INTRODUCTION: Obstructive sleep apnoea (OSA) is common in Singapore, with moderate to severe OSA affecting around 30% of residents. These consensus statements aim to provide scientifically grounded recommendations for the management of OSA, standar-dise the management of OSA in Singapore and promote multidisciplinary collaboration. METHOD: An expert panel, which was convened in 2024, identified several areas of OSA management that require guidance. The expert panel reviewed the current literature and developed consensus statements, which were later independently voted on using a 3-point Likert scale (agree, neutral or disagree). Consensus (total ratings of agree and neutral) was set a priori at ≥80% agreement. Any statement not reaching consensus was excluded. RESULTS: The final consensus included 49 statements that provide guidance on the screening, diagnosis and management of adults with OSA. Additionally, 23 statements on the screening, diagnosis and management of paediatric OSA achieved consensus. These 72 consensus statements considered not only the latest clinical evidence but also the benefits and harms, resource implications, feasibility, acceptability and equity impact of the recommendations. CONCLUSION The statements presented in this paper aim to guide clinicians based on the most updated evidence and collective expert opinion from sleep specialists in Singapore. These recommendations should augment clinical judgement rather than replace it. Management decisions should be individualised, taking into account the patient's clinical characteristics, as well as patient and caregiver concerns and preferences.
Humans ; Sleep Apnea, Obstructive/diagnosis* ; Singapore ; Consensus ; Adult

Background: Nanotechnology and nanomedicine are rising novel fields in plastic and reconstructive surgery (PRS).The use of nanomaterials often goes with regenerative medicine. Due to their nanoscale, these materials stimulate repair at the cellular and molecular levels. Nanomaterials may be placed as components of nanocomposite polymers allowing enhancement of overall biochemical and biomechanical properties with improved scaffold properties, cellular attachment, and tissue regeneration. They may also be formulated as nanoparticle-based delivery systems for controlled release of signal factors or antimicrobials, for example. However, more studies on nanoparticle-based delivery systems still need to be done in this field. Nanomaterials are also used as frameworks for nerves, tendons, and other soft tissues.Main body In this mini-review, we focus on nanoparticle-based delivery systems and nanoparticles targeting cells for response and regeneration in PRS. Specifically, we investigate their roles in various tissue regeneration, skin and wound healing, and infection control. Cell surface-targeted, controlled-release, and inorganic nanoparticle formulations with inherent biological properties have enabled enhanced wound healing, tumor visualization/imaging, tissue viability, and decreased infection, and graft/transplantation rejection through immunosuppression. Conclusions Nanomedicine is also now being applied with electronics, theranostics, and advanced bioengineering technologies. Overall, it is a promising field that can improve patient clinical outcomes in PRS.

Purpose: Asthma is a common chronic lung disease, in which interleukin (IL)-13 is implicated as a central regulator of IgE synthesis, mucus hypersecretion, airway hyperresponsiveness (AHR), and fibrosis. This study was designed to determine the anti-inflammatory effect of atorvastatin, a widely used lipid-lowering agent, on the IL-13-induced lung pathology through the modulation of macrophages. Methods: Atorvastatin (40 mg/kg) was given to transgenic mice overexpressing IL-13 (IL-13 TG mice) and their wild type littermates by oral gavage for 2 weeks. AHR, numbers of inflammatory cells in the airway, and cytokine levels in IL-13 TG mice were measured.Using the alveolar macrophage cell line CRL-2456, the direct effect of atorvastatin on macrophages activated by recombinant IL-13 was assessed. Results: Significant reduction in total leukocytes and alleviation of AHR were observed with administration of atorvastatin in IL-13 TG mice compared to those without atorvastatin treatment (P< 0.05). Atorvastatin administration resulted in upregulation of IL-10 in the lungs of IL-13 TG mice (P< 0.05). In addition, mRNA expression of connective tissue growth factor, fibronectin, and type III collagen as well as chord length enhanced by IL-13 overexpression were reduced by atorvastatin administration (P< 0.05). M2 macrophage markers, such as Ym-1 and CD206, were decreased, while M1 macrophage marker, inducible nitric oxide synthase, was increased upon atorvastatin treatment (P< 0.05). Administration of atorvastatin resulted in improved removal of apoptotic cells (P< 0.05). Conclusion The results of this study reveal a potential of atorvastatin as an effective antiasthmatic agent by reducing IL-13-induced lung inflammation via the modulation of macrophage polarization.

