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  1. Efroymson D, Velasco MG
    Citation: Efroymson D, Velasco MG. Tobacco Use in Southeast Asia: Key Evidences for Policy Development. Bangkok, Thailand: Southeast Asia Tobacco Control Alliance; 2007

    TABLE OF CONTENTS
    Acknowledgement 3
    Introduction to SEATCA Research on Tobacco 4
    Tobacco and Poverty: Lessons from Cambodia and Vietnam 6
    Demand Analysis and Tobacco Taxes in Vietnam and Malaysia 9
    ASEAN Free Trade Area and Tobacco: A Regional Summary 12
    Health Costs of Tobacco 14
    Socio-demographic and Psychological Trends of Youth Smoking 17
    Knowledge, Attitudes, and Practice: Tobacco Use among Health Professionals, Medical Students and Monks 20
    Analysis of Smoking Behavior in Cambodia 23
    Women and Tobacco: Smoke_]free Homes in Cambodia, Malaysia and Vietnam 26
    Women and Tobacco: Reasons for Use, and Prevention Strategies in Cambodia, Malaysia and Thailand 29
    Matched MeSH terms: Asia
  2. Jia Ying S, Ian C, Azlanudin A, Zamri Z, Hairol O
    MyJurnal
    Hypervirulent Klebsiella pneumoniae strain is a major cause of liver abscess and this bacteria has metastatic properties. This distinct liver abscess syndrome has been increasingly reported in Asia over the past two decades, but is emerging as a global disease. We described an 81-year-old lady, who presented to the emergency department with 1-week prior duration of fever and right eye swelling. She had been admitted for recurrent liver abscess prior to this. Hence, she was initially treated as sepsis secondary to recurrent liver abscess. Meanwhile, she was managed concurrently by ophthalmology team for endophtalmitis. Despite the initiation of treatment with antibiotics, she did not show any improvement and required right eye evisceration to treat the sepsis. Invasive liver abscess syndrome with metastatic endophthalmitis should be screened in patient with Klebsiella liver abscess. They should be monitored for ocular symptoms as early recognition can prohibit delays in treatment, which has debilitating consequences.
    Matched MeSH terms: Asia
  3. Kong KH, Zubaid A., Alias Bin Kamis
    Cynopterus brachyotis, a fruit, leaf and nectar eating bat is a common frugivorous bat in Southeast Asia. In the present study, changes in the reproductive hormones of these bats were measured. Bats were captured and blood samples were taken monthly for seven months (January to July 1997) in the surrounding areas of Universiti Kebangsaan Malaysia (UKM) campus in Bangi. The concentration of the reproductive hormones in the blood, such as testosterone (male) and progesterone (female) were measured using ELISA. The results showed that body weight and concentration of reproductive hormones was correlated with the monthly rainfall. Abundance of food during the rainy season was believed to be the important factor in influencing body weight gain and increase in reproductive hormone synthesis.
    Cynopterus brachyotis merupakan kelawar frugivor pemakan buah-buahan, daun dan nektar yang lazim di Asia Tenggara. Matlamat penyelidikan ini ialah untuk menentukan aras hormon yang dirembeskan oleh gonad kelawar frugivor ini, Kelawar-kelawar ini telah ditangkap dan diambil sampel darah pada setiap bulan selama tujuh bulan (Januari hingga Julai 1997) di sekitar kampus Universiti Kebangsaan Malaysia (UKM) di Bangi. Aras hormon pembiakan, iaitu testosteron pada kelawar jantan dan progesteron pada betina ditentukan dengan menggunakan kaedah ELISA. Hasil kajian menunjukkan bahawa berat badan dan aras hormon pembiakan berkait rapat dengan jumlah taburan hujan bulanan. Kelimpahan sumber makanan pada masa taburan hujan yang tinggi dipercayai merangsang pertambahan berat badan dan sintesis hormon pembiakan pada kelawar ini.
    Matched MeSH terms: Asia
  4. Rus Dina Rus Din, Shahrul Hisham Zainal Ariffin, Sahidan Senafi, Rohaya Megat Abdul Wahab, Intan Zarina Zainol Abidin
    Sains Malaysiana, 2014;43:1523-1535.
