Objectives: This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition.The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach. Methods: A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and anti resorptive agents in sequential therapy approaches. Results: The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to anti resorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for in dividuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment. Conclusions This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.

Objectives: Sleep disturbance in the elderly is associated with cognitive decline. Sleep quality is known to deteriorate with age, and prospective studies seldom have examined the relationship between sleep quality and cognitive function. This study investigates the relationship between early sleep quality and cognitive function based on six-year follow-up data of community individuals older than 60 years. Methods: The participants included 622 community elderly people older than 60 years from Jinju-Si. The final analysis comprised 322 elderly people. Pittsburgh sleep quality index (PSQI) and the Korean version of Consortium to Establish a Registry for Alzheimer’s Disease (CERAD-K) were used to assess early sleep quality and cognitive function after six years. Multiple linear regression analysis was performed to investigate the association between early sleep quality and cognitive function in the elderly. Results: Early sleep quality (PSQI) was significantly associated with the results of the digit span test, clock drawing test (clox 1), and word recall test after six years. Sleep quality (PSQI) decreased significantly after six years, and lower quality of sleep (PSQI) score was associated with higher digit span test score (β = -0.167, p = 0.026) and higher clock drawing test score (β = -0.157, p = 0.031). Lower quality of sleep (PSQI) score was associated with higher word recall test (β = -0.140, p = 0.039). Conclusion The digit span test, word recall test, and clock drawing task (CLOX 1) shown to be significantly associated to sleep quality can be performed fast and easily in clinical practice. It is important to assess early cognitive function in the elderly with poor sleep quality, and further studies could suggest that these tests may be useful screening tests for early dementia in elderly with poor sleep quality.

OBJECTIVE: The aim of this study was to identify the morphological and functional characteristics of quadricuspid aortic valves (QAV) on cardiac computed tomography (CCT). MATERIALS AND METHODS: We retrospectively enrolled 11 patients with QAV. All patients underwent CCT and transthoracic echocardiography (TTE), and 7 patients underwent cardiovascular magnetic resonance (CMR). The presence and classification of QAV assessed by CCT was compared with that of TTE and intraoperative findings. The regurgitant orifice area (ROA) measured by CCT was compared with severity of aortic regurgitation (AR) by TTE and the regurgitant fraction (RF) by CMR. RESULTS: All of the patients had AR; 9 had pure AR, 1 had combined aortic stenosis and regurgitation, and 1 had combined subaortic stenosis and regurgitation. Two patients had a subaortic fibrotic membrane and 1 of them showed a subaortic stenosis. One QAV was misdiagnosed as tricuspid aortic valve on TTE. In accordance with the Hurwitz and Robert's classification, consensus was reached on the QAV classification between the CCT and TTE findings in 7 of 10 patients. The patients were classified as type A (n = 1), type B (n = 3), type C (n = 1), type D (n = 4), and type F (n = 2) on CCT. A very high correlation existed between ROA by CCT and RF by CMR (r = 0.99) but a good correlation existed between ROA by CCT and regurgitant severity by TTE (r = 0.62). CONCLUSION: Cardiac computed tomography provides comprehensive anatomical and functional information about the QAV.
Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Aortic Valve* ; Classification ; Consensus ; Constriction, Pathologic ; Echocardiography ; Humans ; Magnetic Resonance Imaging ; Membranes ; Multidetector Computed Tomography ; Retrospective Studies

PURPOSE: The purpose of this study was to investigate the physiological index, anxiety and depression by the severity of lower urinary tract symptoms in patients with benign prostatic hyperplasia. METHODS: This research was conducted from the 4th to the 27th of May in 2016 on112 patients with benign prostatic hyperplasia. The data were analyzed using a chi-square test, ANOVA, and Pearson Correlation Coefficients. RESULTS: The results demonstrated a difference depending on the dysuria period of each lower urinary tract symptom, marital status, occupation and perceived health state of the patient. The physiological index by lower urinary tract symptoms showed a difference in the maximum flow rate, amount of post-void residual urine and Prostate-Specific Antigen (PSA), and anxiety and depression factors also revealed a difference. Lower urinary tract symptoms showed a positive correlation to the amount of post voided residual urine and PSA, a negative correlation to the maximum flow rate and also indicated a positive correlation to depression. CONCLUSION: The results of the study belonging to the moderate and severe categories were high when the result was based on the categorization of subjects with benign prostatic hyperplasia with lower urinary tract symptoms. Considering that depression levels increase as the symptom intensifies and the anxiety score is also high with mild symptoms, psychological support intervention is needed when a pattern of benign prostatic hyperplasia appears.
Anxiety* ; Depression* ; Dysuria ; Humans ; Lower Urinary Tract Symptoms* ; Marital Status ; Occupations ; Prostate-Specific Antigen ; Prostatic Hyperplasia* ; Urinary Tract

