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

Objective To compare the effect of preoperative CTA examination using group injection test and group injection tracking delay protocol on image quality in patients with transcatheter aortic valve implantation(TAVI)/transcatheter aortic valve replacement(TAVR).Methods A total of 43 patients who underwent TAVI/TAVR preoperative one-stop CTA examination in our hospital were randomly divided into two groups,and preoperative CTA examination was performed using group injection tracking and group injection test.After the scanning was completed,the aortic root sinus(C1),the proximal left and right coronary arteries(C2,C3),the ascending aorta(A1),the abdominal aorta(A2),the left and right femoral arteries(A3,A4),and the CT value and SD value of the paraspinal muscles of the same layer were measured;the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the corresponding parts were calculated.The obtained data results were compared and analyzed from both subjective and objective aspects.Results There was no significant difference in image quality between the two groups in the aortic root sinus(C1),the proximal left and right coronary arteries(C2,C3),or the ascending aorta(A1)(P＞0.05).At the renal artery level,there was a significant difference in image quality between the abdominal aorta(A2)and the left and right femoral artery levels(A3,A4)(P＜0.05).Conclusion In the preoperative one-stop CTA examination of TAVI/TAVR patients,the CTA images below the renal artery level can obtain better image quality than the group injection tracking method.

Objective:To explore the difference of the vessel and plaque characteristics, myocardial perfusion and cardiac function between patients with ischemia with non-obstructive coronary artery disease (INOCA) and obstructive coronary artery disease (CAD).Methods:From July 2021 to June 2022, 101 patients with angina were referred to dynamic computed tomography myocardial perfusion (CTP) and coronary computed tomography angiography (CCTA) and retrospectively included in our hospital. Based on the results of CTP and CCTA, patients were divided into INOCA (27 cases), moderate obstructive CAD (26 cases) and severe obstructive CAD (48 cases). The anatomical coronary artery stenosis, plaque characteristics and myocardial perfusion features of all patients were analyzed. Furthermore, left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were obtained on full-phase reconstruction CCTA image by using Medis Suite 3.2 postprocessing software. Multigroup analysis used one way ANOVA or Kruskal Wallis H test. Results:Patients with INOCA were younger than patients with moderate and severe obstructive CAD ( P<0.001). INOCA patients (7.4%, 2/27) had lower rate of positive remodeling than both moderate (57.7%, 15/26, P<0.001) and severe obstructive CAD patients (33.3%, 16/48, P=0.017). The percentage of ischemic myocardium volume in patients with INOCA were similar with those in patients with severe CAD (all P>0.05), but significantly higher than those in patients with moderate CAD (all P<0.05). No significant difference in terms of GLS was detected between patients with INOCA [-17.4% (-21.6%, -11.6%)] and severe CAD [-17.6% (-21.9%, -14.8%), P=0.536], however, patients both with INOCA and severe CAD also had higher GLS than patients with moderate obstructive CAD [-22.3% (-29.8%, -19.0%), all P<0.05]. Conclusions:Based on"one-stop-shop"CTP combined with CCTA imaging, early cardiac functional changes including abnormal myocardial perfusion and myocardial strain in INOCA patients were similar to those in patients with severe obstructive CAD and more severe than those in patients with moderate obstructive CAD.

Objective To discuss the clinical value of magnetic resonance imaging in the diagnosis of inner ear lesion.Methods 94 patients who took magnetic resonance imaging water imaging were selected as study subjects from February 2014 to October 2016 in Heilongjiang Province Hospital.All the patients had surgical data,CT,MRI water imaging data.Based on the standard data of surgery gold,analyzed the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of CT and MRI in the diagnosis of inner ear lesions,compared the statistical differences between the two methods of examination.Results The sensitivity,specificity,positive predictive value and negative predictive value of MRI water imaging in diagnosis of inner ear werehigher than CT,but the differences were no statistically significant (all P ＞ 0.05).In the case of abnormal vestibular aqueduct (x2 =7.265,P =0.015),cochlear deformity (x2 =5.042,P =0.028),diagnostic accuracy of cochlear fibrosis (x2 =5.492,P =0.027),the differences were statistically significant(all P ＜ O.05).Conclusion MRI water imaging can effectively provide the information of ear canal,eudometrial and other internal organs,can provide a favorable clinical diagnosis,it is worth to promote the application in the clinical work.

Epithelial ovarian cancer( EOC) is the most deadly malignant tumor in gynecological cancer. In the past 30 years,although the levels of diagnosis and treatment have made progress,the incidence of EOC and mortality are constant. Over the past few decades,a comprehensive study for molecular mechanisms of EOC pro-gression has been conducted in order to develop new and more effective treatments. Advanced peritoneal metasta-ses occur in the attached small clusters of cancer cells,which shed from the initial site and carried it through the ascites to the abdominal peritoneum or omentum. This behavior suggests that cell-cell or cell-matrix adhesion mechanisms regulate the growth and dissemination of EOC. Complex downstream signaling may be affected by functional crosstalk between adhesion molecules and,co-expressed and activated signaling proteins,which affect the proliferation/survival and migration/invasion of EOC cells. The aim of this review is to define effects of cell and cellular mechanisms,which are adhered by the cadherin and the cell-extracellular matrix,and cascaded by integrin-mediated membrane receptor and cytoplasmic protein -mediated cascade amplification, which is ex-pressed in proliferation,migration and invasion of epithelial ovarian cancer cells.