    Ancient remains are considered very valuable artefacts, as they allow for the study of ancient cultures, phylogeny, evolution and the reconstruction of demographic history. To obtain all the information contained within remains, the investigation of such samples requires the expertise and various techniques from multiple fields of study. The present review focuses on the molecular biology and radiographic approaches used to identify ancient samples. Studies of ancient remains face various limitations; for example, the quality and quantity of the ancient samples can affect the difficulty of the investigations. Due to these limitations, new sophisticated techniques are being introduced to replace the earlier conventional techniques. A search was conducted using PubMed, Scopus, Science Direct and Science Finder to provide a new and timely review on the molecular mitochondrial DNA and radiographic analysis for human archaeology identification. The present review has determined that molecular biological approaches are very accurate and useful for the use in the ancestral determination of incomplete specimens, whereas observations of the dental pulp chamber are suitable for age at death estimations in both adults and children. However, these techniques are expensive and require expert personnel. Therefore, conventional approaches remain the favourite methods of most institutions, especially in Asia.
    Matched MeSH terms: Asia
  5. Nenny Noorina Saaid, Reena Rahayu Md Zin, Siti Aishah Md Ali, Sharifah Noor Akmal Syed Hussain, Zulkifli Zainuddin, Zubaidah Zakaria
    Sains Malaysiana, 2014;43:1317-1326.
    The identification of chromosomal aberrations in prostate cancer has been widely studied with several known oncogenes and tumor suppressor genes have successfully been discovered. The most frequent aberrations detected in western population were losses in chromosome 5q, 6q, 8p, 13q, 16q, 17p, 18q and gains of 7p/q and 8q. The purpose of this study was to determine the chromosomal aberrations among Malaysian men of Southeast Asia population and discover those potential genes within that chromosomal aberrant region. Thirty-six formalin-fixed paraffin embedded specimens consist of eight organ-confined prostate cancer cases, five with capsular invasion, 14 showed metastasis and nine cases had no tumor stage recorded, were analyzed by array CGH technique. Chromosomal losses were frequently detected at 4q, 6q, 8p, 13q, 18q while gains at 7q, 11q, 12p, 16q and 17q. Gain of 16q24.3 was statistically significant with tumor size. Gains of 6q25.1 and Xq12 as well as losses of 3p13-p1.2 and 13q33.1-q33.3 were significantly correlated with Gleason grade whereas 12p13.31 gain was associated with bone metastasis. Several potential genes have also been found within that aberrant region which is myopodin (4q26-q27), ROBO1 (3p13-p11.2), ERCC5 (13q33.1-q33.3) and CD9 (12p13.31), suggesting that these genes may play a role in prostate cancer progression. The chromosomal aberrations identified by array CGH analysis could provide important clues to discover potential genes associated with prostate tumorigenesis of Malaysian men.
    Matched MeSH terms: Asia, Southeastern
  6. Tsuji K, Mohd Nor Faizal Ghazalli, Zulhairil Ariffin, Mohd Shukor Nordin, Khaidizar MI, Mohammad Ehsan Dulloo, et al.
    Sains Malaysiana, 2011;40:1407-1412.
    Nipa (Nypa fruticans) is one of the most widely distributed and useful palm in the mangrove forests in the South, Southeast Asia and Oceania. Its distribution area is known to be larger in ancient time than at present, as evidenced by its fossils found in North America, South America, Egypt and Europe. Nipa has a wide diversity of use. Traditionally it is used as roof materials, cigarette wrapper, medicine and its sap is fermented to alcohol. Recently, research on nipa has focused on its potential use as a biofuel crop because it has several advantages compared with other biofuel-alcohol crops. For example it has high alcohol content, no competition with other crop for agricultural land and no bagasse disposal problem. In spite of such usefulness, scientific reports on biology of nipa are limited. Information on genetic diversity, cytogenetics and chemical composition are lacking for nipa plant. On the other hand, morphological characters of nipa have been described in many reports. This paper attempted to provide a general review of the nipa plant based on available literatures.
    Matched MeSH terms: Asia, Southeastern
  7. Kidokoro T, Suzuki K, Naito H, Balasekaran G, Song JK, Park SY, et al.
    BMC Public Health, 2019 Dec 27;19(1):1737.
    PMID: 31881869 DOI: 10.1186/s12889-019-8079-0
    BACKGROUND: Moderate-to-vigorous physical activity (MVPA) and television viewing are independently associated with cardiorespiratory fitness. However, limited evidence is available on their combined effects, specifically of MVPA and watching television, on cardiorespiratory fitness in the young Asian population. Therefore, the present study examined whether MVPA can attenuate the detrimental effects of prolonged television viewing on the cardiorespiratory fitness of Asian adolescents.

