Pancreaticoduodenectomy (PD) is a primary surgical approach for treating mali-gnant tumors of the pancreatic head and the periampullary region. With the advance in medical technology in recent years, the long-term survival rate of patients undergoing PD has significantly improved, and the incidence of early perioperative complications has markedly decreased. However, current researches predominantly focuse on early postoperative complications, while, limited studies addressing long-term complications. Long-term complications after PD have a significant impact on patients′ quality of life and long-term survival. This authors systematically summarize the common long-term complications following PD, and explore their mechanisms, clinical manifestations, dia-gnostic methods, and treatment strategies, aiming to provide a reference for clinical practice.

Objective To investigate the correlation between self-injurious and suicidal behavior in adolescents with depressive disorder and their non-enzymatic antioxidants and thyroid hormones.Methods A total of 93 adolescent patients with depressive disorder who were hospitalized at the Qingdao Mental Health Center from August 2023 to May 2024 were selected as the research subjects.The patients were divided into three groups:depression group(n=33),self-injurious behavior group(n=30)and a suicidal behavior.Plasma levels of non-enzymatic antioxidants and thyroid hormones were measured at admission and after 8 weeks of treatment,and their clinical symptoms were assessed by the Hamilton depression scale(HAMD)and the Hamilton anxiety scale(HAMA).Differences in plasma non-enzymatic antioxidants and thyroid function levels and scale scores were compared among three groups.Results Compared with depression group,baseline UA levels were lower in self-injurious and suicidal behavior groups.After 8 weeks of treatment,FT3 levels were higher in self-injurious group than in the suicidal behavior group,and both HAMD and HAMA scores decreased in all patients.After correction,HAMA scores were higher in suicidal behavior group than in depression group(P=0.047).Compared to baseline levels,TSH levels increased,and HAMD and HAMA scores decreased in all groups after treatment(P＜0.001).In suicidal behavior group,TBIL and FT3 levels decreased,and UA levels increased after treatment,while in depression group,FT4 levels decreased after treatment.Conclusion Non-enzymatic antioxidants may serve as potential biological markers for adolescents with depressive disorder who exhibit self-injurious and suicidal behavior.

Objective:To propose policy recommendations for the compensation mechanism of high-quality development of municipal public hospitals.Methods:Taking the municipal public hospitals in Shanghai as the research object,the aspects of financial subsidies,the structure of medical service income,investment in scientific research and education,and other social compensations were examined to conduct a systematic simulation of the operation of the average municipal public hospital in Shanghai under different policy intervention scenarios.Results:If the current conditions remain unchanged,the average municipal public hospital in Shanghai will face a deficit starting in 2032,the proportion of income from examinations and laboratory tests will surpass that of medical service income in 2026 and 2031,respectively.If the hospitals follow a plan of Combination Plan 3,4,and 5,the average municipal public hospital in Shanghai will be able to break even from 2023 to 2033,and the structure of medical service income will be significantly optimized.Conclusion:To establish a new compensation mechanism for high-quality hospital development that enhances medical services,it is recommended to optimize the structure of government financial compensation,explore rational pricing strategies based on categories,increase investment in scientific research and education while paying attention to the transformation of scientific and technological achievements,expand compensation channels for public hospitals,and improve relevant laws and regulations.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection，with immune dysregulation serving as the central mechanism. Interleukin-10，a pivotal cytokine in the immunopathological cascade of sepsis，plays dual roles in balancing inflammatory and anti-inflammatory responses. This article provided a concise review of the latest research advances regarding the role of interleukin-10 in the pathogenesis，early diagnosis，prognostic evaluation，and therapeutic strategies of sepsis，aiming to enhance clinical understanding of its diagnostic，therapeutic，and prognostic implications in sepsis management.

Pancreaticoduodenectomy (PD) is a primary surgical approach for treating mali-gnant tumors of the pancreatic head and the periampullary region. With the advance in medical technology in recent years, the long-term survival rate of patients undergoing PD has significantly improved, and the incidence of early perioperative complications has markedly decreased. However, current researches predominantly focuse on early postoperative complications, while, limited studies addressing long-term complications. Long-term complications after PD have a significant impact on patients′ quality of life and long-term survival. This authors systematically summarize the common long-term complications following PD, and explore their mechanisms, clinical manifestations, dia-gnostic methods, and treatment strategies, aiming to provide a reference for clinical practice.

Objective:To propose policy recommendations for the compensation mechanism of high-quality development of municipal public hospitals.Methods:Taking the municipal public hospitals in Shanghai as the research object,the aspects of financial subsidies,the structure of medical service income,investment in scientific research and education,and other social compensations were examined to conduct a systematic simulation of the operation of the average municipal public hospital in Shanghai under different policy intervention scenarios.Results:If the current conditions remain unchanged,the average municipal public hospital in Shanghai will face a deficit starting in 2032,the proportion of income from examinations and laboratory tests will surpass that of medical service income in 2026 and 2031,respectively.If the hospitals follow a plan of Combination Plan 3,4,and 5,the average municipal public hospital in Shanghai will be able to break even from 2023 to 2033,and the structure of medical service income will be significantly optimized.Conclusion:To establish a new compensation mechanism for high-quality hospital development that enhances medical services,it is recommended to optimize the structure of government financial compensation,explore rational pricing strategies based on categories,increase investment in scientific research and education while paying attention to the transformation of scientific and technological achievements,expand compensation channels for public hospitals,and improve relevant laws and regulations.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection，with immune dysregulation serving as the central mechanism. Interleukin-10，a pivotal cytokine in the immunopathological cascade of sepsis，plays dual roles in balancing inflammatory and anti-inflammatory responses. This article provided a concise review of the latest research advances regarding the role of interleukin-10 in the pathogenesis，early diagnosis，prognostic evaluation，and therapeutic strategies of sepsis，aiming to enhance clinical understanding of its diagnostic，therapeutic，and prognostic implications in sepsis management.

