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.

Objective: This study aimed to clarify the details of inpatient cancer rehabilitation interventions provided by designated cancer hospitals in Japan. Methods: This questionnaire-based survey asked specialists regarding the outline of their facilities’ inpatient cancer rehabilitation, Dietz classification, disease, and intervention details. Results: Restorative interventions were the most common, and the most common cancer was lung cancer followed by colorectal cancer; hematologic malignancy; gastric cancer; and liver, gallbladder, and pancreatic cancer. Intervention proportions for colorectal and gastric cancer were significantly higher in general hospitals than in university hospitals and cancer centers; in contrast, those for hematological malignancy were significantly higher in university hospitals than in general hospitals. For bone and soft tissue sarcomas, intervention proportions in cancer centers were significantly higher than those in university and general hospitals; and for oral, pharyngeal, and laryngeal cancers, they were significantly higher in university hospitals and cancer centers than in general hospitals. The most common intervention was walking training, followed by resistance training, basic motor training, activities of daily living training, and respiratory rehabilitation. Respiratory rehabilitation was performed significantly more frequently in university and general hospitals than in cancer centers.Conclusion: The diseases had differed according to the characteristics of the facilities, and the interventions were considered accordingly. In future, it will be necessary to verify the effectiveness of inpatient cancer rehabilitation according to facility characteristics and to disseminate information on inpatient cancer rehabilitation.

Objective: To clarify the profile of cognitive dysfunction and the effects of intensive exercise in spinocerebellar degeneration (SCD). Methods: We enrolled 60 healthy controls and 16 patients with purely cerebellar type SCD without gait disturbance or organic changes other than cerebellar changes. To assess cognitive function, we evaluated the participants using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Montreal Cognitive Assessment-Japanese (MoCA-J) at admission and after intensive exercise. Results: Compared to the controls, SCD patients showed significant cognitive decline. As a result of intensive exercise, significant improvements in motor and cognitive functions were observed: the MMSE score improved from 27.7±1.9 to 29.0±1.3 points (p<0.001); the FAB score improved from 14.8±2.2 to 15.8±2.0 points (p=0.002); and the MoCA-J score improved from 24.6±2.2 to 26.7±1.9 points (p<0.001). For sub-scores, significant improvements were noted in serial 7, lexical fluency, motor series, and delayed recall. Conclusion Our study indicates that intensive exercise can be effective not only for motor dysfunction but also for cognitive dysfunction (Clinical Trial Registration No. UMIN-CTR: UMIN000040079).

  Background: Aging affects thermoregulation and can potentially cause cardiovascular changes during bathing in the elderly, possibly leading to accidents and, in worst cases, drowning. However, adequate data on this subject are lacking. Therefore, the purpose of this study was to clarify the effect of aging on thermoregulatory and cardiovascular changes during bathing in the older versus younger adults the relationship between body temperature and thermoregulatory and cardiovascular changes.   Methods: Ten young (mean age: 20.4 years) and 10 elderly (mean age: 69.7 years) participants were asked to bathe for 15 min using water at 41°C. Tympanic temperature (Tty), skin blood flow (SkBF), sweating rate (SR), blood pressure, heart rate (HR), and double product (DP) were measured. In addition, we measured subjective psychological changes during bathing. Results: The results showed significant changes in SkBF, SR, and HR in the young participants rather than in the elderly participants. However, in the elderly participants, significant change was noted in systolic blood pressure (SBP).   Conclusion: These results demonstrate changes in thermal adaptation and SBP owing to structural and functional progression due to aging.

