Purpose: Tyrosine kinase inhibitors (TKIs) have improved the prognosis of chronic myeloid leukaemia (CML), allowing patients with favourable disease profiles and molecular responses to attempt treatment-free remission (TFR). We aim to establish the relapse-free survival (RFS) outcomes and identify prognostic factors for successful remission maintenance among those who attempt TFR. Methods: Adult CML patients who had undergone TFR from January 1, 2016, to June 30, 2024, were included. Upon TKI discontinuation, real-time quantitative polymerase chain reaction (RQ-PCR) was monitored monthly for the first 12 months, then every 3 months, with TKI reinitiated upon a transcript level above 0.1% (IS). Data analysis was performed using SPSS version 29.0 (SPSS Inc., Chicago, IL, USA). Results: Fifty-seven patients (27 males and 30 females) with a median age of 46 years (range 16 – 70) were analysed.The majority had a low EUTOS long-term survival (ELTS) score (61.4%, n = 35) and received imatinib (87.7%, n = 50).The median treatment duration was 8.8 years (range 4.2 – 18.8), and the median duration for sustained deep molecular remission (DMR) was 4.6 years (range 2.1 – 11.1). RFS was 70.2% at 6 months, 62.5% at 12 months and 56.8% at 2 years after a median follow-up of 34 months (range 9 – 101). The MR5 level was identified as an independent factor associated with sustained remission. All relapsed patients achieved DMR upon treatment reinitiation. Conclusion Treatment discontinuation can be safely performed, with many achieving long-term treatment-free remission. A deeper molecular response (MR5) is associated with an improved likelihood of remission maintenance.

Objective: To compare the clinical and radiological features of various etiologies of chronic diffuse lacrimal gland enlargement. Materials and Methods: We retrospectively reviewed 91 consecutive patients who underwent surgical biopsy for chronic diffuse lacrimal gland enlargement and were diagnosed with non-specific dacryoadenitis (DA) (n = 42), immunoglobulin G4-related dacryoadenitis (IgG4-RD) (n = 33), and lymphoma (n = 16). Data on patient demographics, clinical presentation, and CT imaging findings (n = 73) and MRI (n = 43) were collected. The following radiologic features of lacrimal gland enlargement were evaluated: size, unilaterality, wedge sign, angle with the orbital wall, heterogeneity, signal intensity, degree of enhancement, patterns of dynamic contrast-enhanced, and apparent diffusion coefficient value. Radiological features outside the lacrimal glands, such as extra-lacrimal orbital involvement and extra-orbital head and neck involvement, were also evaluated. The clinical and radiological findings were compared among the three diseases. Results: Compared to the DA and IgG4-RD groups, the lymphoma group was significantly older (mean 59.9 vs. 46.0 and 49.4 years, respectively; p = 0.001) and had a higher frequency of unilateral involvement (62.5% vs. 31.0% and 15.2%, respectively;p = 0.004). Compared to the IgG4-RD and lymphoma groups, the DA group had significantly smaller lacrimal glands (2.3 vs. 2.8 and 3.3 cm, respectively; p < 0.001) and a lower proportion of cases with a wedge sign (54.8% vs. 84.8% and 87.5%, respectively; p = 0.005). The IgG4-RD group showed more frequent involvement of the extra-orbital head and neck structures, including the infraorbital nerve (36.4%), paranasal sinus (72.7%), and salivary gland (58.6%) compared to the DA and lymphoma groups (4.8%–28.6%) (all p < 0.005). Conclusion Patient age, unilaterality, lacrimal gland size, wedge sign, and extra-orbital head and neck involvement differed significantly different between lymphoma, DA, and IgG4-RD. Our results will be useful for the differential diagnosis and proper management of chronic lacrimal gland enlargement.

Growth hormone (GH) deficiency is caused by congenital or acquired causes and occurs in childhood or adulthood. GH replacement therapy brings benefits to body composition, exercise capacity, skeletal health, cardiovascular outcomes, and quality of life. Before initiating GH replacement, GH deficiency should be confirmed through proper stimulation tests, and in cases with proven genetic causes or structural lesions, repeated GH stimulation testing is not necessary. The dosing regimen of GH replacement therapy should be individualized, with the goal of minimizing side effects and maximizing clinical improvements. The Korean Endocrine Society and the Korean Society of Pediatric Endocrinology have developed a position statement on the diagnosis and treatment of GH deficiency. This position statement is based on a systematic review of evidence and expert opinions.

