Immune checkpoint inhibitors (ICIs) including an anti-cytotoxic T-lymphocyte-associated antigen 4 inhibitor, anti-programmed cell death protein 1 (PD-1) inhibitors, and anti-PD-ligand 1 inhibitors are representative therapeutics for various malignancies. In oncology, the application of ICIs is currently expanding to a wider range of malignancies due to their remarkable clinical outcomes. ICIs target immune checkpoints which suppress the activity of T-cells that are specific for tumor antigens, thereby allowing tumor cells to escape the immune response. However, immune checkpoints also play a crucial role in preventing autoimmune reactions. Therefore, ICIs targeting immune checkpoints can trigger various immune-related adverse events (irAEs), especially in endocrine organs. Considering the endocrine organs that are frequently involved, irAEs associated endocrinopathies are frequently life-threatening and have unfavorable clinical implications for patients. However, there are very limited data from large clinical trials that would inform the development of clinical guidelines for patients with irAEs associated endocrinopathies. Considering the current clinical situation, in which the scope and scale of the application of ICIs are increasing, position statements from clinical specialists play an essential role in providing the appropriate recommendations based on both medical evidence and clinical experience. As endocrinologists, we would like to present precautions and recommendations for the management of immune-related endocrine disorders, especially those involving the adrenal, thyroid, and pituitary glands caused by ICIs.

Purpose: At the end of life, communication is a key factor for good care. However, in clinical practice, it is difficult to adequately discuss end-of-life care. In order to understand and analyze how decision-making related to life-sustaining treatment (LST) is performed, the shared decision-making (SDM) behaviors of physicians were investigated. Methods: A questionnaire was designed after reviewing the literature on attitudes toward SDM or decision-making related to LST. A final item was added after consulting experts. The survey was completed by internal medicine residents and hematologists/medical oncologists who treat terminal cancer patients. Results: In total, 202 respondents completed the questionnaire, and 88.6% said that the decision to continue or end LST is usually a result of SDM since they believed that sufficient explanation is provided to patients and caregivers, patients and caregivers make their own decisions according to their values, and there is sufficient time for patients and caregivers to make a decision. Expected satisfaction with the decisionmaking process was the highest for caregivers (57.4%), followed by physicians (49.5%) and patients (41.1%). In total, 38.1% of respondents said that SDM was adequately practiced when making decisions related to LST. The most common reason for inadequate SDM was time pressure (89.6%). Conclusion Although most physicians answered that they practiced SDM when making decisions regarding LST, satisfactory SDM is rarely practiced in the clinical field. A model for the proper implementation of SDM is needed, and additional studies must be conducted to develop an SDM model in collaboration with other academic organizations.

Since the first outbreak of coronavirus disease 2019 (COVID-19), ongoing efforts have been made to discover an efficacious vaccine against COVID-19 to combat the pandemic. In most countries, both mRNA and DNA vaccines have been administered, and their side effects have also been reported. The clinical course of COVID-19 and the effects of vaccination against COVID-19 are both influenced by patients’ health status and involve a systemic physiological response. In view of the systemic function of endocrine hormones, endocrine disorders themselves and the therapeutics used to treat them can influence the outcomes of vaccination for COVID-19. However, there are very limited data to support the development of clinical guidelines for patients with specific medical backgrounds based on large clinical trials. In the current severe circumstances of the COVID-19 pandemic, position statements made by clinical specialists are essential to provide appropriate recommendations based on both medical evidence and clinical experiences. As endocrinologists, we would like to present the medical background of COVID-19 vaccination, as well as precautions to prevent the side effects of COVID-19 vaccination in patients with specific endocrine disorders, including adrenal insufficiency, diabetes mellitus, osteoporosis, autoimmune thyroid disease, hypogonadism, and pituitary disorders.

Since the first outbreak of coronavirus disease 2019 (COVID-19), ongoing efforts have been made to discover an efficacious vaccine against COVID-19 to combat the pandemic. In most countries, both mRNA and DNA vaccines have been administered, and their side effects have also been reported. The clinical course of COVID-19 and the effects of vaccination against COVID-19 are both influenced by patients’ health status and involve a systemic physiological response. In view of the systemic function of endocrine hormones, endocrine disorders themselves and the therapeutics used to treat them can influence the outcomes of vaccination for COVID-19. However, there are very limited data to support the development of clinical guidelines for patients with specific medical backgrounds based on large clinical trials. In the current severe circumstances of the COVID-19 pandemic, position statements made by clinical specialists are essential to provide appropriate recommendations based on both medical evidence and clinical experiences. As endocrinologists, we would like to present the medical background of COVID-19 vaccination, as well as precautions to prevent the side effects of COVID-19 vaccination in patients with specific endocrine disorders, including adrenal insufficiency, diabetes mellitus, osteoporosis, autoimmune thyroid disease, hypogonadism, and pituitary disorders.