Objective To investigate the correlation between self-injurious and suicidal behavior in adolescents with depressive disorder and their non-enzymatic antioxidants and thyroid hormones.Methods A total of 93 adolescent patients with depressive disorder who were hospitalized at the Qingdao Mental Health Center from August 2023 to May 2024 were selected as the research subjects.The patients were divided into three groups:depression group(n=33),self-injurious behavior group(n=30)and a suicidal behavior.Plasma levels of non-enzymatic antioxidants and thyroid hormones were measured at admission and after 8 weeks of treatment,and their clinical symptoms were assessed by the Hamilton depression scale(HAMD)and the Hamilton anxiety scale(HAMA).Differences in plasma non-enzymatic antioxidants and thyroid function levels and scale scores were compared among three groups.Results Compared with depression group,baseline UA levels were lower in self-injurious and suicidal behavior groups.After 8 weeks of treatment,FT3 levels were higher in self-injurious group than in the suicidal behavior group,and both HAMD and HAMA scores decreased in all patients.After correction,HAMA scores were higher in suicidal behavior group than in depression group(P=0.047).Compared to baseline levels,TSH levels increased,and HAMD and HAMA scores decreased in all groups after treatment(P＜0.001).In suicidal behavior group,TBIL and FT3 levels decreased,and UA levels increased after treatment,while in depression group,FT4 levels decreased after treatment.Conclusion Non-enzymatic antioxidants may serve as potential biological markers for adolescents with depressive disorder who exhibit self-injurious and suicidal behavior.

Objective:To investigate the efficacy and safety of ultrasound-guided of lumbar square muscle block on the arcuate ligament in laparoscopic surgery for gastrointestinal tumors.Methods:A retrospective study was conducted on 106 patients who underwent laparoscopic gastrointestinal tumor surgery in Rugao Branch of Affiliated Hospital of Nantong University from January 2020 to December 2022, 53 patients(observation group) were given the ultrasound-guided of lumbar square muscle block on the arcuate ligament before general anesthesia, 53 patients(control group) were given only general anesthesia. The sensory block planes were recorded at 5 min and 15 min after the block in the observation group, and the hemodynamic indexes, stress indexes at differences time points and postoperative analgesia were compared between the two groups.Results:Most patients in the observation group could monitor the T 8 - L 1 sensory block plane at 5 min after block, and the T 5 - L 2 sensory block plane could be reached at 15 min after block, and the percentage of block was 100.00%(53/53). The results of repeated measurement variance analysis (ANOVA) showed that the intergroup - time point interaction of heart rate (HR) and mean arterial pressure (MAP) between the two groups had statistical differences ( P<0.05); the intergroup-time point interaction of the levels of noradrenaline (NE), epinephrine (E), adrenocorticotropic hormone (ACTH), cortisol (Cor) between the two groups had statistical differences ( P<0.05); the intergroup - time point interaction of the resting and active visual analog scale (VAS) scores between the two groups had statistical differences ( P<0.05). The amount of propofol, remifentanil, the number of effective patient-controlled intravenous analgesia (PCIA) compressions, and the total number of PCIA compressions in the observation group were lower than those in the control group: (1 128.36 ± 137.95) mg vs. (1 415.18 ± 153.24) mg, (1.47 ± 0.49) mg vs. (2.76 ± 0.74) mg, (4.25 ± 0.87) times vs. (8.63 ± 0.94) times, (10.27 ± 1.25) times vs. (15.75 ± 1.47) times, there were statistical differences ( P<0.05). The rate of remedial analgesia within 48 h after surgery between the two groups had no statistical difference ( P>0.05). The awakening time, first time out of bed, first time exhaust and hospitalization time in the observation group were shorter than those in the control group: (4.75 ± 0.57) min vs. (7.02 ± 0.64) min, (11.65 ± 1.47) h vs. (15.87 ± 1.94) h, (14.79 ± 2.12) h vs. (19.59 ± 3.30) h, (4.78 ± 0.72) d vs. (7.14 ± 0.98) d, there were statistical differences ( P<0.05). The incidence of adverse reactions between the two groups had no statistical difference ( P>0.05). Conclusions:Ultrasound-guided of lumbar square muscle block on the arcuate ligament in laparoscopic surgery for gastrointestinal tumors has significant analgesic effects, can reduce intraoperative anesthetic maintenance dose, maintain intraoperative hemodynamic stability, reduce postoperative pain sensation and stress response, reduce postoperative analgesic injection dose, shorten postoperative wakefulness time, and accelerate recovery.

【Objective】 To explore the diagnosis and management of liver injury caused by percutaneous nephrolithotripsy (PCNL), so as to provide reference for the diagnoise and treatment of similar patients. 【Methods】 The clinical data of 926 patients who underwent PCNL during Oct.2017 and Oct.2022 were searched, and the data of those complicated with liver injury were analyzed. 【Results】 A total of 11 cases were collected, including 6 males and 5 females, average age (55.00±13.25)years.All injuries were confirmed with CT.The average decrease of hemoglobin after operation was (14.00±11.97)g/L.One patient needed blood transfusion due to pyonephrosis and multiple operations, and all patients were cured and discharged after delaying the removal of nephrostomy tube [an average of (6.73±1.27)days] . 【Conclusion】 In the absence of obvious signs of peritonitis and hemodynamic stability, conservative treatment of liver injury caused by PCNL is safe and effective.