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.

Postmastectomy nipple necrosis is a factor that leads to a poor aesthetic outcome in breast reconstruction because of the unique projective structure of the nipple. We present a case of successful nipple reconstruction using a de-epithelialized rectangular flap. A 45-year-old woman was diagnosed with left breast cancer. She had a vertical scar below the nipple-areolar complex due to previous reduction mammoplasty. She underwent nipple-sparing mastectomy, breast reconstruction with a deep inferior epigastric artery perforator (DIEP) flap, and contralateral reduction. After the operation, the nipple gradually necrotized, and full-thickness nipple necrosis was observed on postoperative day 12. For nipple reconstruction, we designed a 38×23 mm rectangular flap from the DIEP flap considering the contralateral nipple diameter (12 mm), protrusion (2 mm), and ipsilateral mastectomy skin flap thickness (15 mm). The area in contact with the mastectomy skin flap was placed in the defect area after de-epithelialization. The reconstruction was successful and the nipple survived with a slight loss of projection. When unexpected nipple necrosis occurs after DIEP-based breast reconstruction, designing a de-epithelialized rectangular flap using the DIEP flap tissue is a feasible reconstructive method to consider.

Cranial implant removal is recommended if implants become exposed owing to scalp necrosis after cranioplasty. However, it carries the risk of extensive bleeding, and the resultant cranial defects can cause both aesthetic and functional problems. We present a case of a scalp defect exposing a cranial prosthetic implant that was reconstructed with a local flap and salvaged using an indwelling antibiotic irrigation system. A 73-year-old man presented with scalp necrosis after undergoing cranioplasty due to intracranial hemorrhage. The cranial implant was exposed through the scalp defect. Methicillin-resistant Staphylococcus aureus was detected in the culture from the open wound. After debridement of the necrotic tissue and burring of the superficial layer of the implant, a transposition flap was used to cover the defect and an indwelling antibiotic irrigation system was installed. Continuous irrigation with vancomycin was conducted for 5 days, and intravenous vancomycin was continued for 4 weeks. The flap was in good condition at 4 months postoperatively, with no infection. The convex contour of the scalp was well maintained. The patient’s neurological status was stable. Exposed cranial implants can be salvaged with continuous antibiotic irrigation as an alternative to implant removal; thus, the risk of bleeding and possible disfigurement may be avoided.

Osteoporosis and its associated fragility fractures are becoming a severe burden in the healthcare system globally. In the Asian-Pacific (AP) region, the rapidly increasing in aging population is the main reason accounting for the burden. Moreover, the paucity of quality care for osteoporosis continues to be an ongoing challenge. The Fracture Liaison Service (FLS) is a program promoted by International Osteoporosis Foundation (IOF) with a goal to improve quality of postfracture care and prevention of secondary fractures. In this review article, we would like to introduce the Taiwan FLS network. The first 2 programs were initiated in 2014 at the National Taiwan University Hospital and its affiliated Bei-Hu branch. Since then, the Taiwan FLS program has continued to grow exponentially. Through FLS workshops promoted by the Taiwanese Osteoporosis Association (TOA), program mentors have been able to share their valuable knowledge and clinical experience in order to promote establishments of additional programs. With 22 FLS sites including 11 successfully accredited on the best practice map, Taiwan remains as one of the highest FLS coverage countries in the AP region, and was also granted the IOF Best Secondary Fracture Prevention Promotion award in 2017. Despite challenges faced by the TOA, we strive to promote more FLS sites in Taiwan with a main goal of ameliorating further health burden in managing osteoporotic patients.
Aging ; Awards and Prizes ; Delivery of Health Care ; Education ; Financing, Organized ; Humans ; Mentors ; Osteoporosis ; Practice Guidelines as Topic ; Taiwan

OBJECTIVE: We examined the difference in responses to donepezil between carriers and non-carriers of the A allele at the +4 position of the choline acetyltransferase (ChAT) gene in Koreans. METHODS: Patients who met the criteria for probable Alzheimer's disease (AD) (n=199) were recruited. Among these, 145 completed the 12-week follow-up evaluation and 135 completed the 26-week scheduled course. Differences and changes in the Korean version of the mini-mental state examination (MMSE-KC) score, Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery (CERAD-K[N]) wordlist subtest score (WSS), CERAD-K(N) total score (TS), and the Korean version of geriatric depression scale (GDS-K) score between baseline and 12 weeks or 26 weeks were assessed by the Student's t-test. RESULTS: At 12 weeks, the changes in the MMSE-KC score, CERAD-K(N) WSS, and CERAD-K(N) TS from baseline were not significant between ChAT A allele carriers and non-carriers; however, at 26 weeks, these changes were significantly larger in ChAT A allele carriers than in non-carriers (p=0.02 for MMSE-KC and p=0.03 for CERAD-K(N) WSS respectively). CONCLUSION: Our findings in this study suggested that presence of the A allele at the +4 position of ChAT might positively influence the treatment effect of donepezil in the early stages of AD in Koreans.
Alleles ; Alzheimer Disease* ; Choline O-Acetyltransferase* ; Choline* ; Depression ; Follow-Up Studies ; Genotype* ; Humans ; Polymorphism, Single Nucleotide

