Background: s/Aims: Postoperative pancreatic fistulas (POPF) remain a major cause of morbidity and mortality following pancreatoduodenectomy (PD). Pancreatogastrostomy (PG) and pancreatojejunostomy (PJ) are the two most commonly used reconstruction techniques, yet evidence favoring one over the other is inconclusive. This study evaluates postoperative outcomes following open PD at a single institution that transitioned from PG to PJ as the preferred reconstruction method. Methods: This retrospective comparative study included patients who underwent PD between April 2005 and August 2022. Of 757 patients identified, 522 met the inclusion criteria. Propensity score matching (PSM) was performed to adjust for clinically relevant covariates. Primary endpoints were clinically relevant (CR) POPF (grade B/C) and Clavien–Dindo (CD) grade ≥ 3 POPFs. Secondary outcomes included post-pancreatectomy hemorrhage (PPH), delayed gastric emptying (DGE), systemic complications, length of hospital stay, and mortality. Results: Overall, CR-POPF and CD grade ≥ 3 POPFs occurred in 21.3% and 8.0% of patients, respectively. Thirty-day and in-hospital mortality rates were 3.1% and 4.2%. After PSM, 368 patients (184 PG and 184 PJ) were analyzed. Grade B POPFs were more frequent following PJ than PG (24.5% vs. 15.8%, p < 0.001). Although CR-POPF and CD grade ≥ 3 POPFs were numerically higher in the PJ group, differences were not statistically significant. In contrast, DGE, PPH, and in-hospital mortality were significantly higher following PG (37.0% vs. 25.0%, p = 0.025; 16.3% vs. 8.7%, p = 0.025; and 7.6% vs. 2.7%, p = 0.049, respectively). Conclusions PG was associated with a lower incidence of grade B POPFs but higher rates of DGE, PPH, and in-hospital mortality.

Introduction: Central precocious puberty (CPP) is the premature activation of the hypothalamic-pituitary-gonadal axis, often compromising adult height and psychosocial well-being. Timely treatment with gonadotropin-releasing hormone agonists (GnRHa) such as triptorelin is critical to halt pubertal progression and preserve growth potential. This study evaluated the clinical outcomes of triptorelin therapy in CPP at Sarawak General Hospital (SGH). Methodology: A retrospective cross-sectional study was conducted among patients with CPP treated with triptorelin at the Paediatric Endocrine Clinic, SGH, including those currently receiving therapy and those who had discontinued treatment. Demographic and clinical data were extracted from medical records and analyzed using SPSS version 25. Descriptive statistics summarized patient characteristics, while t-tests and non-parametric equivalents assessed treatment outcomes (p <0.05 significant). Results: Eleven patients were included (mean age 6.88 ± 2.21 years; 90.9% female). Two patients (18.2%) were obese at initial diagnosis, and the mean baseline body mass index was 17.64 ± 2.25 kg/m². Most cases were idiopathic (54.5%), while pituitary microadenoma was identified in 36.4%. At diagnosis, the bone age was advanced by a mean of 3.51 ± 1.39 years. Six patients discontinued therapy: four after completion and two at parental request. Among completers, mean treatment duration was 3.21 ± 2.42 years, ending at a mean age of 10.13 ± 0.95 years. Final height did not differ significantly from mid-parental height (p = 0.225). Triptorelin significantly improved final height standard deviation score (SDS) (p = 0.005) and reduced the bone age/ chronological age ratio (p = 0.049), though predicted adult height gains were not statistically significant (p = 0.321). No adverse effects were reported. Conclusion GnRHa therapy slowed pubertal progression and preserved growth potential in children with CPP, with favorable safety outcomes. Larger prospective studies are warranted to validate long-term benefits and identify predictors of optimal response.
Child ; Puberty, Precocious ; Gonadotropin-Releasing Hormone

Objective To investigate the expression and clinical significance of 12 plasma cytokines in patients with pancreatic cancer.Methods The study included 120 patients with pancreatic cancer diagnosed and treated at Qingdao University Affiliated Hospital and 68 healthy controls from March 2023 to June 2024.The levels of 12 plasma cytokines,including interleukin(IL)-1 β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12P,IL-17,interferon(IFN)-α,IFN-γ,and tumor necrosis factor(TNF)-α,were detected using mul-tiplex bead-based flow immunoassay.The levels of tumor markers carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9)and carbohydrate antigen 72-4(CA 72-4)in the serum of pancreatic cancer patients were detected by electrochemilumines-cence,while carbohydrate antigen 242(CA242)were detected by chemiluminescence methods.The correlation between the expression levels of differentially expressed cytokines and those of tumor markers was analyzed using Spearman's rank correlation.Results The plasma levels of 9 cytokines(IL-1 β,IL-4,IL-5,IL-6,IL-8,IL-10,IL-17,IFN-α,and IFN-γ)in the patients with pancreatic canc-er were significantly higher than those in controls(all P＜0.05).The levels of IL-1 β,IL-6,IL-8,IL-10,and IL-17 in the advanced pancreatic cancer group were significantly higher than those in the early-stage group(P＜0.05).The plasma IL-6 level in the poorly dif-ferentiated pancreatic cancer group was significantly higher than that in the well-differentiated group(P＜0.05).The serum levels of CEA,CA19-9,CA242,and CA72-4 in the advanced pancreatic cancer group were significantly higher than those in the early-stage group(P＜0.05).The serum CEA level in the poorly differentiated pancreatic cancer group was significantly higher than that in the moderately differentiated pancreatic cancer group(P＜0.05).After four cycles of chemotherapy,IL-8 levels in the disease control group were significantly reduced compared to pre-treatment levels(P＜0.05),while IL-6,IL-8,and IL-10 levels in the disease progression group were significantly elevated compared to pre-treatment levels(all P＜0.05).In the patients with pancreatic cancer,plasma IL-6 levels were positively correlated with serum CEA levels(rs=0.238,P＜0.01)and serum CA19-9 levels(rs=0.186,P＜0.05).The plasma IL-10 levels were positively correlated with serum CA72-4(rs=0.220,P＜0.05)levels in the patients.Conclusion Nine cyto-kines in plasma,such as IL-6,etc.may be involved in the formation of the inflammatory microenvironment of pancreatic cancer,as well as in the proliferation and differentiation of tumor cells.The determination of their plasma levels should be helpful for the assessing disease conditions and therapeutic effects.