Objective To investigate the expression and clinical value of miRNA -22 in gastric cancer tissues.Methods Real -time PCR was used to detect the miRNA -22 expression in gastric cancer tissues and matched adjacent tissues.The correlations of miRNA -22 expression with clinic pathological features were analyzed. Results 87.5%(77 /88)of the gastric tumor tissues showed aberrant down regulation of miRNA -22 compared with adjacent non -tumor tissues (χ2 =69.32,P <0.05).Lower miRNA -22 level was strongly associated with T3 -T4 stage (χ2 =64.38,P <0.05)and lymph node metastasis(χ2 =68.56,P <0.05).The correlation statistical analysis results indicated that there were no significant differencec in sex,age and differentiation grade (all P >0.05 ). Conclusion The lower expression of miRNA -22 is associated with clinic pathological features.

Objective To evaluate the clinical effect of Wy 10 whitening combined with enamel microabrasion on bleaching dental fluorosis.Methods Forty patients with dental fluorosis were in-cluded and divided into two groups (20 each):group A was treated with Wy 10 whitening and enamel microabrasion,and group B only with Wy 10 whitening.Efficacy was measured according to the Vita classical shade guide before and after treatment.Sensitivity between groups was also tested.Results The effective rate of group A was significantly higher than that of group B (x2 =5.096,P＜0.05).The sensitive rates were 20.0％ (4/20) and 15.0％ (3/20) in group A and group B,respectively.No significant difference was found between the two groups in sensitivity (P＞0.05).Conclusions Wy 10 whitening combined with enamel microabrasion is an effective and safe method for bleaching dental fluorosis.

Objective To study the effect of MMP-9 and ZO-1 expressions on the brain edema in rats with hepatic encepha -lopathy.Methods Ninety rats were randomly divided into two groups .In one group, rats were intraperitoneal of D -galactosamine (400mg/kg) with lipopolysaccharide(100μg/kg) to induce hepatic encephalopathy , and then observe the symptom.12 hours later, ammonia, the evans blue(EB)content, the brain water content and the MMP -9 mRNA and the ZO-1 mRNA in the brain tissue was as-sessed by real-time Q-PCR.Results Two hours later the rats in hepatic encephalopathy groups begin to appear the symptom .12 hours later, the ammonia, the EB content, the brain water content and the MMP -9 mRNA content of the hepatic encephalopathy groups was increased significantly[(279.53 ±9.78)μmol /L vs (33.85 ±1.50)μmol/L, (6.71 ±0.50)μg/g vs (3.96 ±0.48)μg/g, (82.14 ±0.30)% vs (76.07 ±0.39)% and 1.4255 ±0.1131 vs 0.8298 ±0.0537, P <0.01],but the ZO-1 mRNA content was decreased (1.0795 ±0.0534 vs 1.4576 ±0.0654, P <0.01).Conclusions Blood brain barrier permeability enhancement and brain edema in hepatic encephalopathy rats, MMP-9 mRNA increase and ZO-1 mRNA decrease may play an important role .

OBJECTIVETo investigate the effect of different length and diameters on the stability of mini implant and to select optimal length and diameter using continuous variation of parameters.

METHODSTo perform 3-dimensional finite element analysis, finite element models of a maxilla, and mini implants with length of 6-12 mm and diameters of 1.2-2.0 mm were generated. Load of two different forces were applied to the head of mini implant. One type was horizontal force (HF), the other was composite force (CF). The maximum equivalent stress (Max EQV) in maxilla and the maximum displacement (Max DM) of mini implant were evaluated.

RESULTSThe Max EQV in maxilla and Max DM of mini implant decreased as length and diameter increased. When length was more than 9 mm, the evaluation indexes were small and had a less change. Datas indicated that diameter played a more important role in reducing target, and was a more effective parameter in reducing Max EQV when CF was loaded.

CONCLUSIONFrom biomechanical point of view, the choice of the length should not be more than 9 mm. When CF is loaded using the mini implant, diameter exceeding 1.2 mm are optimal design for mini implant.

Objective To investigate the effect of different length and diameters on the stability of mini implant and to select optimal length and diameter using continuous variation of parameters. Methods To perform 3-dimensional finite element analysis, finite element models of a maxilla, and mini implants with length of 6-12 mm and diameters of 1.2-2.0 mm were generated. Load of two different forces were applied to the head of mini implant. One type was horizontal force (HF), the other was composite force (CF). The maximum equivalent stress (Max EQV) in maxilla and the maximum displacement (Max DM) of mini implant were evaluated. Results The Max EQV in maxilla and Max DM of mini implant decreased as length and diameter increased. When length was more than 9 mm, the evaluation indexes were small and had a less change. Datas indicated that diameter played a more important role in reducing target, and was a more effective parameter in re-ducing Max EQV when CF was loaded. Conclusion From biomechanical point of view, the choice of the length should not be more than 9 mm. When CF is loaded using the mini implant, diameter exceeding 1.2 mm are optimal design for mini implant.