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 compare the effects of eccentric cycling (ECC), concentric cycling (CON), and standard care (CTL) on cardiopulmonary capacity, respiratory health, and quality of life (QoL) in patients with chronic kidney disease (CKD). Methods: Thirty-one CKD patients were divided into the CTL, CON, and ECC groups. The CON and ECC groups participated in 8-week, 24-session cycling programs. Outcomes were assessed through cardiopulmonary exercise tests, respiratory function tests, and the 36-Item Short Form Survey Instrument questionnaire. Results: The ECC group achieved significant improvements in maximal oxygen uptake, while the CTL group showed a decline. For oxygen uptake efficiency slope, significant changes were observed only in the ECC group, with a group-by-time interaction effect compared to CTL. Furthermore, the ECC group demonstrated the most significant increase in diaphragm movement and a significant increase in diaphragm thickness, with comparisons indicating that ECC outperformed both CTL and CON. Regarding QoL, the ECC group exhibited significantly greater improvements in Physical Component Summary and Mental Component Summary, with statistically significant differences compared with the CTL and CON groups. Conclusion ECC is a low-effort, high-benefit exercise modality that significantly enhances cardiopulmonary fitness, respiratory function, and QoL in patients with CKD.

Sleep is essential for organisms.Sleep disorders,such as insomnia,sleep fragmenta-tion,and sleep deprivation,deeply impact the physical activity and mental health of humans.The signifi-cant role of sleep in brain function has been well accepted in recent years.This article aims to summarize the research related to sleep disorders,sleep-wake control,the relationships between sleep and atten-tion,and the potential underlying mechanisms.Current interventions are also outlined in the hope of providing insights into sleep and cognitive function.

Objective·To analyze the molecular epidemiological characteristics of Klebsiella pneumoniae isolated from children,including the distribution of serotypes,resistance genes,and virulence genes,to provide a scientific basis for the prevention and treatment strategies of Klebsiella pneumoniae infections in children.Methods·A total of 133 non-duplicate strains of Klebsiella pneumoniae clinically isolated from Shanghai Children's Hospital,Shanghai Jiao Tong University School of Medicine,from April 2023 to April 2024,were collected.Antimicrobial susceptibility testing was performed by using the Vitek-2 Compact system.Capsular polysaccharide K antigen serotypes(K types)were determined by wzy-dependent initiator(wzi)gene sequencing.Resistance genes were detected by the colloidal gold method.Virulence genes and lipopolysaccharide O antigen serotypes(O types)were identified by PCR method.Results·Among the 133 strains of Klebsiella pneumoniae,a total of 50 strains of carbapenem-resistant Klebsiella pneumoniae(CRKP)were detected,mainly distributed in the neonatal ward and intensive care unit(ICU).CRKP exhibited high resistance to most antimicrobial agents,and the main type of carbapenemase gene was blaNDM(34/50,68.00%),followed by co-carriage of blaNDM+blaOXA-48(10/50,20.00%)and blaKPC(6/50,12.00%).Serotype analysis revealed that the 50 CRKP strains could be divided into 8 K types and 6 O types.The most common K type was KL17(30/50,60.00%),followed by KL105(10/50,20.00%)and KL47(5/50,10.00%).The most common O type was O4(30/50,60.00%),followed by O3b(7/50,14.00%,),O3/O3a(6/50,12.00%),and OL101(5/50,10.00%).Significant correlations were identified between KL47 and OL101 serotypes(KL47:OL101),between KL17 and O4 serotypes(KL17:O4),and between KL1/KL2 and O1 serotypes(KL1/KL2:O1).Conclusion·The CRKP strains infecting children primarily carry blaNDM-type carbapenemase genes,showing a significant difference compared to CRKP-infected adults.The detection rate of CRKP in the neonatal ward is significantly higher than those in other departments,suggesting that infection prevention and control measures in this ward need to be strengthened.

