A unified consensus statement on medication-related osteonecrosis of the jaw (MRONJ) has not yet been established among the Asian member countries or regions of the Asian Federation of Osteoporosis Societies (AFOS). This study aimed to develop a consensus on MRONJ in patients with osteoporosis across these countries and regions. In this study, the term “Asia-Pacific” refers specifically to the Asian member countries and regions of AFOS. A structured survey consisting of nine MRONJ-related questions was distributed across 10 countries and regions to assess the level of agreement and summarize regional perspectives. In addition, a manual literature review and voting were conducted to evaluate the current evidence on MRONJ. The key aspects of MRONJ, including definition, staging, diagnosis, pathogenesis, risk factors, management, and prevention, were generally consistent among the AFOS countries and regions. The annual incidence and incidence rate of MRONJ associated with low-dose antiresorptive therapy in patients with osteoporosis ranged from 0.025% to 0.136% and 21 to 283 cases per 100,000 person-years, respectively. However, evidence regarding the benefits of drug discontinuation before dental surgery, such as tooth extraction, remains insufficient. Large-scale, multinational studies across AFOS countries and regions are warranted to determine the incidence of MRONJ better and evaluate the impact of antiresorptive drug discontinuation before dental procedures. These findings may contribute to the devel opment of effective evidence-based strategies for preventing MRONJ in patients with osteoporosis.

Objective To investigate the association between the weight-adjusted waist index (WWI) and prostate cancer (PCa) in order to provide reference for the screening and diagnosis of PCa.Methods Data of 18732 men aged ≥20 years were obtained from the US National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2018. The relationship between WWI and PCa was assessed using a multivariate logistic regression model.A stratified analysis was performed across four time periods:1999—2006, 2007—2010, 2011—2014, and 2015—2018.Restricted cubic splines (RCS) and subgroup analyses were employed to evaluate the potential nonlinear associations and interactions between WWI and PCa risk. The receiver operating characteristic (ROC) curve was utilized to compare the predictive performance of WWI with other obesity-related indicators, including waist-to-height ratio (WtHR), body mass index (BMI), waist circumference, and body weight.Results In the fully adjusted model, each 1-unit increase in WWI was associated with a 74% higher risk of PCa (OR=1.74, 95%CI:1.44-2.11, P＜0.001).Individuals in the highest quartile of WWI had nearly five times greater odds of PCa compared to those in the lowest quartile (OR=4.96, 95%CI:2.69-9.15, P＜0.001).The observed association remained consistent across all four survey cycles.RCS analysis revealed a nonlinear positive association between WWI and PCa risk. Threshold analysis indicated that when WWI ≥9.97, there was a significant positive correlation with PCa risk (OR=1.39, 95% CI:1.18-1.64, P＜0.001).Subgroup analyses confirmed the robustness of this association across different demographic and clinical subpopulations.Furthermore, WWI demonstrated superior discriminatory ability for predicting PCa compared to WtHR, BMI, waist circumference, and body weight (AUC=0.706, 0.608, 0.509, 0.594, 0.488, P＜0.001).Conclusion For the general male population in the US, WWI serves as an independent risk factor for PCa.This association has remained stable over 1999—2018, and WWI outperforms conventional obesity indicators in terms of predictive accuracy.Therefore, individuals with WWI ≥9.97 should be prioritized for prostate-specific antigen (PSA) screening, which may enhance current screening and diagnostic strategies.

Inflammatory diseases (IDs) are a general term of diseases characterized by chronic inflammation as the primary pathogenetic mechanism, which seriously affect the quality of patient′s life and cause significant social and medical burden. Current drugs for IDs include nonsteroidal anti-inflammatory drugs, corticosteroids, immunomodulators, biologics, and antioxidants, but these drugs may cause gastrointestinal side effects, induce or worsen infections, and cause non-response or intolerance. Given the outstanding performance of metal polyphenol network (MPN) in the fields of drug delivery, biomedical imaging, and catalytic therapy, its application in the diagnosis and treatment of IDs has attracted much attention and significant progress has been made. In this paper, we first provide an overview of the types of IDs and their generating mechanisms, then sort out and summarize the different forms of MPN in recent years, and finally discuss in detail the characteristics of MPN and their latest research progress in the diagnosis and treatment of IDs. This research may provide useful references for scientific research and clinical practice in the related fields.

We reported a case with huge mass in the anterior neck region, which pathological diagnosis was thyroid metastasis from hepatocellular carcinoma(HCC). A tracheotomy was performed, and a tracheostomy tube was placed because of postoperative dyspnea. Thyroid metastasis from HCC is very rare. The causes include hematogenous metastasis, lymphatic metastasis and other factors. Furthermore, Hepatitis B virus (HBV) infection also plays an important role in tumor progression. Combined with the literature review, surgical resection of thyroid in the treatment of metastatic thyroid malignant tumors can prolong the survival. In clinical work, it is still necessary to develop a reasonable, standardized and comprehensive diagnosis and treatment strategy to improve the quality of life of patients and the therapeutic efficacy.