    METHODS: This is a cross-sectional study on 9553 adolescents (aged 12-15 years) from 8 Asian metropolitan cities (Tokyo, Hong Kong, Shanghai, Taipei, Bangkok, Kuala Lumpur, Seoul, and Singapore). Cardiorespiratory fitness was assessed by using a 15-m progressive aerobic capacity endurance run (PACER) test. The time spent on MVPA and watching television was assessed using the International Physical Activity Questionnaire-Short Form.

    RESULTS: MVPA was more closely associated with the PACER score than the duration of watching television. Compared with the reference group (i.e. those with the lowest levels of MVPA [

    Matched MeSH terms: Asia
  8. Tagami T, Tanaka H, Shin SD, Ma MH, Ko PC, Karim S, et al.
    Acute medicine & surgery, 2019 05 22;7(1):e430.
    PMID: 31988755 DOI: 10.1002/ams2.430
    Aim: As a population ages, it can impact on the characteristics and outcomes of cardiogenic out-of-hospital cardiac arrest (OHCA) patients. This study aimed to evaluate the relationship between the age incidence of cardiogenic OHCA and population aging.

    Methods: This was a post-hoc analysis of the Pan Asian Resuscitation Outcomes Study (PAROS) database. Data on the population old-age dependency ratio (i.e. elderly/non-elderly) were extracted from publicly accessible sources (United Nations and World Health Organization).

    Results: We analyzed 40,872 OHCA cases from seven PAROS countries over the period 2009 to 2013. We found significant correlation between the population old-age dependency ratio and elderly/non-elderly ratio in OHCA patients (r = 0.92, P = 0.003). There was a significant correlation between the population old-age dependency ratio and risk differences of 30-day survival rates for non-elderly and elderly OHCA patients (r = 0.89, P = 0.007).

    Conclusions: Our findings suggest that the proportion of elderly among OHCA patients will increase, and outcomes could increasingly differ between elderly and non-elderly as a society ages progressively. This has implications for planning and delivery of emergency services as a society ages.

