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The Emerging Role of Drug-Induced Sleep Endoscopy in the Management of Obstructive Sleep Apnea
Crystal SJ Cheong,Weiqiang Loke,Mark Kim Thye Thong,Song Tar Toh,Chi-Hang Lee 대한이비인후과학회 2021 Clinical and Experimental Otorhinolaryngology Vol.14 No.2
Obstructive sleep apnea is a prevalent sleep disorder characterized by partial or complete obstruction of the upper airway. Continuous positive airway pressure is the first-line therapy for most patients, but adherence is often poor. Alternative treatment options such as mandibular advancement devices, positional therapy, and surgical interventions including upper airway stimulation target different levels and patterns of obstruction with varying degrees of success. Drug-induced sleep endoscopy enables the visualization of upper airway obstruction under conditions mimicking sleep. In the era of precision medicine, this additional information may facilitate better decision-making when prescribing alternative treatment modalities, with the hope of achieving better adherence and/or success rates. This review discusses the current knowledge and evidence on the role of drug-induced sleep endoscopy in the non-positive airway pressure management of obstructive sleep apnea.
Yeang, Shu Hui,Chan, Alexandre,Tan, Chuen Wen,Lim, Soon Thye,Ng, HengJoo Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.7
Background: L-asparaginase (ASNase) is commonly used in the treatment of acute lymphoblastic leukemia (ALL) and natural killer (NK)/T-cell lymphoma. This study was designed to describe the incidence of toxicity associated with ASNase in Asian adults. Secondary objectives were to investigate the management and impact of toxicity on subsequent ASNase use, and to compare the actual management against current recommendations. Materials and Methods: In this retrospective, multi-center, observational study, Asian patients ${\geq}18$ years old who received ${\geq}1$ dose of the native E. coli ASNase from 2008 to 2013 were included. Patients were excluded if they did not receive ASNase. Endpoints of this study were development of specific toxicities, whether ASNase was discontinued or re-challenged, and developmentg of recurrent toxicity. All data analyses were performed using SPSS version 20.0. Results: A total of 56 patients were analyzed. Mean (${\pm}SD$) age was 36.2 (${\pm}15.2$) years old, with 62.5% being males, 55.4% with ALL and 28.6% with NK/T-cell lymphoma. Hypersensitivity (12.5%) was associated with the highest incidence of toxicity (6 out of 7 patients had Grade 3 and 4 toxicity), followed by 10.7% for hepatic transaminitis, 3.6% for non-CNS thrombosis and 1.8% each for hyperbilirubinemia and pancreatitis. Hypersensitivity recurred in the 3 patients who were re-challenged with E. coli ASNase. Conclusions: ASNase is associated with a wide range of toxicities, with hypersensitivity being the most commonly observed among Asian adult patients.
Pak Tee Ng,Lana Khong Yiu Lan,Jason Tan Eng Thye 서울대학교 교육연구소 2004 Asia Pacific Education Review Vol.5 No.2
The Singaporean education system is undergoing many changes in order to develop schools and nation which cultivate learning and education. A crucial success factor to these initiatives is the teacher. Singapore needs reflective teachers who can continually reflect upon their own practices to find better ways of teaching as well as maintain their purpose and direction amid a sea of changes. This article describes attempts during the years of 2002 to 2004 to develop trainee teachers into more reflective teachers at the National Institute of Education (NIE), focusing specifically on the experience of two revamped pre-service teacher education modules. The experience suggests that a social constructivist approach, in which trainee teachers discuss and debate critical issues impinging on their professional practice, is more successful than the traditional ‘tell and regurgitate’ approach, in developing reflective teachers.
Seng, Chuah Tse,Lun, Low Van,San, Cha Thye,Sahid, Ismail Bin The Korean Society of Weed Science and The Turfgra 2010 Weed Biology and Management Vol.10 No.4
Field and glasshouse studies have confirmed the presence of a glufosinate- and paraquat-resistant goosegrass biotype that has infested a bitter gourd field in Air Kuning, Perak, Malaysia. Glufosinate and paraquat had been applied at least six times per year to the affected fields (originally a rubber plantation) for more than four consecutive years. Paraquat had been used since 1970 for weed control in the rubber plantation. An on-site field trial revealed that the control of the goosegrass plants, measuring 20-35 cm in height, ranged from 20 to 35% 3 weeks after being treated with each herbicide at twice the recommended rate. Dose-response tests were conducted in the glasshouse, using seedlings at the three-to-four-leaf stage that had been obtained from the plants that had received repeated exposure to these herbicides and a biotype with no history of any herbicide resistance. The comparison of the $GR_{50}$ (the herbicide rate that is required to reduce the shoot fresh weight by 50%) of the seedlings indicated that the resistant biotype of goosegrass is 3.4-fold and 3.6-fold more resistant than the susceptible biotype following treatment with glufosinate and paraquat, respectively. This study has demonstrated the world's first field-evolved instance of multiple resistance in goosegrass to two non-selective herbicides, glufosinate and paraquat.
( Cynthia C. Lim ),( Jason C. J. Choo ),( Hui Zhuan Tan ),( Irene Y. J. Mok ),( Yok Mooi Chin ),( Choong Meng Chan ),( Keng Thye Woo ) 대한신장학회 2021 Kidney Research and Clinical Practice Vol.40 No.2
Background: Cardiovascular disease causes significant morbidity and mortality in patients with glomerulonephritis, which is increasingly diagnosed in older individuals who may have diabetes mellitus (DM). We evaluated the impact of DM on metabolic profile, renal and cardiovascular outcomes during treatment and follow-up of individuals with glomerulonephritis. Methods: We performed a retrospective cohort study of 601 consecutive adults with biopsy-proven glomerulonephritis for factors associated with kidney failure, hospitalization for cardiovascular events, and death. Biopsies with isolated diabetic nephropathy were excluded. Results: The median patient age was 49.8 years (36.7-60.9 years) with estimated glomerular filtration rate of 56.7 mL/min/1.73㎡ (27.7-93.2 mL/min/1.73㎡). DM was present in 25.4%. The most frequent diagnoses were minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS) (29.5%), lupus nephritis (21.3%), immunoglobulin A (IgA) nephropathy (19.1%), and membranous nephropathy (12.1%). The median follow-up was 38.8 months (interquartile range [IQR], 26.8-55.8 months). Among 511 individuals with lupus nephritis, anti-neutrophil cytoplasmic antibody-associated vasculitis, MCD/FSGS, membranous nephropathy, and IgA nephropathy, 52 (10.2%) developed kidney failure at a median 16.4 months (IQR, 2.3-32.2 months), while 29 (5.7%) had cardiovascular-related hospitalizations at 12.9 months (IQR, 4.8-31.8 months) and 31 (6.1%) died at 13.5 months (IQR, 2.5-42.9 months) after diagnosis. Cox regression analysis found that baseline DM was independently associated with kidney failure (adjusted hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.06-4.05, p = 0.03) and cardiovascular-related hospitalization (adjusted HR, 2.69; 95% CI, 1.21-5.98, p = 0.02) but not with mortality. Conclusion: DM was strongly associated with kidney failure and hospitalization for cardiovascular events in patients with biopsy-proven glomerulonephritis.