Objective·To analyze the molecular epidemiological characteristics of Klebsiella pneumoniae isolated from children,including the distribution of serotypes,resistance genes,and virulence genes,to provide a scientific basis for the prevention and treatment strategies of Klebsiella pneumoniae infections in children.Methods·A total of 133 non-duplicate strains of Klebsiella pneumoniae clinically isolated from Shanghai Children's Hospital,Shanghai Jiao Tong University School of Medicine,from April 2023 to April 2024,were collected.Antimicrobial susceptibility testing was performed by using the Vitek-2 Compact system.Capsular polysaccharide K antigen serotypes(K types)were determined by wzy-dependent initiator(wzi)gene sequencing.Resistance genes were detected by the colloidal gold method.Virulence genes and lipopolysaccharide O antigen serotypes(O types)were identified by PCR method.Results·Among the 133 strains of Klebsiella pneumoniae,a total of 50 strains of carbapenem-resistant Klebsiella pneumoniae(CRKP)were detected,mainly distributed in the neonatal ward and intensive care unit(ICU).CRKP exhibited high resistance to most antimicrobial agents,and the main type of carbapenemase gene was blaNDM(34/50,68.00%),followed by co-carriage of blaNDM+blaOXA-48(10/50,20.00%)and blaKPC(6/50,12.00%).Serotype analysis revealed that the 50 CRKP strains could be divided into 8 K types and 6 O types.The most common K type was KL17(30/50,60.00%),followed by KL105(10/50,20.00%)and KL47(5/50,10.00%).The most common O type was O4(30/50,60.00%),followed by O3b(7/50,14.00%,),O3/O3a(6/50,12.00%),and OL101(5/50,10.00%).Significant correlations were identified between KL47 and OL101 serotypes(KL47:OL101),between KL17 and O4 serotypes(KL17:O4),and between KL1/KL2 and O1 serotypes(KL1/KL2:O1).Conclusion·The CRKP strains infecting children primarily carry blaNDM-type carbapenemase genes,showing a significant difference compared to CRKP-infected adults.The detection rate of CRKP in the neonatal ward is significantly higher than those in other departments,suggesting that infection prevention and control measures in this ward need to be strengthened.

Objective:To investigate the relationship among seminal oxidation-reduction potential(nORP),sperm DNA frag-mentation(DFI)and semen parameters in patients with varicocele.Methods:Clinical data of 522 patients treated in the reproduc-tive andrology clinic of the Northern Theater General Hospital from November 2023 to December 2023 were retrospectively analyzed,in-cluding 435 men of childbearing age and 87 men of infertile age.The patients were divided into the varicocele group(n=116)and non-varicocele group(n=406)according to clinical diagnosis.The differences of seminal plasma nORP,DFI,sperm high DNA stain ability(HDS)and semen parameters were analyzed between the two groups.The relationship among general clinical data,seminal plasma nORP,semen parameters,DFI and HDS in patients with varicocele were further analyzed.According to the severity of varico-cele,the patients were divided into three groups,including mild,moderate and severe.And the differences of seminal plasma nORP and semen parameters,DFI and HDS among all groups were analyzed.The differences of seminal plasma nORP,semen parameters,DFI and HDS were compared between the varicocele and non-varicocele groups.Results:The total sperm count,sperm concentra-tion,progressive motility sperm percentage(PR％)and normal sperm morphology rate(NSMR)in patients with varicocele were sig-nificantly lower than those in control group(P＜0.05).And seminal plasma nORP,DFI and HDS in patients with varicocele were sig-nificantly higher than those in control group(P＜0.05).Seminal plasma nORP in patients with varicocele was significantly negatively correlated with total sperm,sperm concentration and NSMR(P＜0.05),and significantly positively correlated with DFI and HDS(P＜0.05).There were significant differences in nORP,total sperm count,sperm concentration,PR％,DFI and HDS among mild,moderate and severe varicocele groups(P＜0.05).Seminal plasma nORP,sperm concentration,PR％and DFI in severe group were significantly lower than those in mild and moderate groups(P＜0.05).Sperm count and HDS in severe group were significantly lower than those in mild group(P＜0.05).In infertile patients,seminal plasma nORP,DFI and HDS in varicocele group were significantly higher than those in control group(P＜0.05).And PR％in varicocele group was significantly lower than that in control group(P＜0.05).Conclusions:Seminal plasma nORP in patients with varicocele may be an important marker of oxidative stress affecting DFI and semen parameters.