  Background: Aging affects thermoregulation and can potentially cause cardiovascular changes during bathing in the elderly, possibly leading to accidents and, in worst cases, drowning. However, adequate data on this subject are lacking. Therefore, the purpose of this study was to clarify the effect of aging on thermoregulatory and cardiovascular changes during bathing in the older versus younger adults the relationship between body temperature and thermoregulatory and cardiovascular changes.   　Methods: Ten young (mean age: 20.4 years) and 10 elderly (mean age: 69.7 years) participants were asked to bathe for 15 min using water at 41°C. Tympanic temperature (Tty), skin blood flow (SkBF), sweating rate (SR), blood pressure, heart rate (HR), and double product (DP) were measured. In addition, we measured subjective psychological changes during bathing. Results: The results showed significant changes in SkBF, SR, and HR in the young participants rather than in the elderly participants. However, in the elderly participants, significant change was noted in systolic blood pressure (SBP).   　Conclusion: These results demonstrate changes in thermal adaptation and SBP owing to structural and functional progression due to aging.

  Background: This study aimed to clarify the effects of bathing on cardiovascular and psychological responses during winter and summer, focusing on three different time points (immediately after entering the bathtub, during bathing, and immediately after leaving the bathtub).   Methods: Ten young (29.6 ± 1.5 years) individuals were asked to bathe for 20 min with 40℃ hot water in summer and with 42℃ hot water in winter. The room temperature and humidity in winter were 20.1℃ and 56.7%, while those in summer were 27.0℃ and 58.3%, respectively. Tympanic temperature (Tty) was measured using a thermistor thermometer; systolic blood pressure (SBP) and diastolic blood pressures (DBP) and heart rate (HR) were measured using an auto-sphygmomanometer, and double product (DP) was calculated using the value of HR multiplied by SBP value. Subjective thermal and comfortable sensations were evaluated using a seven-point rating scale.   Results: Results showed a significant increases in SBP values in both seasons immediately after bathing. In winter, DP increased significantly after bathing. Meanwhile, no significant differences were observed in all parameters immediately after bathing between winter and summer. On the contraly, significant differences were observed in Tty, HR, and DP value between winter and summer during bathing. HR and DP values in winter were significantly lower than those in summer immediately after leaving the bathtub. A relationship between thermal sensation and comfortable sensation was observed in both seasons, but the strength of the relationship was more relevant in summer than in winter.   Conclusion: The effects of bathing in 42℃ hot water on the cardiovascular system in winter are greater than those in 40℃ hot water in summer. The high temperature of the bath water may not produce as much discomfort during winter than that during summer, therefore bathing time may be longer.

  A person regulates body temperature by outside and inside heat from change of environmental temperature. One of the inside heats includes drinking water. However, the effect of drinking water temperature on body temperature is not clear. The purpose of this study was to examine how water temperature influences the change in body temperature. The study participant were 13 men (average age, 21.3 ± 0.8 years), and they drank water at 3°C, room temperature, and 60°C; in addition, one more task was not to drink water. We measured tympanic temperature using a thermometer, skin blood flow using a laser Doppler flow meter, and sweating rate using the capsule ventilation method. The mean skin temperature was measured at seven body points with a thermistor and calculated. Tympanic temperature of drinking water at 3°C and 60°C was significantly in comparison with other conditions. As for skin blood flow between water temperature at 60°C and 3°C, sweating rate between water temperature at 60°Cand other conditions, and mean skin temperature between water temperature at 3°C and other conditions significant differences were recognized. It is thought that the response to early change to drinking water at different temperatures is by responses of thermo-receptors and subsequently by the thermal energy of the drinking water.

We report the case of a 46-year-old Chinese male patient who visited our clinic complaining of infertility. Semen analysis revealed azoospermia, and azoospermia factor c region partial deletion (b1/b3) was detected using Y chromosome microdeletion analysis. Testicular sperm extraction was performed after genetic counseling. The bilateral ductus deferens and a portion of the epididymis were absent, whereas the remaining epididymis was expanded. Motile intratesticular spermatozoa were successfully extracted from the seminiferous tubule. On histopathology, nearly complete spermatogenesis was confirmed in almost every seminiferous tubule. To our knowledge, this is the first case report of b1/b3 deletion with a congenital bilateral absence of the vas deferens and almost normal spermatogenesis.
Asian Continental Ancestry Group ; Azoospermia ; Epididymis ; Genetic Counseling ; Humans ; Infertility ; Infertility, Male ; Male ; Middle Aged ; Semen Analysis ; Seminiferous Tubules ; Spermatogenesis* ; Spermatozoa ; Vas Deferens* ; Y Chromosome*