PURPOSE: We sought to evaluate the clinical usefulness of decision making by a multidisciplinary heart team for identifying potential candidates for transcatheter aortic valve implantation (TAVI) in patients with symptomatic severe aortic stenosis. MATERIALS AND METHODS: The multidisciplinary team consisted of two interventional cardiologists, two cardiovascular surgeons, one cardiac imaging specialist, and two cardiac anesthesiologists. RESULTS: Out of 60 patients who were screened as potential TAVI candidates, 31 patients were initially recommended as appropriate for TAVI, and 20 of these 31 eventually underwent TAVI. Twenty-two patients underwent surgical aortic valve replacement (AVR), and 17 patients received only medical treatment. Patients who underwent TAVI and medical therapy were older than those who underwent surgical AVR (p<0.001). The logistic Euroscore was significantly highest in the TAVI group and lowest in the surgical AVR group (p=0.012). Most patients in the TAVI group (90%) and the surgical AVR group (91%) had severe cardiac symptoms, but only 47% in the medical therapy group had severe symptoms. The cumulative percentages of survival without re-hospitalization or all-cause death at 6 months for the surgical AVR, TAVI, and medical therapy groups were 84%, 75%, and 28%, respectively (p=0.007, by log-rank). CONCLUSION: TAVI was recommended in half of the potential candidates following a multidisciplinary team approach and was eventually performed in one-third of these patients. One-third of the patients who were initially considered potential candidates received surgical AVR with favorable clinical outcomes.
Aged, 80 and over ; Aortic Valve Stenosis/*surgery ; Decision Making ; Female ; Humans ; Male ; *Patient Care Team ; Postoperative Complications/epidemiology ; Risk Factors ; Severity of Illness Index ; *Transcatheter Aortic Valve Replacement ; Treatment Outcome

OBJECTIVE: To compare perioperative outcome of robot-assisted radical hysterectomy with abdominal radical hysterectomy for early-stage cervical cancer and endometrial cancer and to evaluate the feasibility of robotic-assisted radical hysterectomy. METHODS: We reviewed medical record of 37 patients who had radical hysterectomy at Hallym university for cervical cancer stage Ia1 to IIa and endometrial cancer stage Ia to Ib. Abdominal radical hysterectomy was carried out in 27 (Abdominal group) patients and robot-assisted radical hysterectomy carried out in 10 patients (Robotic group). We compared patient's characteristics between two groups. Perioperative characteristics compared included cancer stage, operative time, number of nodes, estimated blood loss, length of hospital stay and complications. RESULTS: There were no differences in age, parity, history of medical disease, body mass index between two groups (p>0.05). Robotic operative times were significantly longer than for abdominal (480.0+/-117.8 vs. 286.9+/-65.6 min, p<0.0001). Blood loss (660.0+/-245.9 vs. 1,137.0+/-608.4 mL. p<0.0001) and length of hospital stay (7.2 versus 17.1 days, p<0.0001) were significantly lower for the robotic group. Lymph node yield in the robotic group was equivalent to that for the abdominal group (30.1+/-8.7 vs. 35.4+/-16.9, p=0.356). No major operative complications occurred with both groups. CONCLUSION: Robot-assisted radical hysterectomy appears safe and feasible in early-stage cervical and endometrial cancer.
Body Mass Index ; Endometrial Neoplasms ; Female ; Humans ; Hysterectomy ; Length of Stay ; Lymph Nodes ; Medical Records ; Operative Time ; Parity ; Uterine Cervical Neoplasms

Although paraovarian cysts rarely cause symptoms, they may be complicated due to massive size, torsion or internal hemorrhage from rupture. Moreover, benign or malignant neoplasms may occasionally develop in paraovarian cysts. We present a case of a 73-year-old patient who suffered from a twisted large left paraovarian cyst. The patient visited emergency room with a chief complaint of acute abdominal pain. The patient was treated with good result by laparoscopic surgery. The maximum diameter of the mass was 10cm which was twisted 3 1/2 times clockwise. In conclusion, paraovarian cysts, even in elderly patients, can reach large sizes requiring awareness of the possible complications caused by large cyst which could be treated successfully by laparoscopy.
Abdominal Pain ; Aged ; Emergencies ; Hemorrhage ; Humans ; Laparoscopy ; Rupture

Aged ; Aged, 80 and over ; Esophagus ; pathology ; virology ; Herpes Simplex ; diagnosis ; genetics ; pathology ; Humans ; In Situ Hybridization ; Male ; Middle Aged ; Simplexvirus ; genetics

Anti-M is detected at room temperature and is often found in the sera of people who have never been exposed to human red cells. In a few cases, anti-M can be detected at 37 degrees C or at the antiglobulin phase, and these antibodies can cause hemolytic diseases in newborn or hemolytic transfusion reactions. Some examples of anti-M demonstrate stronger agglutination at low pH (pH 6.5), and when they react with the red blood cells of the MM type (dosage effect). An unexpected antibody test was carried out for the routine screening of donated blood and two cases that reacted to all panel cells at 5 degrees C were found, which indicated anti-M. We repeated the unexpected antibody identification test at pH 6.5 and confirmed the presence of anti-M. The reduction of the test system pH is a useful and simple method for detecting some cases of anti-M.
Agglutination ; Antibodies ; Blood Group Incompatibility ; Erythrocytes ; Humans ; Hydrogen-Ion Concentration* ; Infant, Newborn ; Mass Screening