Background and Aims:Abdominal aortic aneurysm(AAA)is a common arterial dilation disease in vascular surgery,with aneurysm rupture being its most serious complication,often leading to fatal hemorrhage and posing a severe threat to patients'lives.Endovascular aneurysm repair(EVAR),due to its minimally invasive nature,safety,and rapid recovery,has become the preferred treatment for AAA.However,endoleak,a complication unique to EVAR,remains a major clinical challenge.Persistent endoleak can lead to sustained high pressure within the aneurysm sac,increasing the risk of continued expansion and rupture.It is one of the main causes of the high reintervention rate following EVAR.In particular,the treatment strategy for type Ⅱ endoleaks remains controversial.This study was conducted to evaluate the clinical value of selective sac embolization via the iliac approach combined with standard EVAR in managing intraoperative immediate endoleaks.Methods:The clinical data of AAA patients with a risk of endoleak who underwent standard EVAR at the First Hospital of China Medical University between March 2023 and September 2024 were retrospectively collected.Patients were divided into an intervention group(n=42)and a non-intervention group(n=32)based on whether selective sac embolization via the iliac approach was performed during operation.General clinical data,preoperative anatomical characteristics of the AAA,surgical details,and postoperative follow-up results were compared between the two groups.Results:There were no statistically significant differences between the two groups in terms of age,sex,anatomical features,rupture rate,or off-label use(all P>0.05).The technical success rate during surgery was 100%in both groups.One patient in the intervention group experienced transient sigmoid colon ischemia after operation,which resolved with conservative treatment.The mean follow-up period was(6.49±4.68)months.The proportions of aneurysm sac shrinkage,stability,and enlargement in the intervention group were 40.5%,57.1%,and 2.4%,respectively,compared to 59.4%,40.6%,and 0.0%in the non-intervention group,with no statistically significant differences(all P>0.05).The incidence of endoleak during follow-up was also comparable between the two groups(P>0.05).Conclusion:For intraoperative endoleaks during standard EVAR,selective sac embolization via the iliac approach is a technically simple and safe method that provides short-term outcomes comparable to those in patients without intraoperative endoleaks.Its long-term efficacy warrants further investigation through extended follow-up.

Background: Delivering a poor prognosis to patients and their families is critically challenging in pediatric populations. The application of palliative care (PC) provides a bridge between accepting the occurrence of mortality and offering lifelong support.However, little is known about the specifics of PC. This study aims to explore the unmet need for PC in pediatric populations. Methods: We retrospectively reviewed the medical records of mortality cases in the Department of Pediatric Hematology and Oncology at Chang Gung Memorial Hospital. Statistical tests, including Chi-square and Student’s t-tests, were applied to determine the differences between early and late intervention groups in terms of the timing of PC introduction. Results: During the study period, 41 patients were included. Their median age was 11.8 years (IQR, 7.6-15.9). The majority of the disease statuses were refractory or relapsing (R/R). The incidence of memento application was significantly higher in the early intervention group (47.6% vs. 10%, P=0.0081). Vital signs variations tended to be end-of-life (EoL) indicators in this study. Conclusion The early introduction of PC encourages families to accompany their beloved child. EoL signs in the pediatric population include vital sign variations. With the presence of relevant EoL signs, clinical physicians can apply PC earlier to meet the needs.

Background: The association of changes in metabolic syndrome (MetS) with cognitive function remains unclear. We explored this association using prospective and Mendelian randomization (MR) studies. Methods: MetS components including high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SBP), waist circumference (WC), fasting plasma glucose (FPG), and triglycerides were measured at baseline and two follow-ups, constructing a MetS index. Immediate, delayed memory recall, and cognitive function along with its dimensions were assessed by immediate 10- word recall test (IWRT) and delayed 10-word recall test (DWRT), and mini-mental state examination (MMSE), respectively, at baseline and follow-ups. Linear mixed-effect model was used. Additionally, the genome-wide association study (GWAS) of MetS was conducted and one-sample MR was performed to assess the causality between MetS and cognitive function. Results: Elevated MetS index was associated with decreasing annual change rates (decrease) in DWRT and MMSE scores, and with decreases in attention, calculation and recall dimensions. HDL-C was positively associated with an increase in DWRT scores, while SBP and FPG were negatively associated. HDL-C showed a positive association, whereas WC was negatively associated with increases in MMSE scores, including attention, calculation and recall dimensions. Interaction analysis indicated that the association of MetS index on cognitive decline was predominantly observed in low family income group. The GWAS of MetS identified some genetic variants. MR results showed a non-significant causality between MetS and decrease in DWRT, IWRT, nor MMSE scores. Conclusion Our study indicated a significant association of MetS and its components with declines in memory and cognitive function, especially in delayed memory recall.