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

Oxygen therapy is an important part of perioperative anesthesia management.Oxygen therapy is a double-edged sword:too high oxygen concentration may result in atelectasis and oxidative stress damage,while too low can lead to hypoxemia and affect oxygenation.Therefore,it is a hot and difficult issue to choose the appropriate oxygen concentration perioperatively.This review will discuss the effects of periop-erative oxygenation on the organism,the selection of inhalation oxygen concentration for different types of patients,in order to provide theoretical reference for perioperative precise oxygen therapy.

Multiple sclerosis (MS) is a neuroinflammatory demyelinating disease, mediated by pathogenic T helper 17 (Th17) cells. However, the therapeutic effect is accompanied by the fluctuation of the proportion and function of Th17 cells, which prompted us to find the key regulator of Th17 differentiation in MS. Here, we demonstrated that the triggering receptor expressed on myeloid cells 2 (TREM-2), a modulator of pattern recognition receptors on innate immune cells, was highly expressed on pathogenic CD4-positive T lymphocyte (CD4⁺ T) cells in both patients with MS and experimental autoimmune encephalomyelitis (EAE) mouse models. Conditional knockout of Trem-2 in CD4⁺ T cells significantly alleviated the disease activity and reduced Th17 cell infiltration, activation, differentiation, and inflammatory cytokine production and secretion in EAE mice. Furthermore, with Trem-2 knockout in vivo experiments and in vitro inhibitor assays, the TREM-2/zeta-chain associated protein kinase 70 (ZAP70)/signal transducer and activator of transcription 3 (STAT3) signal axis was essential for Th17 activation and differentiation in EAE progression. In conclusion, TREM-2 is a key regulator of pathogenic Th17 in EAE mice, and this sheds new light on the potential of this therapeutic target for MS.
Animals ; Humans ; Mice ; CD4-Positive T-Lymphocytes/pathology* ; Cell Differentiation ; Encephalomyelitis, Autoimmune, Experimental/metabolism* ; Mice, Inbred C57BL ; Multiple Sclerosis ; Th1 Cells/pathology*

Objective:To apply the best evidence of phaseⅠ cardiac rehabilitation after coronary artery bypass grafting (CABG) into clinical practice and evaluate its effects.Methods:Following the Australian Jonna Briggs Institute (JBI) clinical evidence program and evidence transformational practice application system, the evidence of phaseⅠ cardiac rehabilitation exercise after CABG was retrieved, screened and evaluated, and the review indicators were formulated. From September 2019 to February 2020, 41 nurses and 109 CABG patients from the Cardiovascular Surgery Ward of the Affiliated Hospital of Qingdao University were selected. The data of 56 patients were collected before the application of the best evidence, and those of 53 patients were collected after the application of the best evidence. The implementation rate of the review indicators, the degree of knowledge of the best evidence among nurses and patients, the Six Minute Walk Test (6MWT) distance and the left ventricular ejection fraction (LVEF) before and after the application of the best evidence were compared.Results:After the application of the evidence, the nurses' implementation rate of the 13 review indicators of phaseⅠ cardiac rehabilitation exercises was improved, and the difference was statistically significant ( P<0.05) ; the nurses' exercise knowledge score increased from (53.66±14.01) points to (71.59±14.93) points; the patients' exercise knowledge score increased from (26.22±17.46) points to (60.49±15.52) points, and the differences were statistically significant ( t=-5.61, -9.40; P<0.01) . After the application of the evidence, the patients' 6MWT distance increased from (241.82±72.05) m to (246.25±69.26) m, and the difference was statistically significant ( t=-2.238, P<0.05) ; however, there was no statistically significant difference in LVEF before and after the application of the evidence ( P>0.05) . Conclusions:The clinical application of the best evidence for phase I cardiac rehabilitation exercises in CABG patients can standardize nurses' behaviors, improve nurses and patients' knowledge of evidence, and increase the 6MWT distance of CABG patients.

Objective To investigate the changes and significance of early immune response in specific T cell with invasive pulmonary aspergillosis(IPA) patients. Methods Peripheral blood mononuclear cells (PBMCs) were separated from whole blood of 8 cases of healthy individuals (healthy group) and 24 cases of IPA patients (IPA group, including 6 cases of pathological diagnosis, 9 cases of clinical diagnosis and 9 cases of tentative diagnosis), and the heat-inactivated Aspergillus fumigatus spores (Conidia) was used as an antigen to stimulate PBMCs produce Aspergillus-specific T lymphocytes. Interferon-gamma (IFN-γ) secreation, type and ratio of cytokine synthesis was examined. Results In IPA group, dot enzyme linked immunosorbent assay(ELISPOT) showed that the positive rate of IFN-γin pathological diagnosis patients and clinical diagnosis patients (5/6,7/9) was higher than that in tentative diagnosis patients (3/9). The positive rate of IFN-γin IPA group was 62.5%(15/24), in healthy group was 0 (0/8), and there was significant difference (P<0.05). The levels of CD4+T and CD4+T/CD8+T in IPA group were 0.202 0±0.085 6 and 1.01±0.34, in healthy group were 0.3853±0.1265 and 1.55±0.41. The levels of CD4+T and CD4+T/CD8+T in IPA group were significantly lower than those in healthy group ( P<0.05 or<0.01). The level of CD 8+T in IPA group was 0.298 5±0.069 1, and in healthy group was 0.257 6±0.102 6. The level of CD8+T in IPA group was 05). Conclusion Conidia as antigen can induce the specific Th1-type immune response of IPA, and display the immune status of the IPA patients, and can provide new ideas and methods for the diagnosis and assessment of the disease.