    Matched MeSH terms: Asia
  9. Azman NF, Abdullah WZ, Hanafi S, Diana R, Bahar R, Johan MF, et al.
    Ann Hematol, 2020 Apr;99(4):729-735.
    PMID: 32078010 DOI: 10.1007/s00277-020-03927-5
    HbE/Beta thalassemia (HbE/β-thalassemia) is one of the common genetic disorders in South East Asia. It is heterogeneous in its clinical presentation and molecular defects. There are genetic modifiers which have been reported to influence the disease severity of this disorder. The aim of this study was to determine the genetic polymorphisms which were responsible for the disease clinical diversity. A case-control study was conducted among Malay transfusion-dependent HbE/β-thalassemia patients. Patients who were confirmed HbE/β-thalassemia were recruited and genotyping study was performed on these subjects. Ninety-eight patients were selected and divided into moderate and severe groups based on clinical parameters using Sripichai scoring system (based on hemoglobin level, spleen size, growth development, the age of first transfusion and age of disease presentation). Forty-three (44.9%) and 55 (56.1%) patients were found to have moderate and severe clinical presentation, respectively. Genotyping analysis was performed using Affymetrix 6.0 microarray platform. The SNPs were filtered using PLINK and Manhattan plot by R software. From the GWAS results, 20 most significant SNPs were selected based on disease severity when compared between moderate and severe groups. The significant SNPs found in this study were mostly related to thalassemia complications such as rs7372408, associated with KCNMB2-AS1 and SNPs associated with disease severity. These findings could be used as genetic predictors in managing patients with HbE/β-thalassemia and served as platform for future study.
    Matched MeSH terms: Asia, Southeastern
  10. Kabbani S, Al Habeeb W, Liew HB, Mohan JC, Ogola E, Sim D, et al.
    Cardiology, 2019;142 Suppl 1:1-10.
    PMID: 30947179 DOI: 10.1159/000496663
    OBJECTIVES: The management of heart failure (HF) is most effective when established treatment guidelines and recommendations are followed. We aimed to develop a "Toolbox" of resources to facilitate the care of patients with acute HF and chronic HF with reduced ejection fraction delivered by healthcare professionals across Asia-Pacific, the Middle East and Africa (henceforth referred to as the "Region").

    METHODS: We convened a group of cardiologists from across the Region to develop a set of checklists, algorithms, and other practical resources. These resources are based on our experiences, current evidence, and international guidelines.

    RESULTS: The HF Toolbox comprises three simplified sets of resources for use in the Emergency Room (ER), hospital and outpatient settings. Resources include admission and discharge checklists, treatment algorithms, recommendations for forming a multidisciplinary team, patient education, and self-management materials, and key performance indicators to monitor whether standards of care are met or maintained, or should be improved.

    CONCLUSIONS: The HF Toolbox provides practical resources to simplify the management of patients with HF and to support the formation of HF programs in the Region. The Toolbox is aligned with current guideline recommendations and can support the management of patients from presentation in the ER, through hospital admission to outpatient care.

