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.

This study aims to investigate the ameliorating effect of Corni Fructus(CF) on the myocardial ischemic injury and the pharmacokinetic properties of characteristic components of CF. The mouse model of isoproterenol-induced myocardial ischemia was established and administrated with the aqueous extract of CF. The general efficacy of CF in ameliorating the myocardial ischemic injury was evaluated based on the cardiac histopathology and the levels of myocardial injury markers: creatine kinase isoenzyme(CK-MB) and cardiac troponin I(cTn-I). The metabolomics analysis was carried out for the heart and serum samples of mice to screen the biomarkers of CF in ameliorating the myocardial ischemic injury and then the predicted biomarkers were submitted to metabolic pathway enrichment. The pharmacokinetic analysis was performed for morroniside, loganin, and cornuside Ⅰ in mouse heart and serum samples to obtain the pharmacokinetic parameters of these components. The pharmacokinetic parameters were then integrated on the basis of self-defined weighting coefficients to simulate an integrated pharmacokinetic profile of CF iridoid glycosides in the heart and serum of the mouse model of myocardial ischemia. The results indicated that CF reduced the pathological damage to cardiac cells and tissue(hematoxylin-eosin staining) and lowered the levels of CK-MB and cTn-I in the serum of the mouse model of myocardial ischemia(P<0.01). Metabolomics analysis screed out 31 endogenous metabolites in the heart and 35 in the serum as biomarkers of CF in ameliorating the myocardial ischemic injury. These biomarkers were altered by modeling and restored by CF. Six metabolic pathways in the heart and 5 in the serum were enriched based on these metabolic markers. The main integrated pharmacokinetic parameters of CF iridoid glycosides were T_(max)=1 h, t_(1/2)=(1.52±0.05) h in the heart and T_(max)=1 h, t_(1/2)=(1.56±0.50) h in the serum. Both concentration-time curves showed a double-peak phenomenon. In conclusion, CF demonstrated the cardioprotective effect by regulating metabolic pathways such as taurine and hypotaurine metabolism, and pantothenic acid and coenzyme A biosynthesis. The integrated pharmacokinetics reflect the general pharmacokinetic properties of characteristic components in CF.
Animals ; Cornus/chemistry* ; Mice ; Metabolomics ; Drugs, Chinese Herbal/administration & dosage* ; Male ; Myocardial Ischemia/metabolism* ; Humans ; Troponin I/metabolism* ; Myocardium/pathology* ; Disease Models, Animal ; Biomarkers/metabolism* ; Creatine Kinase, MB Form/metabolism*

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

OBJECTIVE: Exposure to polycyclic aromatic hydrocarbons (PAHs) or metal(loid)s individually has been associated with neural tube defects (NTDs). However, the impacts of PAH and metal(loid) co-exposure and potential interaction effects on NTD risk remain unclear. We conducted a case-control study in China among population with a high prevalence of NTDs to investigate the combined effects of PAH and metal(loid) exposures on the risk of NTD. METHODS: Cases included 80 women who gave birth to offspring with NTDs, whereas controls were 50 women who delivered infants with no congenital malformations. We analyzed the levels of placental PAHs using gas chromatography and mass spectrometry, PAH-DNA adducts with ³²P-post-labeling method, and metal(loid)s with an inductively coupled plasma mass spectrometer. Unconditional logistic regression was employed to estimate the associations between individual exposures and NTDs. Least absolute shrinkage and selection operator (LASSO) penalized regression models were used to select a subset of exposures, while additive interaction models were used to identify interaction effects. RESULTS: In the single-exposure models, we found that eight PAHs, PAH-DNA adducts, and 28 metal(loid)s were associated with NTDs. Pyrene, selenium, molybdenum, cadmium, uranium, and rubidium were selected through LASSO regression and were statistically associated with NTDs in the multiple-exposure models. Women with high levels of pyrene and molybdenum or pyrene and selenium exhibited significantly increased risk of having offspring with NTDs, indicating that these combinations may have synergistic effects on the risk of NTDs. CONCLUSION Our findings suggest that individual PAHs and metal(loid)s, as well as their interactions, may be associated with the risk of NTDs, which warrants further investigation.
Humans ; Neural Tube Defects/chemically induced* ; Polycyclic Aromatic Hydrocarbons/adverse effects* ; Female ; Case-Control Studies ; China/epidemiology* ; Adult ; Pregnancy ; Environmental Pollutants ; Maternal Exposure/adverse effects* ; Metals/toxicity* ; Young Adult ; Risk Factors

