Smoking is a major health risk factor contributing to substantial morbidity and mortality worldwide. Although most smokers express a desire to quit— or they attempt to do so—, achieving smoking cessation solely through individual willpower is often challenging. Primary care plays a pivotal role in supporting smoking cessation efforts by increasing the likelihood of success. Even brief advice from a physician significantly increases the chance of quitting, and combining counseling with pharmacotherapy further improves cessation rates. Particular attention is required for smokers in special populations, such as those with cardiovascular diseases or mental health conditions, wherein tailored and proactive smoking cessation interventions are crucial. Digital health tools, including smartphone applications and text messaging interventions, have recently emerged as effective strategies to support personalized smoking cessation behaviors. Furthermore, institutional support, such as national programs, quitlines, and post-screening counseling for lung cancer, are critical resources that promote successful cessation. Primary care physicians are uniquely positioned to foster longterm smoking cessation success through sustained relationships with patients by leveraging these tools and resources to provide comprehensive and continuous care.

Smoking is a major health risk factor contributing to substantial morbidity and mortality worldwide. Although most smokers express a desire to quit— or they attempt to do so—, achieving smoking cessation solely through individual willpower is often challenging. Primary care plays a pivotal role in supporting smoking cessation efforts by increasing the likelihood of success. Even brief advice from a physician significantly increases the chance of quitting, and combining counseling with pharmacotherapy further improves cessation rates. Particular attention is required for smokers in special populations, such as those with cardiovascular diseases or mental health conditions, wherein tailored and proactive smoking cessation interventions are crucial. Digital health tools, including smartphone applications and text messaging interventions, have recently emerged as effective strategies to support personalized smoking cessation behaviors. Furthermore, institutional support, such as national programs, quitlines, and post-screening counseling for lung cancer, are critical resources that promote successful cessation. Primary care physicians are uniquely positioned to foster longterm smoking cessation success through sustained relationships with patients by leveraging these tools and resources to provide comprehensive and continuous care.

Smoking is a major health risk factor contributing to substantial morbidity and mortality worldwide. Although most smokers express a desire to quit— or they attempt to do so—, achieving smoking cessation solely through individual willpower is often challenging. Primary care plays a pivotal role in supporting smoking cessation efforts by increasing the likelihood of success. Even brief advice from a physician significantly increases the chance of quitting, and combining counseling with pharmacotherapy further improves cessation rates. Particular attention is required for smokers in special populations, such as those with cardiovascular diseases or mental health conditions, wherein tailored and proactive smoking cessation interventions are crucial. Digital health tools, including smartphone applications and text messaging interventions, have recently emerged as effective strategies to support personalized smoking cessation behaviors. Furthermore, institutional support, such as national programs, quitlines, and post-screening counseling for lung cancer, are critical resources that promote successful cessation. Primary care physicians are uniquely positioned to foster longterm smoking cessation success through sustained relationships with patients by leveraging these tools and resources to provide comprehensive and continuous care.

Smoking is a major health risk factor contributing to substantial morbidity and mortality worldwide. Although most smokers express a desire to quit— or they attempt to do so—, achieving smoking cessation solely through individual willpower is often challenging. Primary care plays a pivotal role in supporting smoking cessation efforts by increasing the likelihood of success. Even brief advice from a physician significantly increases the chance of quitting, and combining counseling with pharmacotherapy further improves cessation rates. Particular attention is required for smokers in special populations, such as those with cardiovascular diseases or mental health conditions, wherein tailored and proactive smoking cessation interventions are crucial. Digital health tools, including smartphone applications and text messaging interventions, have recently emerged as effective strategies to support personalized smoking cessation behaviors. Furthermore, institutional support, such as national programs, quitlines, and post-screening counseling for lung cancer, are critical resources that promote successful cessation. Primary care physicians are uniquely positioned to foster longterm smoking cessation success through sustained relationships with patients by leveraging these tools and resources to provide comprehensive and continuous care.