    Matched MeSH terms: Asia
  11. Viswanathan S, Appiwatanakul M, Nayak A, Islam B, Khatri B, Pangeran D, et al.
    Ther Apher Dial, 2019 Jun;23(3):289-297.
    PMID: 30927331 DOI: 10.1111/1744-9987.12806
    In conjunction with the third regional Southeast Asian (SEA) therapeutic plasma exchange (TPE) conference in Kuala Lumpur, Malaysia, 25 clinicians and researchers from SEA and South Asian countries attended the inaugural strategy meeting for the establishment of a regional TPE consortium for neurological disorders. The primary objective was to establish regional collaboration to improve delivery of TPE services in SEA. A pre-meeting survey was conducted to gather insights on disease spectrum, contextual practice challenges, and the need for a regional TPE consensus. Challenges identified include limited healthcare funding in support of diagnostic workup, TPE therapy, as well as development of clinical infrastructure and expertise capacity building. There was favorable interest in developing a working plan contextualized to this region. Strategies to overcome challenges were discussed. This included the need for a comprehensive referral system and network of regional TPE centers suited to local needs, supported by innovative TPE delivery programs.
    Matched MeSH terms: Asia, Southeastern
  12. Jeffrine J. Rovie-Ryan, Millawati Gani, Norsyamimi Rosli, Han Ming Gan, Gilmoore G. Bolongon, Tan Cheng Cheng, et al.
    Sains Malaysiana, 2018;47:2533-2542.
    Slow lorises (Nycticebus) consist of eight species native to Southeast Asia while three species are recognised in
    Malaysia - N. coucang, N. menagensis and N. kayan. This study reports on the rediscovery of the subspecies N. coucang
    insularis Robinson, 1917 in Tioman Island and the genetic assessment of its mitochondrial DNA variation. Morphological
    measurements conform the specimen as the putative N. coucang but with distinct colour and markings. Two mitochondrial
    DNA segments (cytochrome b and control region) were produced from the subspecies representing their first registered
    sequences in GenBank. Genetically, the subspecies showed 99% of nucleotide similarity to N. coucang species type for
    both the DNA segments and constitute its own unique haplotype. Phylogenetic trees constructed using three methods
    (neighbour joining, maximum likelihood and Bayesian inference) showed two major groups within Nycticebus; the
    basal group was formed by N. pygmaeus while the second group consisted of the remaining Nycticebus species. The
    phylogenetic position of the subspecies, however, remains unresolved due to the observed mixing between N. coucang and
    N. bengalensis. Several reasons could lead to this condition including the lack of well documented voucher specimens and
    the short DNA fragments used. In addition, the possibility of hybridisation event between N. coucang and N. bengalensis
    could not be excluded as a possible explanation since both species occur sympatrically at the Isthmus of Kra region
    until the Thailand-Malaysia border. The rediscovery of this subspecies displays the unique faunal diversity that justifies
    the importance of Tioman Island as a protected area.
    Matched MeSH terms: Asia, Southeastern
  13. Binns C, Low WY
    Asia Pac J Public Health, 2019 07;31(5):396-403.
    PMID: 31142125 DOI: 10.1177/1010539519849966
    The publication of information is essential for expanding the benefits of public health throughout the Asia-Pacific region. All academics are familiar with the adage "Publish or perish," but for public health, this should be rewritten as "Publish or the population perishes." Publication and communication in public health continues to undergo rapid change. There are many challenges that a regional journal faces. The number of printed journals is beginning to decline. Digital publishing and extensive databases and search engines have become the only practical way to access data. But the advent of digital publishing has seen the arrival of profit-making entrepreneurs. Whether a Journal is in the printed form or digital, it remains the key communication in public health and ultimately improve the health of the people. The Asia-Pacific Journal of Public Health (APJPH), which is owned by Asia Pacific Academic Consortium for Public Health (APACPH) and published by Sage ensures that your data gets maximum digital exposure in the region where it can make a difference. Over the years, APJPH has increased its impact factor and gained in prestige. Although impact factor of a journal is important in documenting the recognition of work by academics, it does not necessarily reflect importance to our region. There needs to be a re-evaluation of publication and communication strategies so that all citizens of the Asia-Pacific region benefit.
    Matched MeSH terms: Asia
  14. Chin Yi Chan, Norazlina Mohamed, Soelaiman Ima-nirwana, Kok-yong Chin
    Sains Malaysiana, 2018;47:1801-1810.
    The prevalence of osteoporosis is increasing in Asian countries. Optimum calcium intake and vitamin D level are
    important to prevent osteoporosis. The attitude of the society towards calcium food sources and supplements, as well
    as sun exposure, influence their bone health practices. This review aimed to summarize the current literature on the
    attitude of Asians on calcium and vitamin D rich foods and supplements to understand the barriers among the Asians
    in achieving adequate calcium intake and vitamin D level. Studies showed that most Asians have a negative attitude
    towards calcium-rich foods, mainly dairy products due to lactose intolerance, aversion to the taste of dairy products or
    the absence of motivation. Although they took supplements to fill the gap in their diet, they were not aware of the daily
    recommended intake of calcium. Besides, the majority of them have a negative attitude towards sun exposure due to the
    fear of getting skin cancer or tanning. As a conclusion, most of Asians are still not aware of the importance of calcium
    and vitamin D for their health and their negative attitude must be corrected to prevent the rise of osteoporosis.
    Matched MeSH terms: Asia
  15. Krackhardt F, Waliszewski M, Wan Ahmad WA, Kočka V, Toušek P, Janek B, et al.
    PLoS One, 2020;15(1):e0226606.
    PMID: 31929543 DOI: 10.1371/journal.pone.0226606
    BACKGROUND: The objective of this study was to assess regional and ethnic differences in an unselected patient population treated with polymer-free sirolimus-eluting stents (PF-SES) in Asia and Europe.