In the original version of this Article, Figure 1c was inadvertently assembled with a duplicate of Figure 1b. The correct image for Figure 1c, shown below, has been added in the HTML and PDF versions of the Article. This does not affect the conclusions of the study. We sincerely apologize for any inconvenience this may have caused our readers.

OBJECTIVE: To better understand the ergonomics associated with robotic surgery including physical discomfort and symptoms, factors influencing symptom reporting, and robotic surgery systems components recommended to be improved. METHODS: The anonymous survey included 20 questions regarding demographics, systems, ergonomics, and physical symptoms and was completed by experienced robotic surgeons online through American Association of Gynecologic Laparoscopists (AAGL) and Society of Robotic Surgery (SRS). RESULTS: There were 289 (260 gynecology, 22 gynecology-oncology, and 7 urogynecology) gynecologic surgeon respondents regularly practicing robotic surgery. Statistical data analysis was performed using the t-test, χ² test, and logistic regression. One hundred fifty-six surgeons (54.0%) reported experiencing physical symptoms or discomfort. Participants with higher robotic case volume reported significantly lower physical symptom report rates (p<0.05). Gynecologists who felt highly confident about managing ergonomic settings not only acknowledged that the adjustments were helpful for better ergonomics but also reported a lower physical symptom rate (p<0.05). In minimizing their symptoms, surgeons changed ergonomic settings (32.7%), took a break (33.3%) or simply ignored the problem (34%). Fingers and neck were the most common body parts with symptoms. Eye symptom complaints were significantly decreased with the Si robot (p<0.05). The most common robotic system components to be improved for better ergonomics were microphone/speaker, pedal design, and finger clutch. CONCLUSION: More than half of participants reported physical symptoms which were found to be primarily associated with confidence in managing ergonomic settings and familiarity with the system depending on the volume of robotic cases. Optimal guidelines and education on managing ergonomic settings should be implemented to maximize the ergonomic benefits of robotic surgery.
Anonyms and Pseudonyms ; Data Interpretation, Statistical ; Demography ; Education ; Fingers ; Gynecology ; Human Body ; Human Engineering* ; Logistic Models ; Neck ; Recognition (Psychology) ; Robotic Surgical Procedures ; Surgeons* ; Surveys and Questionnaires

INTRODUCTIONTrauma is the fifth principal cause of death in Singapore, with traumatic brain injury (TBI) being the leading specific subordinate cause.

METHODSThis study was an eight-year retrospective review of the demographic profiles of patients with severe TBI who were admitted to the neurointensive care unit (NICU) of the National Neuroscience Institute at Tan Tock Seng Hospital, Singapore, between 2004 and 2011.

RESULTSA total of 780 TBI patients were admitted during the study period; 365 (46.8%) patients sustained severe TBI (i.e. Glasgow Coma Scale score ≤ 8), with the majority (75.3%) being male. The ages of patients with severe TBI ranged from 14-93 years, with a bimodal preponderance in young adults (i.e. 21-40 years) and elderly persons (i.e. > 60 years). Motor vehicle accidents (48.8%) and falls (42.5%) were the main mechanisms of injury. Invasive line monitoring was frequently employed; invasive arterial blood pressure monitoring and central venous pressure monitoring were used in 81.6% and 60.0% of the patients, respectively, while intracranial pressure (ICP) measurement was required in 47.4% of the patients. The use of tiered therapy to control ICP (e.g. sedation, osmotherapy, cerebrospinal fluid drainage, moderate hyperventilation and barbiturate-induced coma) converged with international practices.