Background/Aims: The multidisciplinary team (MDT) approach is a cornerstone of clinical oncology. This study investigated the current state of MDT care, including patient satisfaction, in Korea. Methods: We obtained the annual number of cancer patients who have received MDT care since 2014 from the registry of the Health Insurance Review and Assessment Service (HIRA). In addition, patients who received MDT care from August 2014 to May 2017 at four university hospitals were further characterized, and patient satisfaction was measured prospectively using a patient-reported questionnaire. Results: The total number of patients who received MDT care increased from 2014 to 2016 (2,113 to 9,998 patients, respectively) in the HIRA Cohort. The type of cancer that most often required MDT was breast cancer (23.8%), followed by colorectal cancer (19.1%). In the Representative Cohort (n = 1,032), MDT was requested by the surgeon more than half the time (55.7%). The main focus of MDT was decision making for further treatment planning (99.0%). The number of doctors participating in the MDT was usually five (70.0%). After initiating an MDT approach, the treatment plan changed for 17.4% of patients. Among these patients, 359 completed a prospective satisfaction survey regarding their MDT care. The overall satisfaction with the MDT approach was very high, with an average score of 9.6 out of 10 points. Conclusions The application of MDT care is a rapidly growing trend in clinical oncology, and shows high patient satisfaction. Further research is needed to determine which types of cancer patients could benefit most from MDT, and to enable MDT care to operate more efficiently so that it may expand successfully throughout Korea.

The teeth are the hardest structures in the body and can be a biomarker of aging. The aging process and degenerative changes in the teeth are helpful for estimation of age in adults. One of the best-known features of dental aging is a reduction in the size of the pulp chamber as a result of secondary deposition of dentin. In this study, we developed new regression models to estimate chronological age in Korean adults using the mandibular first molars to examine the relationship between age and pulp cavity size on intraoral radiographs. Intraoral periapical digital radiographs of the mandibular first molars were collected from 243 patients (147 male, 96 female) of known age. The radiographic images were analyzed by using the Adobe Photoshop CS5 image editing program. The pulp chamber height ratio (PCHR), pulp chamber width ratio (PCWR) were calculated and found to have a significant negative correlation with age. The correlation was consistently higher for PCHR than for PCWR. The strongest correlation was found for PCHR in female patients (r=−0.824). Multiple regression models were derived using the PCHR and PCWR. The determination coefficients (R²) of the models ranged from 0.660 to 0.730. Our results indicate that the measurement of pulp chamber height and width in the mandibular first molar is a practical, simple and reliable method for estimation of age in Korean adults.

PURPOSE: To investigate the change in axial length (AL) in highly myopic adults using partial coherence interferometry, and to identify the factors associated with the increase in AL. METHODS: Medical records of highly myopic adults (≥ −6 diopters [D] or AL ≥ 26.0 mm) were retrospectively reviewed. The AL of each patient was measured using partial coherence interferometry at least three times over 2 years, and the yearly change in AL was calculated. Associations between age, AL, choroidal thickness, and the rate of AL change were evaluated using multiple regression analysis. RESULTS: In total, 24 patients (4 males, 20 females) and 44 eyes were included in this study. The mean age was 54.9 ± 10.4 years, the initial AL was 29.335 ± 2.006 mm, the choroidal thickness was 72.7 ± 41.80 µm, the average spherical equivalent was −11.86 ± 3.85 D (−5.1~−22.0 D), and the mean follow-up period was 2.2 ± 0.5 years. A significant increase in AL of ≥0.05 mm was observed in 38 eyes (86.4%) at 2 years. The mean AL was significantly increased, to 29.409 ± 2.007 mm (p < 0.001), at 1 year and to 29.476 ± 2.028 mm (p < 0.001) at 2 years. The average rate of AL change was 0.071 ± 0.049 mm (−0.01~0.19 mm) per year. None of the included factors showed an association with the rate of AL change in multiple regression analysis. CONCLUSIONS: In this study, an increase in AL in highly myopic adults was more frequent than in previous reports using A-scan. Periodic measurements are therefore recommended for the early detection of complications.
Adult ; Choroid ; Follow-Up Studies ; Humans ; Interferometry ; Male ; Medical Records ; Retrospective Studies