Cigarette smoking is the leading preventable cause of death, with smoking cessation representing the most effective strategy to reduce the risk of smoking-related diseases. Pharmacotherapeutic interventions for smoking cessation such as nicotine replacement therapy, bupropion, and varenicline aim to manage the symptoms of nicotine cravings and withdrawal. Evidence-based practice guidelines for pharmacotherapy in smoking cessation have been recently developed in Korea.Current Concepts: Among the general population, varenicline is the recommended first-line therapy for smoking cessation, surpassing nicotine patches and bupropion therapy. Although varenicline is commonly effective, combination therapy with varenicline and a nicotine patches may be considered when varenicline monotherapy is insufficient for managing nicotine cravings and withdrawal symptoms. Extended-duration therapy (>12 weeks) has demonstrated greater efficacy compared to standard therapy (6-12 weeks). Varenicline can promote attempts to quit smoking in smokers who are not yet prepared to quit. In cases of smokers with comorbid psychiatric conditions, varenicline is preferred over nicotine patches. The efficacy and safety profiles of smoking cessation medications have been well established in patients with cardiovascular diseases.Discussion and Conclusion: Smoking is a chronic condition associated with a high risk of relapse, emphasizing the crucial role of pharmacotherapy in increasing the success rates of smoking cessation. In accordance with evidence-based smoking cessation guidelines, the careful selection of pharmacotherapeutic agents tailored to individual smokers is pivotal.

Although major countries, such as South Korea, have developed and disseminated national smoking cessation guidelines, these efforts have been limited to developing individual societies or specialized institution-based recommendations. Therefore, evidence-based clinical guidelines are essential for developing smoking cessation interventions and promoting effective smoking cessation treatments. This guideline targets frontline clinical practitioners involved in a smoking cessation treatment support program implemented in 2015 with the support of the National Health Insurance Service. The Guideline Development Group of 10 multidisciplinary smoking cessation experts employed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach to review recent domestic and international research and guidelines and to determine evidence levels using the GRADE methodology. The guideline panel formulated six strong recommendations and one conditional recommendation regarding pharmacotherapy choices among general and special populations (mental disorders and chronic obstructive lung disease [COPD]). Strong recommendations favor varenicline rather than a nicotine patch or bupropion, using varenicline even if they are not ready to quit, using extended pharmacotherapy (>12 weeks) rather than standard treatment (8–12 weeks), or using pharmacotherapy for individuals with mental disorders or COPD. The conditional recommendation suggests combining varenicline with a nicotine patch instead of using varenicline alone. Aligned with the Korean Society of Medicine’s clinical guideline development process, this is South Korea’s first domestic smoking cessation treatment guideline that follows standardized guidelines. Primarily focusing on pharmacotherapy, it can serve as a foundation for comprehensive future smoking cessation clinical guidelines, encompassing broader treatment topics beyond medications.

Background: Several noninvasive tools are available for the assessment of nonalcoholic fatty liver disease (NAFLD) including clinical and blood biomarkers, transient elastography (TE), and magnetic resonance imaging (MRI) techniques, such as proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE). In the present study, we aimed to evaluate whether magnetic resonance (MR)-based examinations better discriminate the pathophysiologic features and fibrosis progression in NAFLD than other noninvasive methods. Methods: A total of 133 subjects (31 healthy volunteers and 102 patients with NAFLD) were subjected to clinical and noninvasive NAFLD evaluation, with additional liver biopsy in some patients (n=54). Results: MRI-PDFF correlated far better with hepatic fat measured by MR spectroscopy (r=0.978, P<0.001) than with the TE controlled attenuation parameter (CAP) (r=0.727, P<0.001). In addition, MRI-PDFF showed stronger correlations with various pathophysiologic parameters for cellular injury, glucose and lipid metabolism, and inflammation, than the TE-CAP. The MRI-PDFF and TE-CAP cutoff levels associated with abnormal elevation of serum alanine aminotransferase were 9.9% and 270 dB/m, respectively. The MRE liver stiffness measurement (LSM) showed stronger correlations with liver enzymes, platelets, complement component 3, several clinical fibrosis scores, and the enhanced liver fibrosis (ELF) score than the TE-LSM. In an analysis of only biopsied patients, MRE performed better in discriminating advanced fibrosis with a cutoff value of 3.9 kPa than the TE (cutoff 8.1 kPa) and ELF test (cutoff 9.2 kPa). Conclusion Our results suggest that MRI-based assessment of NAFLD is the best non-invasive tool that captures the histologic, pathophysiologic and metabolic features of the disease.