ObjectiveTo establish consensus on Chinese Herbal Medicine (CHM) for rheumatoid arthritis (RA) among 21 Singaporean experts, this study addressed the lack of CHM clinical practice guidelines (CPGs) in Singapore. Despite advancements in RA therapies, the disease's progressive nature and high costs of novel treatments worsen disparities in management and outcomes. The initiative aimed to bridge this gap by developing expert-backed recommendations for CHM use in RA care.MethodsThe group of experts conducted two rounds of Delphi surveys containing 29 items identified from a literature review. Consensus was defined as ≥75% of votes in dichotomized ratings on a five-point ordinal scale for recognition. Items that did not reach consensus were discussed in a focus group with four selected experts.ResultsNineteen experts completed both rounds of Delphi surveys. A consensus was reached for 27 items, which encompassed Chinese medicine rationale, pattern differentiation, management, CHM prescription, and co-effectiveness with pharmacological therapy. Collective expert opinions were formed for the two remaining items. All items received a recognition score 3.5.ConclusionsThe consensus derived from this study provides a foundation for CHM CPGs for RA in Singapore. However, the findings are limited by the demographic composition of the experts and the representativeness of the patient pool.

Objective:To investigate the association between vitamin D deficiency, overweight and mild obstructive sleep apnea (OSA).Methods:The study was a cross-sectional study. A total of 82 mild OSA patients diagnosed in Pujin Community Health Service Center of Shanghai Minhang District and the medical consortium of Shanghai Fifth People′s Hospital from January to December 2022 were enrolled, and 82 non-OSA patients visiting outpatient clinics at the same period were selected as controls. All participants underwent polysomnography monitoring and AHI and LpO 2 were recorded. Venous blood was collected and serum vitamin D concentration was detected by ELISA method. The associated factors of mild OSA were determined with logistic regression analysis. Results:The prevalence of tonsillar hypertrophy (32.90%(27/82) vs. 18.29%(15/82)), smoking (52.4%(43/82) vs. 35.37%(29/82)) and allergic rhinitis (24.39% (20/82) vs. 12.20% (10/82) ) in mild OSA group was significantly higher than that in the control group ( χ2=4.609, 4.853 and 4.080, all P<0.05). The mild OSA group had a higher BMI ( (26.23±4.21) kg/m 2vs. (21.85±1.36) kg/m 2, t=2.517, P<0.05 ) and lower serum vitamin D level ( (12.36±7.98) pg/ml vs. (23.56±9.32) pg/ml, t=-11.818, P<0.05) compared with the non-OSA group. There were no significant differences in rates of alcohol consumption (39.02%(32/82) vs. 34.15%(28/82)) and family history of OSA (9.76%(8/82) vs. 6.10%(5/82), χ2=0.752) between the two groups. Multivariate logistic regression analysis showed that overweight ( OR=1.227, 95% CI: 1.045-1.441, P<0.05) was an independent risk factor for mild OSA, while vitamin D level ( OR=0.904, 95% CI: 0.832-0.981, P<0.05) was a protective factor for mild OSA. Interaction analysis revealed that the risk of combination of two factors for developing mild OSA was 5.638, which exceeded that of high BMI (1.375) or vitamin D deficiency alone (2.216) (all P<0.05). Conclusion:Vitamin D deficiency and overweight are risk factors for the development of mild OSA, and there is a positive interaction between these two factors.

The clinical burden of colorectal cancer (CRC) is high. Population-based screening and early detection are essential to improve the long-term clinical outcome. Nonetheless, a significant proportion of patients still present at an advanced stage, including with acute large bowel obstruction. Image-enhanced endoscopy and artificial intelligence can improve the detection and diagnosis of colonic adenomas and early cancer. Endoscopic resection is regarded as the preferred curative treatment option for colonic adenoma and T0 and T1 CRC limited to the superficial submucosa. Emergency colonic stenting as bridge to interval curative surgery is increasingly accepted as a first-line option when technically feasible. Minimally invasive resection techniques such as laparoscopic colectomy and robot-assisted colorectal surgery have also come of age. These techniques reduce post-treatment morbidity, shorten the recovery process and can be cost-effective while maintaining long-term oncological cure. These outcome measures are relevant to our patients; therefore, minimally invasive approaches to curative resection should be embraced.
Humans ; Colorectal Neoplasms/surgery* ; Minimally Invasive Surgical Procedures/methods* ; Laparoscopy/methods* ; Colectomy/methods* ; Robotic Surgical Procedures/methods* ; Treatment Outcome ; Colonoscopy/methods*

Environmental damage affects many aspects of healthcare, from extreme weather events to evolving population disease. Singapore's healthcare sector has the world's second highest healthcare emissions per capita, hampering the nation's pledge to reduce emissions by 2030 and achieve net zero emissions by 2050. In this review, we provide an overview of the impact environmental damage has on healthcare, including facilities, supply chain and human health, and examine measures to address healthcare's impact on the environment. Utilising the 'R's of sustainability - rethinking, reducing/refusing, reusing/repurposing/reprocessing, repairing, recycling and research - we have summarised the opportunities and challenges across medical disciplines. Awareness and advocacy to adopt strategies at institutional and individual levels is needed to revolutionise our environmental footprint and improve healthcare sustainability. By leveraging evidence from ongoing trials and integrating sustainable practices, our healthcare system can remain resilient against environment-driven challenges and evolving healthcare demands while minimising further impacts of environmental destruction.
Humans ; Climate Change ; Delivery of Health Care ; Singapore ; Conservation of Natural Resources ; Sustainable Development ; Environment