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

Purinergic receptors have been reported to be involved in brain disorders. In this study, we explored their roles and mechanisms underlying the memory impairment in rats with type 2 diabetes mellitus (T2DM). T2DM rats exhibited a worse performance in the T-maze and Morris water maze (MWM) than controls. Microglia positive for P2X purinoceptor 4 (P2X4R) in the hippocampus were reduced and activated microglia were increased in T2DM rats. Long Amplicon PCR (LA-PCR) showed that DNA amplification of the p2x4r gene in the hippocampus was lower in T2DM rats. Minocycline significantly reduced the number of activated microglia and the mean distance traveled by T2DM rats in the MWM. Most importantly, P2X4R overexpression suppressed the activated microglia and rescued the memory impairment of T2DM rats. Overall, T2DM led to excessive activation of microglia in the hippocampus, partly through the DNA damage-mediated downregulation of P2X4Rs, thus contributing to memory impairment.

OBJECTIVETo study a non-drug therapy for hypertension disease by combining percutaneous laser and electric pulse stimulation to acupoint with music, and to test the efficiency of the combining treatment to grade 1 essential hypertension.

METHODSA total of 174 patients with grade 1 essential hypertension were randomly assigned to 3 groups with a random number table after Chinese medicine (CM) syndrome differentiation: the photoelectric and musical treatment group (Group 1, with a self-developed multi-mode audio frequency pulse photoelectric therapeutic apparatus), acupuncture group (Group 2), and oral placebo group (Group 3), 58 cases per group. The curative effect of each group was evaluated by the changes of blood pressure and CM syndrome integral before and after treatment.

RESULTSCompared with Group 3, there were significant decrease of blood pressure and CM syndrome integral in Group 1 and Group 2 (P<0.01). Compared with Group 2, Group 1 showed the highest decrease in systolic pressure (P<0.017). The total effective rate of anti-hypertension in Group 1 (91.38%, 53/58) was significantly higher than that in Group 2 (74.13%, 43/58) and Group 3 (18.97%, 11/58, P<0.05 or P<0.01); and that in Group 2 was also significantly higher than that in Group 3 (P<0.01). There were significant difference in the total effective rate of CM syndrome integral in both Group 1 (93.10%, 54/58) and Group 2 (84.48%, 49/58) as compared with Group 3 (17.24%, 10/58, P<0.01), while there was no significant difference between Group 1 and Group 2 (P>0.05).

CONCLUSIONSThe multi-mode audio frequency pulse photoelectric therapeutic apparatus, combining music, laser and electric pulse stimulation, is clinically useful for grade 1 essential hypertension. This "three in one" therapy method is non-invasive, easy and simple to handle. It is expected to be popularized as a new alternative treatment.

Acupuncture Points ; Blood Pressure ; Electric Stimulation Therapy ; Essential Hypertension ; Female ; Humans ; Hypertension ; physiopathology ; therapy ; Lasers ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Music ; Syndrome ; Treatment Outcome

OBJECTIVETo review the clinical characteristics, diagnosis, treatment and prognosis of esophageal mucoepidermoid carcinoma (MEC).

METHODSClinical data of 36 patients with pathologically confirmed esophageal MEC who received surgical treatment in Cancer Hospital of Shantou University Medical College from Jan 1991 to Jun 2010 were retrospectively analyzed. The survival analysis was performed using Kaplan-Meier method.

RESULTSOf the 4253 patients diagnosed as esophageal cancer during the same time in our center, only 36 had esophageal MEC, accounted for 0.8%. This group included 27 men and 9 women ranging in age from 40 to 78 years (median 58 years). Esophageal MEC showed similar clinical symptoms, radiological and endoscopic features to esophageal squamous cell carcinoma (ESCC). Of the 20 cases who received preoperatively endoscopic biopsy, 18 were misdiagnosed as ESCC and 2 were misdiagnosed as esophageal adenosquamous carcinoma. The mean follow-up duration of this series was 38.8 months (3-142 months). 22 patients died of the disease during the follow-up period, 12 were still alive and 2 were lost of follow-up. The median survival time (MST) of the 36 patients was 29.0 months, and the 1-, 2-, 3-, and 5-year overall survival rates (OS) were 80.6%, 57.1%, 34.4%, 25.8%, respectively.