Acromegaly is a chronic disorder caused by excessive growth hormone (GH) secretion. In most cases, the excess GH originates from GH-producing pituitary adenomas. Surgery is the preferred first-line treatment for patients with acromegaly, but medical management is considered when the disease persists after surgery or in cases where patients refuse surgery or are poor candidates for surgery. Somatostatin analogues are commonly used to treat acromegaly. The Korean Endocrine Society and the Korean Neuroendocrine Study Group have developed a position statement for the use of somatostatin analogues in the medical treatment of acromegaly. This position statement is based on evidence from the current literature and expert opinions. In the case of discrepancies among expert opinions, the experts voted to determine the recommended approach.
Acromegaly ; Expert Testimony ; Growth Hormone ; Humans ; Octreotide ; Pituitary Neoplasms ; Somatostatin

Background: It is not uncommon that anxiety and depression occur in patients with cancers, and past researches have shown that the quality of life of patients is negatively affected. This study aims to determine the prevalence of anxiety and depression of patients with haematological cancers in Malaysia and to investigate the possible association of these psychological symptoms with their quality of life. Methods: This is a cross-sectional study where patients with haematological cancers attending two major hospitals were recruited. Anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression scale (HADS). Quality of life (QoL) of these patients was measured using the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ C30). An overall summary QoL score in combination with financial difficulty score and global health score were used for analysis. Results: A total of 319 patients were recruited. Thirty-three percent of patients had anxiety symptoms, 23.5% had depression symptoms. In summary the overall score of QoL is significantly lower in patients with higher scores for depression and anxiety, (p<0.05). Patients who exhibit anxiety symptoms were more frequently female, still undergoing treatment whereas patients who had higher depression scores were older and had acute leukemias or myeloproliferative neoplasms. Patients who have depression are significantly associated with a higher financial difficulty score, p<0.05. Conclusion: The poor quality of life in patients who have anxiety and depression should raise awareness amongst the health professions treating them so that additional support can be provided.

The Korean Endocrine Society (KES) published clinical practice guidelines for the treatment of acromegaly in 2011. Since then, the number of acromegaly cases, publications on studies addressing medical treatment of acromegaly, and demands for improvements in insurance coverage have been dramatically increasing. In 2017, the KES Committee of Health Insurance decided to publish a position statement regarding the use of somatostatin analogues in acromegaly. Accordingly, consensus opinions for the position statement were collected after intensive review of the relevant literature and discussions among experts affiliated with the KES, and the Korean Neuroendocrine Study Group. This position statement includes the characteristics, indications, dose, interval (including extended dose interval in case of lanreotide autogel), switching and preoperative use of somatostatin analogues in medical treatment of acromegaly. The recommended approach is based on the expert opinions in case of insufficient clinical evidence, and where discrepancies among the expert opinions were found, the experts voted to determine the recommended approach.
Acromegaly ; Consensus ; Expert Testimony ; Insurance Coverage ; Insurance, Health ; Octreotide ; Somatostatin

Acromegaly is a chronic disorder caused by excessive growth hormone (GH) secretion. In most cases, the excess GH originates from GH-producing pituitary adenomas. Surgery is the preferred first-line treatment for patients with acromegaly, but medical management is considered when the disease persists after surgery or in cases where patients refuse surgery or are poor candidates for surgery. Somatostatin analogues are commonly used to treat acromegaly. The Korean Endocrine Society and the Korean Neuroendocrine Study Group have developed a position statement for the use of somatostatin analogues in the medical treatment of acromegaly. This position statement is based on evidence from the current literature and expert opinions. In the case of discrepancies among expert opinions, the experts voted to determine the recommended approach.

AIMTo evaluate the efficacy and tolerability of vardenafil, a phosphodiesterase type-5 (PDE-5) inhibitor, in men of Asian ethnicity with erectile dysfunction (ED).

METHODSIn this prospective, double-blind, multinational study, Asian men were randomized to receive vardenafil (10 mg) or placebo (4:1 ratio) for 12 weeks. The primary efficacy variables were the International Index of Erectile Function erectile function domain (IIEF-EF), and Sexual Encounter Profile (SEP) questions related to penetration and intercourse completion. Significant mean improvements were required in all three measures to show positive benefits of vardenafil treatment. Secondary efficacy variables included the Global Assessment Question (GAQ) on erection improvement.

