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 evaluates the impact of the coronavirus disease 2019 (COVID-19) pandemic on emergency medical service (EMS) responses and out-of-hospital cardiac arrest (OHCA) outcomes. Methods: This is a retrospective comparison study analyzing the OHCA data of a university medical center in Seoul during the COVID-19 pandemic period (January 2020-January 2021) and non-pandemic period (January 2019-January 2020). The EMS response time and OHCA outcomes were compared between both periods. Based on the weekly mean number of confirmed cases and their EMS response time, patients were classified into six groups and OHCA outcomes were compared. Results: This study evaluated 309 OHCA patients (non-pandemic period of 146, pandemic period of 163). Significant delays in the EMS response and transport time were observed during the pandemic period. However, no significant differences were obtained in the rate of return of spontaneous circulation (ROSC) and survival at discharge (12.4% in pandemic vs. 13.8% in non-pandemic; P=0.722). According to the weekly mean COVID-19 incidence when patients were over 100, there was a significant increase in the EMS response and transport time, whereas ROSC and survival rate were dramatically decreased. Conclusion During the pandemic, the EMS service for OHCA patients was worse than before, with delayed and reduced survival for OHCA patients. We further determined that an increase in the number of COVID-19 cases (especially when weekly mean numbers were over 100) dramatically delayed the EMS response time. This resulted in a very low survival rate of OHCA patients.

Objective: Acute renal infarction is a rare and easily misdiagnosed disease. Scarce research has been conducted on the predictive factors and prognosis of acute renal infarction due to its rarity. In this study, we analyzed the clinical and laboratory findings of a patient diagnosed with renal infarction to predict clinical outcomes. Methods: In this retrospective clinical study, we collected and analyzed the medical records data of 61 acute renal infarction patients diagnosed in the emergency department (ED) of Konkuk University Hospital, Seoul, South Korea from January 2007 to December 2020. Results: Lactate dehydrogenase (LDH; 93.3%, 28 of 30 patients) and D-dimer (77.8%, 28 of 36 patients) levels of the acute renal infarction patients were higher than the normal. Proteinuria was found in 26 of 47 patients. The only significant prognostic factor for the occurrence of acute kidney injury (AKI) in acute renal infarction is the ratio of the infarction volume to the total renal volume. Age, occurrence of AKI, and proteinuria were correlated with the progression of chronic kidney disease (CKD). Conclusion The ratio of the infarction volume to the total renal correlated with occurance of AKI. Age, AKI, and proteinuria were correlated with the progression of CKD.

Objective: In the coronavirus disease 2019 pandemic, virus transmission via exposal to arrest victims infected can be a huge risk to rescuers during cardiopulmonary resuscitation (CPR). We hypothesized that using a mechanical chest compression device can reduce the rescuer’s exposure to cardiac arrest patients during CPR. Methods: This is a retrospective clinical study that compared CPRs using a mechanical chest compression device (mCPR) with CPRs with manual chest compression (c-CPR). All CPR data were obtained by analyzing recorded video clips and the medical charts. The primary outcome was the number of rescuers who participated in CPR. In addition, the length of time rescuers’ staying around the arrested victim and some procedure time were evaluated. Results: There was no significant difference in baseline data of CPR between the m-CPR (n=28) and c-CPR (n=25) groups. The m-CPR group showed a significantly reduced mean number of rescuers (4.4±0.5 vs. 5.5±0.5) and mean total time of rescuer’s staying (2,609.9±315.4 seconds vs. 3,286.0±329.9 seconds) comparing with the c-CPR group (P<0.05). The m-CPR group showed a delay in the first rhythm analysis compared with the c-CPR group (40.0 seconds [30.0-57.5] vs. 27.0 seconds [25.0-43.5]) Conclusion The usage of a mechanical compression device can reduce the number of rescuers and the length of time staying around the victim. However, a delay in rhythm analysis can occur in the m-CPR group.

Objective: This study aimed to evaluate the effectiveness of video laryngoscopy (VL; Glidescope) compared to direct laryngoscopy (DL) when performing endotracheal intubation (ETI) in trauma patients with cervical spine immobilization. Methods: This was a retrospective clinical study. A total of 98 trauma patients with cervical spine immobilization were included. These patients underwent intubation using VL and DL from 2009 to 2014 in the emergency department. All data were collected through electronic medical records. The primary outcome was the first-attempt intubation success rate of ETI. Secondary outcomes were complications of ETI, including esophageal intubation and tooth injuries. We compared the outcomes of the two devices. Results: VL showed higher first-attempt ETI success rates compared to DL (94.0% vs. 74.5%, P=0.011). There were no statistically significant differences in the ETI complication rates between VL and DL such as esophageal intubation (2.0% vs. 4.3%, P=0.610) and tooth injuries (6.0% vs. 10.6%, P=0.478). The multivariate analysis showed that VL was an independent factor for predicting higher first-attempt intubation success with an odds ratio of 4.538 (95% confidence interval, 1.084-18.988; P=0.038) Conclusion For patients with cervical spine immobilization, VL could provide a higher first-attempt ETI success rate compared to DL in a real clinical setting.