CONCLUSIONThe high-risk groups for severe TBI were young adults and elderly persons involved in motor vehicle accidents and falls, respectively. In the NICU, the care of patients with severe TBI requires heavy utilisation of resources. The healthcare burden of these patients extends beyond the acute critical care phase.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain Injuries, Traumatic ; economics ; epidemiology ; therapy ; Critical Care ; economics ; statistics & numerical data ; Female ; Glasgow Coma Scale ; Hospitalization ; Humans ; Intensive Care Units ; economics ; statistics & numerical data ; Intracranial Pressure ; Male ; Middle Aged ; Monitoring, Physiologic ; Public Health ; Resource Allocation ; Retrospective Studies ; Singapore ; Young Adult

INTRODUCTIONPostoperative nausea and vomiting (PONV), and postoperative pain are common during the early postoperative period. In addition to these problems, elderly patients risk developing postoperative confusion. This study aimed to identify the risk factors associated with these problems, and the extent of these problems, in a Singapore inpatient surgical population.

METHODSOver a period of six weeks, we surveyed 707 elective surgical inpatients aged ≥ 18 years who received general anaesthesia and/or regional anaesthesia.

RESULTSThe incidence of PONV was 31.8% (95% confidence interval [CI] 34.8-41.9). The incidence increased with increasing Apfel score (p < 0.001) and were higher in female patients (odds ratio [OR] 1.74, 95% CI 1.28-2.36), non-smokers (OR 1.72, 95% CI 1.04-2.88), patients with a history of PONV and/or motion sickness (OR 3.45, 95% CI 2.38-5.24), patients who received opioids (OR 1.39, 95% CI 1.03-1.88), and patients who received general anaesthesia (OR 1.76, 95% CI 1.11-2.79). Moderate to severe pain at rest and with movement were reported in 19.9% and 52.5% of patients, respectively. Among the patients who were predicted to experience mild pain, 29.5% reported moderate pain and 8.1% reported severe pain. The prevalence of postoperative confusion was 3.9% in the geriatric population.

CONCLUSIONHigher Apfel scores were associated with a higher risk of PONV and multimodal treatment for postoperative pain management was found to be insufficient. The incidence of postoperative confusion was low in this study.

Adult ; Aged ; Aged, 80 and over ; Anesthesia, General ; adverse effects ; Confusion ; chemically induced ; Female ; Humans ; Incidence ; Inpatients ; Male ; Middle Aged ; Pain, Postoperative ; drug therapy ; Postoperative Complications ; chemically induced ; Postoperative Nausea and Vomiting ; chemically induced ; Postoperative Period ; Risk Factors ; Severity of Illness Index ; Sex Factors ; Singapore ; Surveys and Questionnaires ; Young Adult