Background: Several noninvasive tools are available for the assessment of nonalcoholic fatty liver disease (NAFLD) including clinical and blood biomarkers, transient elastography (TE), and magnetic resonance imaging (MRI) techniques, such as proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE). In the present study, we aimed to evaluate whether magnetic resonance (MR)-based examinations better discriminate the pathophysiologic features and fibrosis progression in NAFLD than other noninvasive methods. Methods: A total of 133 subjects (31 healthy volunteers and 102 patients with NAFLD) were subjected to clinical and noninvasive NAFLD evaluation, with additional liver biopsy in some patients (n=54). Results: MRI-PDFF correlated far better with hepatic fat measured by MR spectroscopy (r=0.978, P<0.001) than with the TE controlled attenuation parameter (CAP) (r=0.727, P<0.001). In addition, MRI-PDFF showed stronger correlations with various pathophysiologic parameters for cellular injury, glucose and lipid metabolism, and inflammation, than the TE-CAP. The MRI-PDFF and TE-CAP cutoff levels associated with abnormal elevation of serum alanine aminotransferase were 9.9% and 270 dB/m, respectively. The MRE liver stiffness measurement (LSM) showed stronger correlations with liver enzymes, platelets, complement component 3, several clinical fibrosis scores, and the enhanced liver fibrosis (ELF) score than the TE-LSM. In an analysis of only biopsied patients, MRE performed better in discriminating advanced fibrosis with a cutoff value of 3.9 kPa than the TE (cutoff 8.1 kPa) and ELF test (cutoff 9.2 kPa). Conclusion Our results suggest that MRI-based assessment of NAFLD is the best non-invasive tool that captures the histologic, pathophysiologic and metabolic features of the disease.

PURPOSE: To investigate the differences in treatment outcomes between two radiation techniques, intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT).MATERIALS AND METHODS: We retrospectively analyzed 160 (IMRT = 23, 3DCRT = 137) patients with stage I glottic cancer treated from January 2005 through December 2016. The IMRT was performed with TomoTherapy (16 patients), volumetric-modulated arc therapy (6 patients), and step-and-shoot technique (1 patient), respectively. The 3DCRT was performed with bilateral parallel opposing fields. The median follow-up duration was 30 months (range, 31 to 42 months) in the IMRT group and 65 months (range, 20 to 143 months) in the 3DCRT group.RESULTS: The 5-year overall survival and 3-year local control rates of the 160 patients were 95.7% and 91.4%, respectively. There was no significant difference in 3-year local control rates between the IMRT and 3DCRT groups (94.4% vs. 91.0%; p = 0.587). Thirteen of 137 patients in the 3DCRT group had recurrences. In the IMRT group, one patient had a recurrence at the true vocal cord. Patients treated with IMRT had less grade 2 skin reaction than the 3DCRT group, but this had no statistical significance (4.3% vs. 21.2%; p = 0.080).CONCLUSION: IMRT had comparable outcomes with 3DCRT, and a trend of less acute skin reaction in stage I glottic cancer patients
Follow-Up Studies ; Glottis ; Humans ; Laryngeal Neoplasms ; Radiotherapy, Conformal ; Radiotherapy, Intensity-Modulated ; Recurrence ; Retrospective Studies ; Skin ; Vocal Cords