OBJECTIVE: This study aimed to investigate the prevalence of HIV pretreatment drug resistance (PDR) and the transmission clusters associated with PDR-related mutations in newly diagnosed, treatment-naive patients between 2020 and 2023 in Dehong prefecture, Yunnan province, China. METHODS: Demographic information and plasma samples were collected from study participants. PDR was assessed using the Stanford HIV Drug Resistance Database. The Tamura-Nei 93 model within HIV-TRACE was employed to compute pairwise matches with a genetic distance of 0.015 substitutions per site. RESULTS: Among 948 treatment-naive individuals with eligible sequences, 36 HIV subtypes were identified, with unique recombinant forms (URFs) being the most prevalent (18.8%, 178/948). The overall prevalence of PDR was 12.4% (118/948), and resistance to non-nucleotide reverse transcriptase inhibitors (NNRTIs), nucleotide reverse transcriptase inhibitors (NRTIs), and protease inhibitors (PIs) was 10.7%, 1.3%, and 1.6%, respectively. A total of 91 clusters were identified, among which eight showed evidence of PDR strain transmission. The largest PDR-associated cluster consisted of six CRF01_AE drug-resistant strains carrying K103N and V179T mutations; five of these individuals had initial CD4+ cell counts < 200 cells/μL. CONCLUSION The distribution of HIV subtypes in Dehong is diverse and complex. PDR was moderately prevalent (12.4%) between 2020 and 2023. Evidence of transmission of CRF01_AE strains carrying K103N and V179T mutations was found. Routine surveillance of PDR and the strengthening of control measures are essential to limit the spread of drug-resistance HIV strains.
Humans ; HIV Infections/virology* ; China/epidemiology* ; Drug Resistance, Viral ; Male ; Adult ; Female ; Middle Aged ; HIV-1/genetics* ; Anti-HIV Agents/therapeutic use* ; Myanmar/epidemiology* ; Young Adult ; Prevalence ; Adolescent ; Mutation

The National Institute for Health and Care Excellence(NICE)first updated its 2013 Health Technology Evaluations Guidelines in 2022,followed by further minor adjustments in 2023.This round of updates primarily focuses on five key areas:mea-suring the value of health technologies,understanding and improving the evidence base,structured decision-making,addressing challenging diseases and technologies,and ensuring consistency in methods across evaluation and review projects.It outlines the up-date process and major changes,providing an analysis of these key points with the aim of offering valuable insights and methodologi-cal references for health technology assessment in China.

Objective:To investigate GPRC5D expression on myeloma cells in newly diagnosed multiple myeloma (NDMM) patients and evaluate its prognostic significance.Methods:This study retrospectively analyzed the clinical data of 65 patients with NDMM treated at the Affiliated Hospital of Xuzhou Medical University from April 2023 to April 2024. The expression of GPRC5D on the surface of myeloma cells in all patients was detected with flow cytometry before induction therapy, and patients were stratified into high and low GPRC5D expression groups based on the median GPRC5D positivity rate. Clinical characteristics, immune status, treatment response after induction therapy, and prognosis were compared between the two groups.Results:The median positive rate of GPRC5D in the plasma cells of 65 patients with NDMM was 32.68%. Based on this threshold, patients were categorized into the high (33 cases, GPRC5D positive rate ≥ 32.68%) and low (32 cases, GPRC5D positive rate <32.68%) GPRC5D expression groups. Compared with the low GPRC5D expression group, the high GPRC5D expression group demonstrated a higher proportion of 1q21 gain (78.8% vs 43.8%, P=0.004), a higher incidence of immunoparesis involving ≥2 uninvolved immunoglobulins (87.9% vs 62.5%, P=0.018), and severe immunoparesis (59.4% vs 33.3%, P=0.046). Further, CD16 +CD56 + cell levels were lower in the high GPRC5D expression group [ (16.60±8.70) % vs (27.78±15.78) %, P=0.005]. No significant difference was observed in the overall response rate between the high and low GPRC5D expression groups (78.8% vs 93.8%, P=0.165). However, the high GPRC5D expression group exhibited a significantly lower rate of achieving very good partial remission or better (42.4% vs 78.2%, P=0.003) and a lower MRD negativity rate (30.0% vs 68.8%, P=0.002). Compared with the low GPRC5D expression group, patients with high expression demonstrated a significantly shorter median progression-free survival (11.2 months vs not reached, P=0.002), whereas the median overall survival was not reached in either group, with no statistically significant difference ( P=0.069) . Conclusions:The GPRC5D positivity rate in the plasma cells of patients with NDMM is associated with 1q21 gain and immune status. High GPRC5D expression at diagnosis may predict poor response to induction therapy and an unfavorable prognosis.

