identify pilots with substantial risk. Normal age-related cognitive changes have minimal impact on gradual performance degradation. If pilot is good above average health, training, and experience,he can fly until after age 65, Relationship between aviation safety and increased accident risk for over-60-year-old pilots has not been fully explored. By far, no study on aircraft safety has shown an increased accident risk for over-60-year-old pilots. With improved aeromedical certification test and adequate performance testing, a gradual increase of the retirement age to approximately age 70 would seem justified. In the future, a longitudinal database focusing on aged pilots should be established to validate medical tests for their ability to predict a pilot's accident risk. Aeromedical decision makers should consider the factors of age, health, and piloting experience and their interaction in the modern flightenvironment to ensure the maintenance of flight safety in aged airline pilots.

For nonsmall cell lung cancer (NSCLC), surgery is indicated only for stage 3 as a curative measure. Even so, there is a high risk of recurrence following stage 3 lung cancer surgery, a third (33.9%) of patients experienced a cancer recurrence mostly within 2 years after surgery. The median survival time for all stages reaches only 21.9 months. For people undergoing surgery for stage 3A NSCLC, a pre-operative course of (neoadjuvant chemotherapy) can improve survival times, by improving the resectability and lowering the risk of recurrence. Pleural metastases are frequently associated with tumors of the lung and breast. Chest radiographs and computed tomography scans of pleural metastases can present as an effusion or smooth or nodular pleural thickening. In the absence of irregular or nodular pleural thickening, it is difficult to distinguish a benign from a malignant pleural effusion. To treat lung cancer, tyrosine kinase inhibitors (TKIs) recently have been used to cope with genetic mutations, apart from cytotoxic anticancer drugs. Compared to cytotoxic drugs, they are effective, have fewer side effects, and are easy to administer. Airman must have no cancer disease to apply for Class-I medical certification. Specifically, if previously operated on cancer, the cancer should not remain in the body at present, and the disease free state should persist at least one year after all kinds of anti-cancer treatments including adjuvant chemotherapy are completed. Here, this case deals with a 41-year-old pilot who has ATP license who had stage 3A NSCLC. The pilot underwent curative lung cancer surgery (lobectomy) a year ago and showed suspicious pleural metastasis at the time of his application for certification and was still using anunauthorized TKI agent alectinib (Alecensa; Roche, Basel, Switzerland).

Purpose: The medical certification for pilots is required by the aviation safety authority based with the aviation safety act. Methods: In this study, aeromedical decision results according to aviation medical examination of the years from 2013 to 2015 were reviewed by retrospective analysis. Results: Data from a cumulative total of 19,459 cases were screened. Of these, 15% were determined to be fit with condition. Among them, 259 were diagnosed with cancer. The ratios by cancer type are as follows: the most common cancer was thyroid cancer (39.7%), followed by gastric cancer (12.1%), kidney cancer (7.9%), colorectal cancer (7.9%), skin cancer (7.9%), prostate cancer (7.5%), lymphoma/leukemia (5.9%), lung cancer (5.0%), head and neck cancer (2.5%), and other cancers (2.5%). Conclusion The number of aircrew with cancer tends to increase slightly every year.The most common cause of thyroid cancer seems to be due to excessive diagnostic activity.

Chronic myeloid leukemia (CML) is myeloproliferative neoplasm associated with a characteristic chromosomal translocation (bcr-abl) called Philadelphia chromosome which plays a key role in the pathogenesis. Approximately 85% of patients with CML are in the chronic phase at the time of diagnosis. During this phase, patients are well tolerated and have few symptoms. But untreated, over the course of several years progresses to an accelerated phase and ultimately to a blast crisis, the terminal phase. CML is largely treated with targeted drug therapy called tyrosine-kinase inhibitors (TKIs) which have led to dramatically improved long-term survival rates since 2001. These drugs became standard treatment of this disease and allow most patients to have much better quality of life when compared to the former chemotherapy drugs and the bone marrow transplantation. Imatinib (Gleevec or Glivec, Norvatis) was the first of these TKIs and found to inhibit the progression of CML in the majority of patients (65%–75%) sufficiently to achieve remission. Since the advent of imatinib, CML has become the first neoplasm in which a medical treatment can give to the patient a normal life expectancy.

No abstract available.
Antiemetics* ; Drug Therapy, Combination* ; Humans ; Ondansetron*

As a minor blood antigen, the Duffy blood group has 5 antigens which are Fya, Fyb, Fy3, Fy4 and Fy5. When the Duffy group is implicated in delayed transfusion reactions, one expects to find anti-Fya rather than Fyb. We experienced a case of delayed hemolytic transfusion reaction caused by anti-Fyb antibody. A 69 year-old woman was referred having had hematuria, fever, chill and jaundice 9 days after transfusion. The hemoglobin was 9.5mg/dl, reticulocyte count 1.4%, liver function test showed total bilirubin 10.8mg/dL, LDH 5,225IU/L, alkaline phosphatase 26IU/L. Indirect antiglobulin test was positive, while the direct one was negative. A delayed hemolytic transfusion reaction was suspected as patient's serum was reacted with panel cells for the antibody identification test and the anti-Fyb was finally identified. The patient recovered without specific treatment. There were no severe complication and sequele.It appears to be the first reported case of hemolytic transfusion reaction caused by anti-Fyb in Korea.
Aged ; Alkaline Phosphatase ; Bilirubin ; Blood Group Incompatibility ; Coombs Test ; Female ; Fever ; Hematuria ; Humans ; Jaundice ; Korea ; Liver Function Tests ; Reticulocyte Count

Purpose: The medical certification for pilots is required by the aviation safety authority based with the aviation safety act. Methods: In this study, medical examination items of the year of 2021 performed during the aviation medical examination in Korea were reviewed by retrospective analysis. Results: Data from a total of 27 hospitals were collected. The number of inspection items ranged from a minimum of 22 items to a maximum of 57 items, showing a difference of more than double. Data from tertiary general hospitals and large airlines showed a tendency to perform more items of test compared to clinic-level institutions. The ratios for each inspection item are as follows: 1) 100% inspection items: urine test, ophthalmic test (except fundus test), fasting blood sugar, general blood test (complete blood count), electrocardiogram, electoencephalography, chest posterior anterior, pure tone audiometry, and total cholesterol; 2) 65%–74% inspection items: triglyceride, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, blood urea nitrogen/creatinine, and hepatitis B surface antigen; 3) 57% inspection items: hepatitis B surface antibody, human immunodeficiency virus, and venereal disease research laboratory; 4) 50% inspection items: urate and fundus examination. Conclusion There have been many changes in the medical field over the past 40 years, but in terms of examination items, the aviation physical examination does not reflect the flow of change. Over the past years, the number of pilots has increased significantly, the flight environment has changed, and medical examination methods have been developed and diversified. In accordance with this, it is necessary to change the test items.