RESULTSLeast-squares mean baseline IIEF-EF domain scores (vardenafil 14.6, placebo 13.4) were consistent with moderate ED. After 12 weeks, vardenafil treatment was associated with significant increases from the baseline in IIEF-EF domain scores compared with the placebo (22.4 vs. 14.3; P<0.001). Vardenafil was associated with significant improvements from baseline in least squares (LS) mean success rates for SEP-2 (vardenafil 82.2 vs. placebo 43.6; P<0.001) and SEP-3 (vardenafil 66.1 vs. placebo 24.0; P<0.001). Positive GAQ responses were reported by 81.8% of vardenafil recipients vs. 24.3% of placebo recipients. Adverse events were reported by 25.4% of the vardenafil group, the majority mild and transient.

CONCLUSIONVardenafil (10 mg) is a highly effective and well-tolerated treatment for moderate ED in Asian men. These results add to the increasing amount of data demonstrating the safety and efficacy of vardenafil for the treatment of ED in a range of patient populations.

Adult ; Aged ; Double-Blind Method ; Erectile Dysfunction ; drug therapy ; Humans ; Imidazoles ; adverse effects ; therapeutic use ; Male ; Middle Aged ; Phosphodiesterase Inhibitors ; adverse effects ; therapeutic use ; Piperazines ; adverse effects ; therapeutic use ; Prospective Studies ; Sulfones ; adverse effects ; therapeutic use ; Triazines ; adverse effects ; therapeutic use ; Vardenafil Dihydrochloride

Background. Ultimate goal for the treatment of the deformities in the lower extremities is to minimize the energy requirement and conserve the energy on walking and daily living. The normal energy saving mechanism is usually broken down in the patients with the deformities in the lower extremity, and they need more energy consumption. This is the reason why they feel fatigue frequently. It is well known that the deformity in the lower extremity cause excessive energy consumption. Objectives. There is no report that compared the energy consumption according to the deformities of the lower extremity. When we decide the priority of the treatment in cases of multiple deformities, it will be important to understand the energy demand according to each deformity. Therefore, it is the purpose of this study that assess the energy consumption according to the various types of lower extremity deformities. Method. We induced the multiple deformities in ten normal adults with the brace artificially. The induced deformities are as follows: Equinus deformity; mild (10degrees), moderate (20degrees), severe (30degrees), Knee flexion deformity; mild (10degrees), moderate (20degrees), severe (30degrees), Hip flexion deformity; mild (10degrees), moderate (20degrees), severe (30degrees). For the control group, same braces were applied without any deformity. Oxygen consumption was measured for the energy consumption with the Oxygen Consumption Meter (Morgan Oxylog II, Morgan Ltd. England). Heart rate was checked with the Telemonitor (Dynascope, Fukuda Ltd, Japan). We evaluated the inspired volume, oxygen rate, oxygen cost, and heart rate in each group and compared the data among the groups. Result. Energy consumption was higher in the hip deformity group, in the knee deformity group, and in the ankle deformity group in that order. Conclusion. When there are concomitant deformities in hip, knee and ankle, the priority of treatment may be hip, knee and ankle, in that order in terms of energy consumption.
Adult ; Ankle ; Braces ; Congenital Abnormalities* ; Equinus Deformity ; Fatigue ; Heart Rate ; Hip ; Humans ; Joints* ; Knee ; Lower Extremity* ; Oxygen ; Oxygen Consumption ; Walking

Twenty-eight cases of initial psoriasis were studied with histochemical methods in an attempt to obtain changes of acid mucopolysaccharides and mast cells. Early psoriatic lesions (pin head sized) and clinically uninvolved skin at distances of 2-4cm from the psoriatic lesions were excised respectively. The results are as follows; 1. Dermal changes were more prominent than the epidermal changes in almost all specimens in early psoriatic lesions. The main features of the dermal changes were perivascular inflammatory infiltrate which were consisted mainly of lymphoid cells. 2. Inflammatory infiltrate in the region of epidermal a.lteration and papillary edema is par ticulary striking. R. Among the 26 cases, the amount of acid mucopalysaccharides of initial lesion was lesser in 14 cases, greater in 4 cases and same in 8 cases as compared with clinically normal skin. 4. The number of mast cells of initial psoriatic lesion as compared with clinically normal skin was increased(p<0. 01).
Dermis* ; Edema ; Glycosaminoglycans ; Head ; Lymphocytes ; Mast Cells* ; Psoriasis* ; Skin ; Strikes, Employee