OBJECTIVES: To compare the incidence of osteoporosis and the related factors among fracture sites in above 50 year-old patients with fractures caused by low-energy trauma. MATERIALS AND METHODS: Seven hundred and fourteen patients with fracture from low energy trauma were evaluated retrospectively. By the Dual-energy x-ray absorptionmetry, we measured bone mineral density (BMD) at lumbar spine and proximal femur, and compared the incidence of osteoporosis, age, sex, body mass index (BMI), previous fracture history, past osteoporosis medication history according to each fracture sites. RESULTS: BMD was decreased according to increasing age with statistical significance (P<0.001). Sex has no significant difference according to fracture site (P=0.141). Average age of patients with osteoporotic fracture was 73.8, 72.8, 66.3, 73.4, 78.3 years old according to fracture site as T-spine, L-spine, distal radius, proximal humerus and proximal femur, respectively. There was significant difference among groups (P<0.001). Average BMI related with osteoporotic fracture site was 22.9 kg/m2, 22.7 kg/m2, 23.4 kg/m2, 23.0 kg/m2, 21.7 kg/m2, respectively and it showed significant difference among groups (P<0.001). Average bone mass and T-score related with osteoporotic fracture site was 0.587 g/cm2 (-3.5), 0.614 g/cm2 (-3.1), 0.647 g/cm2 (-2.6), 0.597 g/cm2 (-3.1), 0.554 g/cm2 (-3.5), with significant difference among groups (P<0.001). Previous fracture history had no significant difference among groups (P=0.078). Previous osteoporosis medication history had significant difference among the groups (P<0.001). CONCLUSIONS: In low-energy traumatic fracture, age, BMI and previous osteoporosis medication history are significantly related factors with BMD and osteoporotic fracture. Early diagnosis of osteoporosis and osteoporotic medication use is effective for decrease incidence of low-energy osteoporotic fracture.
Body Mass Index ; Bone Density ; Early Diagnosis ; Femur ; Humans ; Humerus ; Incidence ; Middle Aged ; Osteoporosis ; Osteoporotic Fractures ; Radius ; Retrospective Studies ; Spine

BACKGROUND: The aim of this study is to evaluate the clinical and rhythm outcomes of atrial fibrillation (AF) ablation through a port access approach compared with sternotomy in patients with AF associated with mitral valve diseases. MATERIALS AND METHODS: From February 2006 through December 2009, 135 patients underwent biatrial AF ablation with a mitral operation via either a port-access approach (n=78, minimally invasive cardiac surgery [MICS] group) or a conventional sternotomy (n=57, sternotomy group). To adjust for the differences in the two groups' baseline characteristics, a propensity score analysis was performed. RESULTS: After adjustment, there were no significant differences in the two groups' baseline profiles. The cardiopulmonary bypass time was significantly longer (p=0.045) in the MICS group (176.0+/-49.5 minutes) than the sternotomy group (150.0+/-51.9 minutes). There were no significant differences (p=0.31) in the two groups' rate of reoperation for bleeding (MICS=6 vs. sternotomy= 2, p=0.47) or the requirement for permanent pacing (MICS=1 vs. sternotomy=3). The major event-free survival rates at two years were 87.4+/-8.1% in the MICS group and 89.6+/-5.8% in the sternotomy group (p=0.92). Freedom from late AF at 2 years was 86.8+/-6.2% in the MICS group and 85.0+/-6.9% in the sternotomy group (p=0.86). CONCLUSION: Both the port-access approach and sternotomy showed tolerable clinical outcomes following biatrial AF ablation with mitral valve surgery.
Atrial Fibrillation ; Cardiopulmonary Bypass ; Disease-Free Survival ; Freedom ; Hemorrhage ; Humans ; Mitral Valve ; Propensity Score ; Reoperation ; Sternotomy ; Thoracic Surgery

Acute gluteal compartment syndrome (AGCS) is a rare condition associated with trauma, drug abuse, alcohol intoxication, prolonged immobilization, hip arthroplasty and epidural anesthesia. We report the case of a 42-year-old woman presenting severe buttock pain following decreased lower extremity motor function after an incident whereby she rolled down a flight of stairs. We performed fasciotomy of the gluteal fascia in order to provide relief from acute gluteal compartment syndrome. At the 2 month follow up visit her sensory and motor function had improved. Acute gluteal compartment syndrome is a rare condition which can result in misdiagnosis or delayed diagnosis. Careful consideration is needed for patients suffering severe buttock pain.
Adult ; Anesthesia, Epidural ; Arthroplasty ; Buttocks ; Compartment Syndromes ; Delayed Diagnosis ; Diagnostic Errors ; Fascia ; Female ; Follow-Up Studies ; Hip ; Humans ; Immobilization ; Lower Extremity ; Sciatic Nerve ; Stress, Psychological ; Substance-Related Disorders