Onco-testicular sperm extraction is used to preserve fertility in patients with bilateral testicular tumors and azoospermia. We report the case of a testicular tumor in the solitary testis of a patient who had previously undergone successful contralateral orchiectomy and whose sperm was preserved by onco-testicular sperm extraction. A 35-year-old patient presented with swelling of his right scrotum that had lasted for 1 month. His medical history included a contralateral orchiectomy during childhood. Ultrasonography revealed a mosaic echoic area in his scrotum, suggesting a testicular tumor. The lesion was palpated within the normal testicular tissue along its edge and semen analysis showed azoospermia. Radical inguinal orchiectomy and onco-testicular sperm extraction were performed simultaneously. Motile spermatozoa were extracted from normal seminiferous tubules under microscopy and were frozen. Eventual intracytoplasmic sperm injection using the frozen spermatozoa is planned. Onco-testicular sperm extraction is an important fertility preservation method in patients with bilateral testicular tumors or a history of a previous contralateral orchiectomy.
Adult ; Azoospermia* ; Fertility ; Fertility Preservation ; Humans ; Infertility, Male ; Male ; Methods ; Microscopy ; Orchiectomy ; Scrotum ; Semen Analysis ; Seminiferous Tubules ; Sperm Injections, Intracytoplasmic ; Sperm Retrieval ; Spermatozoa* ; Testicular Neoplasms* ; Testis* ; Ultrasonography

BACKGROUND/AIMS: Recent research has highlighted the importance of interactions between commensal fungi and intestinal inflammation. However, there are few studies investigating whether commensal fungi contribute to inflammation in patients with Crohn's disease (CD). The aim of this study is to investigate reveal interactions between commensal fungi and host immune cells in CD. METHODS: CD14-positive monocytes were isolated from peripheral blood mononuclear cells from healthy human volunteers and then differentiated in the presence of macrophage colony-stimulating factor (M-CSF) (referred to as M-macrophages, M-Mϕs) or M-CSF and interferon-γ (IFN-γ) (referred to as M-gamma macrophages, Mγ-Mϕs). Cytokine production by these in vitro differentiated macrophages in response to β-(1,3)-glucan was analyzed by flow cytometry. Expression of Dectin-1 was examined using flow cytometry, western blotting, and quantitative reverse transcription-polymerase chain reaction. Cytokine production by in vitro differentiated macrophages in response to β-(1,3)-glucan was measured in the presence of an anti-Dectin-1 receptor antagonist, anti-Syr, or an anti-Fas-1 antibody. Cytokine production by lamina propria mononuclear cells (LPMCs) derived from CD patients in response to β-(1,3)-glucan was also analyzed. RESULTS: Mγ-Mϕs produced a large amount of tumor necrosis factor-α (TNF-α) and interleukin-6 in response to β-(1,3)-glucan. Dectin-1 expression was significantly higher in Mγ-Mϕs than in M-Mϕs. The increase in TNF-α production by Mγ-Mϕs stimulated with glucan was reversed by blocking Dectin-1, Syr or Fas-1. LPMCs derived from CD patients stimulated with β-(1,3)-glucan produced significantly higher amount of TNF-α than LPMCs derived from UC patients. CONCLUSIONS: These results suggest that commensal fungal microbiota may contribute to the pathogenesis of CD by inducing macrophages-derived pro-inflammatory cytokines.
Blotting, Western ; Candida albicans* ; Candida* ; Crohn Disease* ; Cytokines* ; Flow Cytometry ; Fungi ; Healthy Volunteers ; Humans ; In Vitro Techniques ; Inflammation ; Interleukin-6 ; Macrophage Colony-Stimulating Factor ; Macrophages* ; Microbiota ; Monocytes ; Mucous Membrane* ; Necrosis ; Tumor Necrosis Factor-alpha