Objective:To understand the current status of health management cognition and healthcare behaviors of community residents in Shanghai, and to analyze their related influencing factors, in order to promote the optimization of proactive health-oriented health management strategies.Methods:This study was a cross-sectional survey. From February to May 2023, 1-4 community health service centers were randomly selected from each administrative district in Shanghai by stratified random sampling using the random number table method. Ultimately, 28 community health service centers were selected as research sites. The research team then used convenience sampling method to select at least 50 patients as research subjects from those visiting each selected center. A total of 1 436 community residents were included in this study in the form of on-site completion of questionnaire stars, and the study covered the residents′ level of health management cognition, chronic disease management, intention to seek medical care, physical examination behavior, and handling of abnormal values. Multiple regression analysis was used to assess the correlation between health management cognition and medical consultation behavior and their influencing factors.Results:The results of the health management awareness survey showed that 827 residents (57.6%) had a relatively high level of awareness. Among the 755 residents (52.6%) with chronic diseases, the proportion of self-assessed stable control was significantly higher in the high-cognition group (318 (76.0%)) than that in the low-cognition group (223 (66.2%)), and the difference was statistically significant ( χ2=9.01, P=0.003). Multiple regression analysis showed that females ( OR=1.293, 95% CI: 1.028-1.627),≤44 years old and 45-59 years old ( OR=2.328, 95% CI: 1.648-2.328; OR=1.351, 95% CI: 1.035-1.763), bachelor′s degree or above ( OR=1.784, 95% CI: 1.256-2.534), living in suburban area ( OR=1.577, 95% CI: 1.235-2.014), use of employee health insurance and resident health insurance ( OR=2.294, 95% CI: 1.629-3.232; OR=1.628, 95% CI: 1.149-2.306), suffering from a chronic disease ( OR=3.110, 95% CI: 1.918-5.042), and having a contracted family doctor ( OR=1.870, 95% CI: 1.431-2.442) were all positive correlation with health management perception(all P<0.05). In terms of health care behavior, 908 (63.2%) residents showed a high active intention to seek medical care, and 906 (63.1%) and 796 (55.4%) residents showed active participation in medical check-ups and timely handling of medical check-up abnormal values, respectively. Residents in the high awareness group were significantly better than those in the low awareness group in terms of intention to seek medical care ( χ2=33.26), mode of medical checkups ( χ2=110.71), frequency of medical checkups ( χ2=45.37), and the way of dealing with abnormal values after medical checkups ( χ2=93.14), with the difference being statistically significant(all P<0.05). The results of linear regression analysis of the factors influencing the medical behavior of community residents showed that age≤44 and 45-59 ( B=0.479, 0.167), high school and specialist versus bachelor′s degree and above ( B=0.465, 0.739), use of employee medical insurance and residents′ health insurance ( B=0.604, 0.420), the number of current chronic diseases 1 ( B=0.919) and contracted family doctor ( B=0.134) of community residents′ health care behaviors are better (all P<0.05). Conclusions:The level of community residents′ health management cognition needs to be improved, and high health management cognition can significantly promote proactive healthcare-seeking behavior. However, residents′ medical behavior is still influenced by multidimensional factors. Signing a contract with a family doctor is significantly associated with high cognition and quality healthcare behaviors.

Aim To investigate the protective effects of resveratrol(RSV)on hypoxia/reoxygenation(H/R)-induced apoptosis in H9c2 cardiomyocytes and the un-derlying mechanisms.Methods A model of H/R was established in H9c2 cardiomyocytes.Cell apoptosis was determined by flow cytometry.The expressions of Bax,Bcl-2,cleaved caspase-3 and JAK2/STAT3 signa-ling pathway proteins were detected by Western blot.The inhibitor of JAK2,AG490,was used to assess the effect of RSV on H/R-induced apoptosis in H9c2 car-diomyocytes after inhibiting JAK2/STAT3 signaling pathway.Results RSV could effectively inhibit H/R-provoked cell apoptosis in H9c2 cardiomyocytes and increase the expression of p-JAK2 and p-STAT3.After AG490 intervention,the anti-apoptotic effect of RSV on H9c2 cardiomyocytes caused by H/R was significantly counteracted.Conclusions RSV can inhibit H/R-in-duced apoptosis in H9c2 cardiomyocytes through the activation of JAK2/STAT3 signaling pathway.

Objective To investigate the nutritional status of tumor patients in yuncheng region and to identify the factors influencing nutritional literacy. Methods Among the 486 patients with malignant digestive system tumors who attended our hospital from February 2021 to January 2024 were selected. The general data were collected in all patients. All patients were assessed using nutritional risk screening 2002, Patient-Generated Subjective Global Assessment (PG-SGA) and Self-made Nutrition Literacy Scale. Then the prevalence of malnutrition was recorded, and factors affecting the nutritional literacy in patients with malignant digestive system tumors were screened using Logistic regression analysis. Results A total of 486 patients, The number of patients with nutritional risks reached 49.59% (241/486) and 185 (38.07%) developed malnutrition, of which the incidence of moderate malnutrition was 26.13 % (127/486) and the incidence of severe malnutrition was 11.93% (58/486). The mean nutritional literacy score of all patients was (49.22±7.67) and only 87 patients (17.90%) had a score of ≥60. Logistic regression analysis denoted that gender (OR=1.531, 95%CI: 1.146-1.876), age (OR=1.483, 95%CI: 1.061-1.724), educational background (OR=1.788, 95%CI: 1.247-2.334), marital status (OR=1.925, 95%CI: 1.436-2.846), place of residence (OR=2.102, 95%CI: 1.520-3.282), monthly income (OR=1.863, 95%CI: 1.386-2.622), and social support score (OR=1.972, 95%CI: 1.395-2.743) were all influencing factors of nutritional literacy level in patients with malignant digestive system tumors (P<0.05). Conclusion Patients with malignant digestive system tumors are at high risk of malnutrition, and their level of nutrient literacy needs to be improved. Targeted measures can be carried out based on these characteristics to improve the nutritional quality of patients.