Acute gluteal compartment syndrome (AGCS) is a rare condition associated with trauma, drug abuse, alcohol intoxication, prolonged immobilization, hip arthroplasty and epidural anesthesia. We report the case of a 42-year-old woman presenting severe buttock pain following decreased lower extremity motor function after an incident whereby she rolled down a flight of stairs. We performed fasciotomy of the gluteal fascia in order to provide relief from acute gluteal compartment syndrome. At the 2 month follow up visit her sensory and motor function had improved. Acute gluteal compartment syndrome is a rare condition which can result in misdiagnosis or delayed diagnosis. Careful consideration is needed for patients suffering severe buttock pain.
Adult ; Anesthesia, Epidural ; Arthroplasty ; Buttocks ; Compartment Syndromes ; Delayed Diagnosis ; Diagnostic Errors ; Fascia ; Female ; Follow-Up Studies ; Hip ; Humans ; Immobilization ; Lower Extremity ; Sciatic Nerve ; Stress, Psychological ; Substance-Related Disorders

PURPOSE: To measure and to analyze the relationships among the rotational axes of the distal femoral region by means of 3-dimensional (3D) computed tomographic (CT) images taken perpendicularly to the mechanical axis and a 3D rendering program. MATERIALS AND METHODS: Fifty cases involving the lower extremity were included in this study, which used 3D computed tomographic angiograms. CT images of the perpendicular cross-sections to the mechanical axis of the femur were obtained by processing 3D recombinant images using Aquaris NET(R). The following anatomical angles were obtained from axial imaging using the 3D reconstructed bone model: transepicondylar axis, surgical transepicondylar axis, anteroposterior axis, and real posterior condylar axis. RESULTS: In the tomographic images, the angles to the real posterior condylar axis formed by the anatomical femoral transepicondylar axis, the anatomical femoral transepicondylar axis, and the anteroposterior axis were 6.34+/-1.23degrees, 2.43+/-1.56degrees, and 96.52+/-1.77degrees, respectively. The angles to the anatomical femoral transepicondylar axis formed by the anteroposterior axis and the surgical femoral transepicondylar axis were 90.19+/-1.61degrees and 3.91+/-0.90degrees, respectively. In the recombinant 3D femur model, the angles to the real posterior condylar axis formed by the anatomical femoral transepicondylar axis and the anteroposterior axis were 6.29+/-1.86degrees, and 93.33+/-3.76degrees, respectively. And, the angle for anteroposterior axis from anatomical transepicondylar axis was 87.04+/-4.11degrees. CONCLUSION: The method of measuring the rotational axes of the distal femur using the CT image taken perpendicularly to the mechanical axis is considered reproducible. In particular, the measurement method using the anatomical transepicondylar axis is more accurate than that using the anteroposterior axis.
Axis, Cervical Vertebra ; Femur ; Lower Extremity

PURPOSE: Our goal was to investigate an improvement in hand strength and its associated factors after carpal tunnel decompression in patients with carpal tunnel syndrome. MATERIALS AND METHODS: Between January 2008 and January 2009, a total of 31 patients (50 hands) treated with carpal tunnel decompression for carpal tunnel syndrome were enrolled into the study. Hand-strength was assessed pre- and post-surgery. In the pre-operation evaluation, we assessed multiple factors and investigated the association between these factors and recovery of hand strength. RESULTS: All patients regained hand strength after surgery. On average, the grip strength was 14.8 kg preoperatively, 13.0 kg at 6 weeks, 16.2 kg at 3 months, 18.7 kg at 6 months, and 20.6 kg at 1year postoperatively. The tip-pinch strength was 3.4 kg preoperatively and improved to 3.9 kg at 6 weeks, 4.0 kg at 3 months, 4.4 kg at 6 months and 4.7 kg at 1 year postoperatively. The key-pinch strength showed same pattern of improvement. The recovery of grip strength was significantly slower in patients with longer duration of carpal tunnel syndrome, with diabetes, or with nocturnal pain. There was no factor affecting the recovery of tip-pinch strength. Recovery of key-pinch strength was slower in patients that had experienced a longer duration of symptoms. CONCLUSION: Grip strength and pinch strength were recovered within 3 months and 6 weeks, respectively, after carpal tunnel decompression; both improved gradually until 12 months after surgery. Disease duration, diabetes, and nocturnal pain were significant factors that impacted on post-surgery recovery.
Carpal Tunnel Syndrome ; Decompression ; Hand ; Hand Strength ; Humans ; Median Nerve ; Pinch Strength