CONCLUSIONSEsophageal MEC is a rare disease and prone to be misdiagnosed by endoscopic biopsy. Surgical resection is the primary treatment but the prognosis is poor.

Adult ; Aged ; Biopsy ; Carcinoma, Adenosquamous ; pathology ; Carcinoma, Mucoepidermoid ; pathology ; radiotherapy ; surgery ; Carcinoma, Squamous Cell ; pathology ; Diagnostic Errors ; Esophageal Neoplasms ; pathology ; radiotherapy ; surgery ; Esophagectomy ; methods ; Esophagoscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Radiotherapy, Adjuvant ; Retrospective Studies ; Survival Rate

OBJECTIVE: To study the application value of contrast vision in identifying the malingering decreased vision in the practice of clinical forensic medicine. METHODS: Thirty-one young and middle aged volunteers were selected and divided randomly into group 1 (16 persons with 32 eyes) and group 2 (15 persons with 30 eyes). The optotype contrast was 100%, 25%, 10% and 5%, respectively. The contrast vision of group 1 was tested. The contrast vision of group 2 was tested as follows: (1) the volunteers cooperated without inspector's interference; (2) the volunteers cooperated under inspector's interference; (3) the volunteers disguised decreased vision without inspector's interference; (4) the volunteers disguised decreased vision under inspector's interference. The data was then analyzed by statistics. RESULTS: There was a close correlation between contrast vision and contrast. As the contrast decreased, the vision acuity also decreased. The contrast vision curve of former two methods showed a good reproducibility while the contrast vision curve of latter two methods had a bad reproducibility. CONCLUSION The repetition of contrast curve with or without inspector's interference can be used to discriminate malingering vision. The acquired contrast curves can be provided to the court as direct evidence and can help enhance the verification conclusion.
Adult ; Contrast Sensitivity/physiology* ; Diagnosis, Differential ; Female ; Humans ; Male ; Malingering/psychology* ; Reproducibility of Results ; Sensitivity and Specificity ; Severity of Illness Index ; Vision Tests/statistics & numerical data* ; Vision, Binocular ; Vision, Low/psychology* ; Visual Acuity ; Young Adult

Objective To investigate the prevalence of high risk human papillomavirus (HPV) genital infection and cervical cancer in adult women from Shenzhen.Methods Cluster sampling was used to investigate the prevalence of HPV infection and cervical cancer from women aged 20-59 years old living in Luohu,Futian,Nanshan,Longgang and Baoan districts in Shenzhen from April 2006 to April 2010.All women were detected for liquid-based cytology test (LCT) or Thinprep cytologic test (TCT)and high-risk HPV-DNA test with hybrid capture Ⅱ (HC-Ⅱ ).All women with ≥ASC-US by cytology and/or a positive HC- Ⅱ test were asked to return for colposcopy and four-quadrant biopsy.Endocervical curettage was performed.Pathological finding were used as the gold standard of the diagnosis of cervical intraepithelial neoplasia.Results 10 210 women were involved in the study and 10 017 of them having completed data.The overall positive rate of high-risk HPV-DNA was 16.29％.HPV positive rates in 20-,30-,35-,40-,45-,50-59 age groups were 17.37％,15.59％,16.33％,14.74％,17.16％ and 17.98％,respectively.The curve of HPV infection rates in different age groups appeared a ‘W' shape.HPV infection rates in the 25-years-olds and 50-59 year-olds groups were significantly higher than the other age groups (x2=4.50,P=0.03 ).The overall prevalence rate of cervical intraepithelial lesions (CIN) was 7.52％,of which the prevalence rates of low-grade cervical intraepithelial lesions (CIN Ⅰ) was 5.32％ high-grade cervical intraepithelial lesions (CIN Ⅱ/Ⅲ ) was 2.21％,cervical cancer was 0.12％.The prevalence of CIN Ⅰ was significantly higher than the CIN Ⅱ/Ⅲ (x2=134.15,P＜0.001 ).The prevalence of cervical cancer in 45- age group was 0.12％,the highest.HPV infection rates increased with the grades of cervical lesions including women without CIN as 44.31％,in CIN Ⅰ as 70.73％,in CIN Ⅱ as 86.73％,and in CIN Ⅲ as 96.75％ and in cancer as 100.00％.The HPV infection rates were different in districts (x2=17.81,P=0.03 ),with Futian and Luohu higher than those of Nanshan,Longgang and Baoan district.The prevalence rate of CIN in Baoan was lower than other districts.The CIN prevalence rates were not significantly different among the other districts of Shenzhen (x2=4.84,P=0.18).Conclusion The prevalence of cervical cancer was low in adult women living in Shenzhen,with cervical lesions still in the early stage.Prevention of HPV infection and treatment of CIN were the key points for the prevention of cervical cancer.