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis. Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

Background and Objectives: The clinical implications of the BRAF V600E mutation in papillary thyroid microcarcinoma (PTMC), defined as ≤1.0 cm of tumor size, remain controversial. We investigated the association between the BRAFV600E mutation and PTMC recurrence in a retrospective cohort of patients with thyroid cancer. Materials and Methods: This study included 2319 patients with PTMC (median age, 50 years [interquartile range (IQR), 41-57 years]) who underwent thyroid surgery from 2010 to 2019 at a single tertiary medical center. The median follow-up time was 75 months (IQR, 30-98 months). Tumor recurrence was confirmed by histological, cytological, radiographic, and biochemical criteria, combined with persistent and recurrent disease. Results: A total of 60.2% (1395/2319) patients with PTMC had the BRAF V600E mutation. The tumor recurrence rate was 2.1% (19/924) in BRAF mutation-negative patients and 2.9% (41/1395) in BRAF mutation-positive patients, with a hazard ratio (HR) of 1.05 (95% confidence interval [CI], 0.61-1.84) after adjusting for clinicopathological risk factors. Similar results were found in patients with high-risk PTMC (adjusted HR, 1.09; 95% CI, 0.56-2.11) who had lymph node metastasis (LNM), extrathyroidal extension (ETE), or distant metastasis (DM) at diagnosis and in patients with low-risk PTMC (adjusted HR, 1.00; 95% CI, 0.35-2.83) who had no LNM, ETE, or DM. Conclusion The finding that the BRAF V600E mutation was not associated with tumor recurrence in our cohort of Korean patients with PTMC, especially in patients with low-risk PTMC, suggests that its value in the prediction of disease progression is limited.

Purpose: The aim of this study was to determine the survival benefit based on different treatment strategies in patients with small, solitary, recurring intrahepatic hepatocellular carcinomas (HCCs) that were defined as recurred Barcelona Clinic Liver Cancer stage O (reBCLC-O). Methods: Among the 917 patients with HCC recurrence after primary hepatic resection, 394 patients with reBCLC-O were selected. Of these, 150 patients underwent curative treatment (re-resection, radiofrequency ablation, and liver transplantation) and 203 underwent transarterial chemoembolization (TACE) group for recurrent HCC. After propensity score matching (PSM), both the groups were well balanced (89 patients in each group). Results: Before PSM, the 1-, 3-, and 5-year overall survival (OS) rates of patients in the curative treatment group (96.7%, 78.6%, and 70.5%, respectively) were significantly better than those in the TACE treatment group (95.6%, 53.7%, and 44.2%, respectively) (P < 0.001). After PSM, the 1-, 3-, and 5-year OS rates also differed significantly (92.0%, 79.6%, and 71.1% in the curative treatment group vs. 88.8%, 65.6%, and 57.9% in the TACE group) (P = 0.005). The independent predictors of worse OS were tumor number at the time of resection and treatment modality for the recurrence, time interval to recurrence, and prothrombin time international normalized ratio and alpha-fetoprotein levels at the time of recurrence. Conclusion The OS of patients in the curative treatment group was better than that in the non-curative treatment group after PSM. Based on our results, curative treatment should be strongly recommended in the patients with reBCLC-O recurrence for better survival.

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

Purpose: The aim of this study was to determine the survival benefit based on different treatment strategies in patients with small, solitary, recurring intrahepatic hepatocellular carcinomas (HCCs) that were defined as recurred Barcelona Clinic Liver Cancer stage O (reBCLC-O). Methods: Among the 917 patients with HCC recurrence after primary hepatic resection, 394 patients with reBCLC-O were selected. Of these, 150 patients underwent curative treatment (re-resection, radiofrequency ablation, and liver transplantation) and 203 underwent transarterial chemoembolization (TACE) group for recurrent HCC. After propensity score matching (PSM), both the groups were well balanced (89 patients in each group). Results: Before PSM, the 1-, 3-, and 5-year overall survival (OS) rates of patients in the curative treatment group (96.7%, 78.6%, and 70.5%, respectively) were significantly better than those in the TACE treatment group (95.6%, 53.7%, and 44.2%, respectively) (P < 0.001). After PSM, the 1-, 3-, and 5-year OS rates also differed significantly (92.0%, 79.6%, and 71.1% in the curative treatment group vs. 88.8%, 65.6%, and 57.9% in the TACE group) (P = 0.005). The independent predictors of worse OS were tumor number at the time of resection and treatment modality for the recurrence, time interval to recurrence, and prothrombin time international normalized ratio and alpha-fetoprotein levels at the time of recurrence. Conclusion The OS of patients in the curative treatment group was better than that in the non-curative treatment group after PSM. Based on our results, curative treatment should be strongly recommended in the patients with reBCLC-O recurrence for better survival.