The teeth are the hardest structures in the body and can be a biomarker of aging. The aging process and degenerative changes in the teeth are helpful for estimation of age in adults. One of the best-known features of dental aging is a reduction in the size of the pulp chamber as a result of secondary deposition of dentin. In this study, we developed new regression models to estimate chronological age in Korean adults using the mandibular first molars to examine the relationship between age and pulp cavity size on intraoral radiographs. Intraoral periapical digital radiographs of the mandibular first molars were collected from 243 patients (147 male, 96 female) of known age. The radiographic images were analyzed by using the Adobe Photoshop CS5 image editing program. The pulp chamber height ratio (PCHR), pulp chamber width ratio (PCWR) were calculated and found to have a significant negative correlation with age. The correlation was consistently higher for PCHR than for PCWR. The strongest correlation was found for PCHR in female patients (r=−0.824). Multiple regression models were derived using the PCHR and PCWR. The determination coefficients (R²) of the models ranged from 0.660 to 0.730. Our results indicate that the measurement of pulp chamber height and width in the mandibular first molar is a practical, simple and reliable method for estimation of age in Korean adults.
Adult ; Age Determination by Teeth ; Aging ; Dental Pulp Cavity ; Dentin ; Female ; Humans ; Korea ; Male ; Methods ; Molar ; Radiography ; Tooth

Age estimation is important in the practice of forensic science to establish the identity of human remains, as well as with living persons. Particularly in Korea, age estimation in adults has been increase in the demand for incorrect birth records in order to be entitled to civil liability, social benefits, employment. The reduction of pulp cavity size as a result of secondary dentin deposit with increasing age could be used to estimate age. This regressive change can be analyzed using radiological techniques; thus, a variety of methods for dental age estimation based on this approach have been proposed. The purpose of this study is to evaluate the concurrence between the Drusini's method and the Jeon's method using the mandibular first molar on orthopantomographs (OPGs) in Korean adults. A total of 232 OPGs (91 females and 141 males) of Korean individuals with ages ranging from 20 to 69 years were analyzed using Drusini's method and Jeon's method. Our results revealed that the correlation of the two methods with age was statistically significant (r=0.501). Both Drusini's method and Jeon's method showed significant correlation with chronological age, and Jeon's method showed a greater correlation with chronological age (r=0.738) than Drusini's method (r=0.586). The mean absolute error was 7.99 years for Jeon's method and 9.79 years for Drusini's method. Our results demonstrate that Jeon's method using the mandibular first molar on OPGs is a practical and suitable method for age estimation in Korean adults.
Adult* ; Age Determination by Teeth ; Birth Certificates ; Dentin ; Dentin, Secondary ; Employment ; Female ; Forensic Sciences ; Humans ; Korea ; Methods* ; Molar* ; Radiography

PURPOSE: We aimed to evaluate the use and safety of double dose oseltamivir for patients manifesting severe respiratory symptoms or showing no improvement of clinical symptoms after 72 hours' treatment with the usual oseltamivir dosage. METHODS: We analyzed the clinical features of 2009 influenza A H1N1 inpatients who had been admitted to a university hospital's Department of Pediatrics between August 2009 and January 2010. The Influenza A H1N1 diagnoses were confirmed by real-time reverse transcriptase polymerase chain reaction. RESULTS: The study participants numbered 157 (mean age, 5.0 years; male-to-female ratio, 1.1:1). Among them, twenty (mean age, 5.2 years) were administered double dose oseltamivir. This double dose group showed higher peak body temperatures and more abnormal radiologic results than the other, usual-dose group. The mean time duration between high fever and afebrile status after initiation of double-dose oseltamivir administration was 2.1 days, whereas that within the usual-dose group was 1.7 days. There were no adverse effects in the patients treated with double-dose oseltamivir. CONCLUSION: Double-dose oseltamivir was well tolerated in patients with severe 2009 influenza A H1N1 infection.
Body Temperature ; Diagnosis ; Fever ; Humans ; Influenza A virus ; Influenza, Human* ; Inpatients ; Oseltamivir* ; Pandemics* ; Pediatrics ; Reverse Transcriptase Polymerase Chain Reaction ; Severity of Illness Index