    METHODS: Two all-comers observational studies based on the same protocol (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were combined for data analysis to assure sufficient statistical power. The primary endpoint was the accumulated target lesion revascularization (TLR) rate at 9-12 months.

    RESULTS: Of the total population of 7243 patients, 44.0% (3186) were recruited in the Mediterranean region and 32.0% (2317) in central Europe. The most prominent Asian region was South Korea (17.6%, 1274) followed by Malaysia (5.7%, 413). Major cardiovascular risk factors varied significantly across regions. The overall rates for accumulated TLR and MACE were low with 2.2% (140/6374) and 4.4% (279/6374), respectively. In ACS patients, there were no differences in terms of MACE, TLR, MI and accumulated mortality between the investigated regions. Moreover, dual antiplatelet therapy (DAPT) regimens were substantially longer in Asian countries even in patients with stable coronary artery disease as compared to those in Europe.

    CONCLUSIONS: PF-SES angioplasty is associated with low clinical event rates in all regions. Further reductions in clinical event rates seem to be associated with longer DAPT regimens.

    Matched MeSH terms: Asia
  16. Zhu X, Chen H, Li S, Wang LC, Wu DR, Wang XM, et al.
    Front Microbiol, 2020;11:778.
    PMID: 32457710 DOI: 10.3389/fmicb.2020.00778
    Melioidosis is a common infectious disease in Southeast Asia and Northern Australia. In Hainan, several cases have been reported, but no systematic study has yet been done on the molecular epidemiology profiles of the organism. An investigation of the molecular epidemiology links and population structure of Burkholderia pseudomallei would help to better understand the clonally of the isolates and differences among them. In this study, multilocus variable-number tandem repeat analysis (MLVA), and multilocus sequence typing (MLST) were applied to examine the epidemiological relatedness and population structure of 166 B. pseudomallei isolates obtained during 2002-2014 in Hainan, China. Both the MLVA_4 and MLST approaches had high discriminatory power for this population, with diversity indices of 0.9899 and 0.9457, respectively. However, the MLVA_4 assay showed a higher discriminatory power than the MLST approach, and a variable-number tandem repeat (VNTR3 933) found by the MLVA approach was the most useful in discriminating strains from this province. A total of 166 strains yielded 99 MLVA_4 genotypes, of which 34 genotypes were shared by 101 isolates, for a clustering rate of 60.8% (101/166), which suggested that some cases may have a common source. Additionally, 65 isolates showed distinct genotypes, indicating that more than 39.2% (65/166) of melioidosis cases in Hainan had epidemiologically unrelated or sporadic characteristics. The 166 isolates were resolved into 48 STs, of which five STs (ST55, -70, -46, -50, and -58) were here found to be predominant. Phylogenetic analysis of 116 isolates conducted using the eBURST v3 segregated the 48 STs into eight groups with ST50 as predicted founder, and 21 STs were found to be singletons, which suggest that the strains in the Hainan region represent a high diversity of ST clones, indicating that many B. pseudomallei clone groups are endemic to this region. Moreover, ST50 had 5 SLV, 7 DLV, 6 TLV, and 29 satellite STs and formed a radial expansion pattern, suggesting that the melioidosis epidemic in this study was mainly caused by the clonal expansion of ST 50. Phylogenetic analysis on global scale suggests that China's isolates are closely related to isolates from Southeast Asia, particularly from Thailand and Malaysia.
    Matched MeSH terms: Asia, Southeastern
  17. Binns C, Lee MK, Yun Low W, Baker P, Bulgiba A, Dahlui M, et al.
    Asia Pac J Public Health, 2020 05;32(4):179-187.
    PMID: 32475150 DOI: 10.1177/1010539520931328
    Good nutrition in the first "1000 days," including breastfeeding and appropriate complementary foods, prepares for a healthy childhood and adult life, also contributes to the prevention of the double burden of malnutrition. Exclusive breastfeeding provides all required nutrients until an infant is around 6 months of age when complementary foods are needed. A literature review was undertaken of complementary foods in the Asia Pacific region. The foods being used at present are often of low nutrient density may provide insufficient amounts of some critical nutrients, and generally the variety is limited. Guidelines for complementary feeding are provided to assist in education and in public health planning.
    Matched MeSH terms: Asia
  18. Han X, Young BE, Gill MJ, Hamilton H, Vergara SG
    Data Brief, 2020 Aug;31:105705.
    PMID: 32490077 DOI: 10.1016/j.dib.2020.105705
    The data presented in this article are related to the research article entitled "Progress on National Biodiversity Indicator Reporting and Prospects for Filling Indicator Gaps in Southeast Asia " (Han et al., 2020). We examined quantifiable information about biodiversity indicators from the most recent two national reports (i.e., 4th in 2010 and 5th in 2015) to the United Nation's Convention on Biological Diversity (CBD) by the 10-member countries of the Association of Southeast Asian Nations (ASEAN): Brunei Darussalam, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam. This article presents the number of indicators, their level of development, and detailed lists of indicators for each country, and demonstrates general improvement in indicator use by the highest level of government reporting about implementation of the CBD at the national scale.
    Matched MeSH terms: Asia, Southeastern
  19. Shetty AP, Rajavelu R, Viswanathan VK, Watanabe K, Chhabra HS, Kanna RM, et al.
    Asian Spine J, 2020 Aug;14(4):475-488.
    PMID: 32493003 DOI: 10.31616/asj.2020.0014
    STUDY DESIGN: Multicenter validation study.