OBJECTIVETo investigate the prevalence of high-risk human papillomavirus (HPV) and incidence of cervical intraepithelial neoplasia (CIN) in female populations in Shenzhen, Guangdong Province, China.

METHODSTotally 1137 women aged 15-59 from Shahe Community, Nanshan District, Shenzhen were investigated for cervical cancer during an population-based epidemiological screening from November 2004 to December 2004. Visual inspection with acetic acid (VIA), colposcopy, liquid-based cytology test (LCT), and hybrid capture 2 (HC-) were performed to detect the high-risk HPV types in cervical secretions. Biopsy under colposcope was performed in women who were HPV-positive with LCT >or= atypical squamous cells of undetermined sign (ASCUS) or HPV-negative with LCT >or= low grade squamous intraepithelial lesion (LSIL), with the pathological results as the golden standards.

RESULTSThe detection rate of high-risk HPV-DNA was 14.0%. HPV detection rates in 15-24, 25-29, 30-34, 35-39, 40-44, 45-49, and 50-59 age groups were 15.5%, 17.7%, 12.6%, 8.8%, 10.2%, 15.3%, and 21.0%, respectively (P < 0.05). HPV detection rates in 25-29 years group and 50-59 years group were significantly higher than those in other groups (P < 0.05) and 35-39 group had the lowest detection rate. The curve of HPV infection rates in all groups was 'V' type. The overall incidence of CIN was 4.4%. The incidences of CIN , CIN , and CIN were 3.2%, 1.0%, and 0.3%, respectively, in which the incidence of CIN was significantly higher than those of CIN and . HPV detection rates increased with cervical lesion grades, which in >or=CIN groups and normal group were 100.0% and 8.3%, respectively. No cervical cancer was identified in this research. The sensitivities of VIA, colposcopy, LCT, and HC-II for high-risk HPV screening were 35.7%, 50.0%, 92.9%,and 100%, respectively, in detecting high-grade squamous intraepithelial lesion (HSIL), the specificities of these four methods were 96.0%, 87.2%, 88.4%, and 86.9%, respectively. Satisfactory negative predictive values were obtained for all methods.

CONCLUSIONSHPV infection is the main risk factor for CIN. Cervical cancer among female populations in Shenzhen is still in early stages. Prevention of HPV infection and treatment of CIN are key for the prevention of cervical cancer.

Adolescent ; Adult ; Cervical Intraepithelial Neoplasia ; epidemiology ; Chi-Square Distribution ; China ; epidemiology ; DNA, Viral ; isolation & purification ; Female ; Humans ; Incidence ; Mass Screening ; methods ; Middle Aged ; Papillomaviridae ; genetics ; Papillomavirus Infections ; epidemiology ; Uterine Cervical Neoplasms ; diagnosis ; Young Adult

Objective To investigate the status of infection and distribution of rabies virus (RV) in different epidemic areas in China. Methods Brain specimens from animals and suspected patients were collected at the districts of high-, medium- and low incidence rates of human rabies and detected by both direct Immunofluorescence assay (DFA) and RT-PCR. Results 254 of 3007 specimens of dog brains showed RV positive by DFA (positive rate of 8.4% ). Among these 254 samples, 78 showed positive (positive rate of 30.7% ) by RT-PCR. 93 specimens from dogs and cats that had attacked human beings, 63 of them showed positive by DFA (positive rate of 67.7%) and all of them were also positive by RT-PCR. In addition, RV could also be detected in Apodemus agrarius,ferret badger, and suspected patients specimens from the districts under survey. There was no statistical difference between the infection rates of RV in different provinces and regions with different incidence of rabies. Conclusion There might be a relatively high infection rate of RV among the domestic dogs/cats in the endemic areas in China. Wild animals might have been infected with RV in the districts under survey.