Mesenchymal stem cell (MSC)-mediated therapy has been shown to be clinically effective in regenerating tissue defects. For improved regenerative therapy, it is critical to isolate homogenous populations of MSCs with high capacity to differentiate into appropriate tissues. The utilization of stem cell surface antigens provides a means to identify MSCs from various tissues. However, few surface markers that consistently isolate highly regenerative MSCs have been validated, making it challenging for routine clinical applications and making it all the more imperative to identify reliable surface markers. In this study, we used three surface marker combinations: CD51/CD140α, CD271, and STRO-1/CD146 for the isolation of homogenous populations of dental mesenchymal stem cells (DMSCs) from heterogeneous periodontal ligament cells (PDLCs). Fluorescence-activated cell sorting analysis revealed that 24% of PDLCs were CD51(+)/CD140α(+), 0.8% were CD271(+), and 2.4% were STRO-1(+)/CD146(+). Sorted cell populations were further assessed for their multipotent properties by inducing osteogenic and chondrogenic differentiation. All three subsets of isolated DMSCs exhibited differentiation capacity into osteogenic and chondrogenic lineages but with varying degrees. CD271(+) DMSCs demonstrated the greatest osteogenic potential with strong induction of osteogenic markers such as DLX5, RUNX2, and BGLAP. Our study provides evidence that surface marker combinations used in this study are sufficient markers for the isolation of DMSCs from PDLCs. These results provide important insight into using specific surface markers for identifying homogenous populations of DMSCs for their improved utilization in regenerative medicine.
Adaptor Proteins, Signal Transducing ; analysis ; Adult ; Aggrecans ; analysis ; Antigens, CD ; analysis ; Antigens, Surface ; analysis ; CD146 Antigen ; analysis ; Cell Differentiation ; physiology ; Cell Lineage ; Cell Separation ; methods ; Cells, Cultured ; Chondrogenesis ; physiology ; Collagen Type II ; analysis ; Core Binding Factor Alpha 1 Subunit ; analysis ; Flow Cytometry ; methods ; Homeodomain Proteins ; analysis ; Humans ; Integrin alphaV ; analysis ; Mesenchymal Stromal Cells ; cytology ; physiology ; Multipotent Stem Cells ; cytology ; physiology ; Nerve Tissue Proteins ; analysis ; Osteogenesis ; physiology ; Periodontal Ligament ; cytology ; Receptor, Platelet-Derived Growth Factor alpha ; analysis ; Receptors, Nerve Growth Factor ; analysis ; SOX9 Transcription Factor ; analysis ; Time Factors ; Transcription Factors ; analysis

Mesenchymal stem cells (MSCs) are a promising tool in regenerative medicine due to their capacity to differentiate into multiple lineages. In addition to MSCs isolated from bone marrow (BMSCs), adult MSCs are isolated from craniofacial tissues including dental pulp tissues (DPs) using various stem cell surface markers. However, there has been a lack of consensus on a set of surface makers that are reproducibly effective at isolating putative multipotent dental mesenchymal stem cells (DMSCs). In this study, we used different combinations of surface markers (CD51/CD140α, CD271, and STRO-1/CD146) to isolate homogeneous populations of DMSCs from heterogeneous dental pulp cells (DPCs) obtained from DP and compared their capacity to undergo multilineage differentiation. Fluorescence-activated cell sorting revealed that 27.3% of DPCs were CD51(+)/CD140α(+), 10.6% were CD271(+), and 0.3% were STRO-1(+)/CD146(+). Under odontogenic conditions, all three subsets of isolated DMSCs exhibited differentiation capacity into odontogenic lineages. Among these isolated subsets of DMSCs, CD271(+) DMSCs demonstrated the greatest odontogenic potential. While all three combinations of surface markers in this study successfully isolated DMSCs from DPCs, the single CD271 marker presents the most effective stem cell surface marker for identification of DMSCs with high odontogenic potential. Isolated CD271(+) DMSCs could potentially be utilized for future clinical applications in dentistry and regenerative medicine.
Adult ; Adult Stem Cells ; cytology ; Antigens, CD ; analysis ; Antigens, Surface ; analysis ; Biomarkers ; analysis ; CD146 Antigen ; analysis ; Cell Culture Techniques ; Cell Differentiation ; physiology ; Cell Lineage ; Cell Separation ; methods ; Cells, Cultured ; Chondrogenesis ; physiology ; Dental Pulp ; cytology ; Flow Cytometry ; methods ; Humans ; Integrin alphaV ; analysis ; Mesenchymal Stromal Cells ; cytology ; Multipotent Stem Cells ; cytology ; Nerve Tissue Proteins ; analysis ; Odontogenesis ; physiology ; Receptor, Platelet-Derived Growth Factor alpha ; analysis ; Receptors, Nerve Growth Factor ; analysis