Background: We investigated osteoporosis management strategies and clinical outcomes following the occurrence of medicationrelated osteonecrosis of the jaw (MRONJ). Methods: We retrospectively studied individuals diagnosed with MRONJ during osteoporosis treatment who were managed in the Osteoporosis Center or the Oral Maxillofacial Surgery & Dental Unit at Queen Mary Hospital in Hong Kong between 2010 and 2022. We examined subsequent osteoporosis management plans, fracture events, and bone mineral density (BMD). Results: Thirty-six individuals were included (mean age, 78.5 years; 94.4% women). The estimated prevalence of MRONJ was 0.26%. All patients had been exposed to bisphosphonates, and seven had also received denosumab before MRONJ. Following MRONJ, only 14 individuals continued anti-osteoporosis treatment, a decision influenced by a higher fracture probability at MRONJ onset. The most common regimen was a teriparatide-raloxifene sequence (n=8): three patients achieved stable BMD, four achieved improving BMD, and one exhibited a mixed response. The patient with a mixed BMD response had also been treated with denosumab. Six patients sustained incident fractures after MRONJ, and these patients had lower BMD T-scores than their counterparts. Two patients experienced MRONJ recurrence, which was associated with the resumption of bisphosphonate or denosumab therapy after MRONJ. These patients had higher BMD T-scores than those who did not experience MRONJ recurrence. Conclusion MRONJ is challenging because high fracture risk necessitates discontinuation of antiresorptive agents. Teriparatide followed by raloxifene may be a reasonable regimen. Individualised decisions in osteoporosis management after MRONJ are required to balance fracture risk reduction with minimising MRONJ recurrence.

Objective To compare the efficacy of TightRope loop plate and Endobutton plate in the treatment of acromioclavicular joint dislocation.Methods A retrospective analysis was conducted on 94 patients with acromioclavicular joint dislocation who were treated at this center from March 2021 to February 2023.They were divided into two groups based on different admission date.The Group E(n =47)received Endobutton plate treatment between March 2021 and February 2022,while the Group T(n =47)received TightRope loop plate treatment between March 2022 and February 2023.At the last follow-up,the perioperative indicators,Visual Analogue Scale(VAS),Constant-Murley shoulder joint function scores,and surgical complications were compared between the two groups.Results The surgical time,intraoperative bleeding,incision length,and VAS scores at 7 days after surgery in the Group T were shorter or lower than those in the Group E(P<0.05).There were no statistical differences in the incidence of perioperative nerve injury,internal fixation displacement,clavicle fracture,vascular injury,and infection between the two groups(P>0.05).The subjective and objective scores of Constant-Murley shoulder joint function in both groups at9 months after surgery showed significant improvement compared to preoperative scores(all P =0.000).There was no significant difference in the subjective and objective scores of Constant-Murley shoulder joint function between the two groups at 9 months after surgery(P>0.05).Conclusions The treatment of acromioclavicular joint dislocation with TightRope loop plate ot or Endobutton plate has a significant effect and can effectively improve shoulder joint function.Compared with Endobutton plate,use of TightRope loop plate has minor surgical trauma,less bleeding,and significantly reduced postoperative pain,being more conducive to early functional exercise for patients.

Introduction: We examined the causative diseases of patients presenting with a chief complaint of fever.Methods: The patients were new patients visiting the Department of General Medicine at the University of Tsukuba Hospital between April 2018 and March 2020. The chief complaints were obtained from the patients' medical records, categorized according to the International Classification of Primary Care Second Edition. Patients with fever (A03) as the chief complaint were enrolled and their diagnoses were investigated.Results: Of 610 eligible patients, 85 had fever as the chief complaint. Causative diseases were infectious disease in 31 patients (36%), noninfectious inflammatory diseases in nine patients (11%), malignancy in three patients (3%), others in 14 patients (16%), unknown in 19 patients (22%), and exhibiting no pathologic conditions in nine patients (11%). Specific diagnoses were viral infection for the infectious disease patients, collagen diseases for the noninfectious inflammatory disease patients, hematologic diseases for the malignancy patients, and drug-related issues for others.Conclusion: The most common cause of fever was infectious diseases. Some patients were concerned about disease even when their temperatures were in the physiologic range.

To introduce early palliative care to patients, we have proactively used a palliative care screening tool to identify needs. We have emphasized not doing work in a routine manner, rather seeking to improve by continuous reevaluations. Because of a lack of feedback regarding changes in screening scores and actionable solutions derived from it, we executed a retrospective study about the effectiveness of our palliative care team and the identification of problems. All 91 cases studied meaningfully ameliorated their focused symptoms. However, we could not verify our team’s effectiveness because the backgrounds of patients who were eligible but not involved with our team differed significantly. The current study suggested that some patients missed opportunities to receive palliative care. We need to strengthen the system used with our patients as a safety-net so as not to overlook care opportunities by utilizing more effective screening methodology.