Objective Throush identify biochemical characteristics and virulence factors of 2 strains suspected Yersinia pestis(Y.pestis)isolated from the dead Marmota himalayana(M.himalayana)to confirm the nature epidemic focus in Dege County,Sichuan Province.Methods Y.pestis was analyzed by specific staining and shape,culturing characteristics,splitting-test by bacteriophage,test of biochemical characteristics and glycolysis ability,virulence factors,virulence,nutritional requirement,plasmid,genetic test and genetic type. Results The tested strains were Gram staining bacilus.The main biochemical characteristics were Arabinose(+)、 Rhamnose(-),Maltose(+),Melibiose(-),Glycerol(+),Denitrification(+).The virulence factors with FI+.VW+, Pgm+,Pst I+;and with the common 6.0×106,45.0×106,65.0×106 plasmids,also with the virulence-relative plasmid gene.Both their absolutely lethal dose(LD100)in mice were 50 bacteria.The nutritional requirement appeared which were depended on Phenylalanine and Methionine.With the Genomovar 5 genotype characteristics of M.himalayana plague foci of Qinghai-Tibet plateau.The difference between tested strains and Yersinia pseudotubercuosis on the 3 different culture medium was obvious.The tested strains had a Y.pestis' specific 3a fragment,Pst I and FI-Ag,at 22 ℃,the strains could be split by bacteriophage completely.Conclusions According to the diagnostic criteria of plague in China,the 2 suspected strains isolated from Dege County,Sichuan Province ale confirmed as Y.pestis.both with powerful virulenceand with the characteristics of the Y.pestis of M.himahtyana in Qinghai-Tibet plateau plague natural focus.

Objective To evaluate the value of cervical cytology and hybrid capture Ⅱ (HC-Ⅱ) human papillomavarus (HPV) test for screening cervical lesion. Methods Conventional papanicolaou (Pap) smear by improved take-samples, liquid-based cytology test (LCT) and HC-Ⅱ human papillomavarus test were performed in 425 women in Shang Mei-lin community of Futian region in Shenzhen city, from December 2007 to March 2008 and the above methods were performed in 75 women in Shenzhen Hospital of Peking University at the same time. Age stratified sampling was used. Samples of Pap were taken a broom-type sampling device (take-samples used for LCT) with split-sampling method. Those women with HPV-positive, Pap≥atypical squamous cells of undetermined sign (ASCUS) or LCT≥ASCUS received multi-spot biopsy and endocervical curettage under colposcopy. Final diagnosis would depend on pathological findings as well, to evaluate the values of Pap, LCT, HC-Ⅱ HPV, Pap-HPV parallel test, LCT-HPV parallel test, Pap-HPV serial test and LCT-HPV serial test for the screening program on cervical cancer. Results (1) In this study, 7 women bad cervical intraepithelial neoplasia (CIN) Ⅱ, another 7 had CIN Ⅲ, 1 had cervical cancer in the community; 9 had CIN Ⅱ, 11 had CIN Ⅲ, 3 had cervical cancer in the hospital, respectively. (2) The sensitivity of HC-Ⅱ HPV and cytology-HPV parallel test for detecting≥CIN Ⅱ was >95.0% while negative pre-value were nearly 100.0%. (3) There were no significant differences of screening effectiveness and unsatisfactory rates between Pap of improved take-samples and LCT. (4) The cost-effectiveness ratio of Pap-HPV parallel test was higher than LCT-HPV parallel test. Conclusion It was suggested that the first choice for screening of cervical serious lesion were HC-Ⅱ HPV and cytology-HPV parallel test while Pap-HPV parallel test was the best method for screening purposes.