    PURPOSE: To evaluate the inter-rater reliability of Rajasekaran's kyphosis classification through a multicenter validation study.

    OVERVIEW OF LITERATURE: The classification of kyphosis, developed by Rajasekaran, incorporates factors related to curve characteristics, including column deficiency, disc mobility, curve magnitude, and osteotomy requirements. Although the classification offers significant benefits in determining prognosis and management decisions, it has not been subjected to multicenter validation.

    METHODS: A total of 30 sets of images, including plain radiographs, computed tomography scans, and magnetic resonance imaging scans, were randomly selected from our hospital patient database. All patients had undergone deformity correction surgery for kyphosis. Twelve spine surgeons from the Asia-Pacific region (six different countries) independently evaluated and classified the deformity types and proposed their surgical recommendations. This information was then compared with standard deformity classification and surgical recommendations.

    RESULTS: The kappa coefficients for the classification were as follows: 0.88 for type 1A, 0.78 for type 1B, 0.50 for type 2B, 0.40 for type 3A, 0.63 for type 3B, and 0.86 for type 3C deformities. The overall kappa coefficient for the classification was 0.68. Regarding the repeatability of osteotomy recommendations, kappa values were the highest for Ponte's (Schwab type 2) osteotomy (kappa 0.8). Kappa values for other osteotomy recommendations were 0.52 for pedicle subtraction/disc-bone osteotomy (Schwab type 3/4), 0.42 for vertebral column resection (VCR, type 5), and 0.30 for multilevel VCRs (type 6).

    CONCLUSIONS: Excellent accuracy was found for types 1A, 1B, and 3C deformities (ends of spectrum). There was more variation among surgeons in differentiating between one-column (types 2A and 2B) and two-column (types 3A and 3B) deficiencies, as surgeons often failed to recognize the radiological signs of posterior column failure. This failure to identify column deficiencies can potentially alter kyphosis management. There was excellent consensus among surgeons in the recommendation of type 2 osteotomy; however, some variation was observed in their choice for other osteotomies.

    Matched MeSH terms: Asia
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