Objective: Most airway prediction tools only consider anatomical factors. The HEAVEN criteria incorporate both anatomical and physiological elements, but have never been studied in the emergency department. This study aimed to evaluate the association between HEAVEN criteria and intubation difficulty. Methods: We conducted a prospective cross-sectional study from April 1, 2020 to January 31, 2021 in the emergency department of a tertiary public hospital. All patients requiring rapid-sequence or delayed-sequence intubation were included. Patients intubated during cardiopulmonary resuscitation were excluded. We enrolled 174 patients. Study endpoints were first pass success and intubation complications. Results: The presence of any HEAVEN criteria was associated with a decrease in the first pass success rate (odds ratio [OR], 0.10; 95% confidence interval [CI], 0.02–0.43; P < 0.01). The anatomical challenge was the only criterion associated with first pass sucess (OR, 0.13; 95% CI, 0.05– 0.29; P < 0.01), whilst other criteria (hypoxemia, extremes of size, vomit/blood/fluid, exsanguination, and neck mobility) were not (P > 0.05). All anatomical factor criteria were associated with difficult airway view (P < 0.05). Intubation complications occurred more in the presence of hypoxemia (OR, 7.44; 95% CI, 2.82–19.63; P < 0.01) and vomit/blood/fluid (OR, 5.55; 95% CI, 2.39–12.92; P < 0.01). Conclusion Anatomical challenge in HEAVEN criteria can predict first pass success. All anatomical factors in HEAVEN criteria could predict difficult airway view and peri-intubation hypoxemia could be used to anticipate intubation complications. More validation studies are still needed to evaluate the use of HEAVEN criteria as a predictor tool for difficult airway.

Purpose: This study aimed to evaluate the role of gallium-67 single photon emission computed tomography (SPECT) with contrast computed tomography (CT) in the evaluation and monitoring of infected abdominal aortic aneurysms (IAAA). Materials and Methods: A retrospective cohort analysis was performed using prospectively collected data of consecutive patients with IAAA in Princess Margaret Hospital in Hong Kong between January 2010 and December 2020. The patients were identified using the Radiology Information System. Results: All five patients had proven IAAA on CT and/or metabolic imaging.Among them, three were further supported by positive blood culture results. Gallium-67 SPECT with contrast CT was useful in the detection of residual disease, monitoring, and detection of recurrence. Conclusion Gallium-67 SPECT with contrast CT is helpful for evaluating IAAA.It serves an important role in guiding management, especially during long-term follow-up.

Purpose: This study aimed to evaluate the role of gallium-67 single photon emission computed tomography (SPECT) with contrast computed tomography (CT) in the evaluation and monitoring of infected abdominal aortic aneurysms (IAAA). Materials and Methods: A retrospective cohort analysis was performed using prospectively collected data of consecutive patients with IAAA in Princess Margaret Hospital in Hong Kong between January 2010 and December 2020. The patients were identified using the Radiology Information System. Results: All five patients had proven IAAA on CT and/or metabolic imaging.Among them, three were further supported by positive blood culture results. Gallium-67 SPECT with contrast CT was useful in the detection of residual disease, monitoring, and detection of recurrence. Conclusion Gallium-67 SPECT with contrast CT is helpful for evaluating IAAA.It serves an important role in guiding management, especially during long-term follow-up.

There are increasing reports of methanol poisoning (MP) incidence worldwide. In Malaysia, the largest first methanol poisoning was reported in Selangor in 2013 with a total of 41 patients and cluster of cases been reported from the country since then. Often MP involved adulterated alcohol containing more than the legal permissible concentration of methanol. Methanol is rapidly absorbed and metabolised into formic acid which causes variable symptoms of the central nervous system such as blindness, seizure, coma and gastrointestinal disturbances. Mortality could reach up to 83% as reported using the coma state, pH and pCO2 level in the worst-case scenario.

Objective: To explore the method and result of repairing segmental ear defect with postauricular skin flap according to different region. Methods: 25 partial ear defects were divided into 5 regions.The cases with defect in 1 and 2nd regions were treated by postauricular flap combined with ipsilateral conchal cartilage graft in one stage; Cases in the 3rd regions were repaired with the posterior pedicled flap combined with conchal or rib cartilage graft in two stages; According to the defect in 4th region, post-auricular skin flap was transplanted anteriorly to repair; The temporal fascial flap and skin graft were used for the 3 cases with post-operative cartilage exposure. Results: All flaps survived with good shape except one case with partial epidermal necrosis and 3 cases deep color after the temporal fascial flap and skin graft. 9 cases that needed second operation. Conclusions The postauricular flap is a preferred alternative method in case periauricular skin is in fact, which yields closer tissue match, color, and texture. It is safe and effective for the correction of segmental ear defect with satisfied shape. The temporal fascial flap can be regarded as the last alternatives.