Objective To investigate the expression and clinical significance of 12 plasma cytokines in patients with pancreatic cancer.Methods The study included 120 patients with pancreatic cancer diagnosed and treated at Qingdao University Affiliated Hospital and 68 healthy controls from March 2023 to June 2024.The levels of 12 plasma cytokines,including interleukin(IL)-1 β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12P,IL-17,interferon(IFN)-α,IFN-γ,and tumor necrosis factor(TNF)-α,were detected using mul-tiplex bead-based flow immunoassay.The levels of tumor markers carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9)and carbohydrate antigen 72-4(CA 72-4)in the serum of pancreatic cancer patients were detected by electrochemilumines-cence,while carbohydrate antigen 242(CA242)were detected by chemiluminescence methods.The correlation between the expression levels of differentially expressed cytokines and those of tumor markers was analyzed using Spearman's rank correlation.Results The plasma levels of 9 cytokines(IL-1 β,IL-4,IL-5,IL-6,IL-8,IL-10,IL-17,IFN-α,and IFN-γ)in the patients with pancreatic canc-er were significantly higher than those in controls(all P＜0.05).The levels of IL-1 β,IL-6,IL-8,IL-10,and IL-17 in the advanced pancreatic cancer group were significantly higher than those in the early-stage group(P＜0.05).The plasma IL-6 level in the poorly dif-ferentiated pancreatic cancer group was significantly higher than that in the well-differentiated group(P＜0.05).The serum levels of CEA,CA19-9,CA242,and CA72-4 in the advanced pancreatic cancer group were significantly higher than those in the early-stage group(P＜0.05).The serum CEA level in the poorly differentiated pancreatic cancer group was significantly higher than that in the moderately differentiated pancreatic cancer group(P＜0.05).After four cycles of chemotherapy,IL-8 levels in the disease control group were significantly reduced compared to pre-treatment levels(P＜0.05),while IL-6,IL-8,and IL-10 levels in the disease progression group were significantly elevated compared to pre-treatment levels(all P＜0.05).In the patients with pancreatic cancer,plasma IL-6 levels were positively correlated with serum CEA levels(rs=0.238,P＜0.01)and serum CA19-9 levels(rs=0.186,P＜0.05).The plasma IL-10 levels were positively correlated with serum CA72-4(rs=0.220,P＜0.05)levels in the patients.Conclusion Nine cyto-kines in plasma,such as IL-6,etc.may be involved in the formation of the inflammatory microenvironment of pancreatic cancer,as well as in the proliferation and differentiation of tumor cells.The determination of their plasma levels should be helpful for the assessing disease conditions and therapeutic effects.

The existing relevant standards and registration of disposable sterile surgical drapes were introduced,and four times of national supervision and sample inspection of disposable sterile surgical drapes from 2017 to 2023 were described.The unqualified items found in the supervision and sample inspection were analyzed,the exploratory research projects carried out were summarized and other problems encountered during the sample inspection were pointed out.Relevant enterprises were suggested to strengthen the implementation of industry standards,take seriously the product material identification information,clearly limit the raw materials used and standardize the product registration name.References were provided for the industrial supervision and development of disposable sterile surgical drapes.[Chinese Medical Equipment Journal,2025,46(5):66-72]

Objective:To investigate the biological role and molecular mechanism of checkpoint kinase 1 (CHK1) in delaying cardiac aging in mice.Methods:In vitro, a senescence model of H9C2 cells (a cardiomyocyte line) was induced using H 2O 2. A control group (without H 2O 2 treatment) and three H 2O 2-treated groups (at concentrations of 10, 30, and 50 μmol/L) were set up. The CCK-8 assay was used to evaluate the proliferative activity of cells in each group; Western blot analysis was employed to detect the expression level of CHK1; and quantitative real-time polymerase chain reaction (qRT-PCR) was utilized to determine the messenger RNA (mRNA) expression levels of P16 and interleukin-1β (IL-1β). In vivo, C57BL/6 wild-type mice aged 2 months ( n=15) and 24 months ( n=40), as well as myocardial-specific CHK1-overexpressing (CHK1-TG) mice aged 2 months ( n=15) and 24 months ( n=40), were selected. The mice were divided into four groups based on age and genotype: 2-month-old wild-type (WT-2M), 24-month-old wild-type (WT-24M), 2-month-old CHK1-TG (CHK1-TG-2M), and 24-month-old CHK1-TG (CHK1-TG-24M). Echocardiography was used to evaluate cardiac function of mice in the WT-24M and CHK1-TG-24M groups. Western blot analysis was conducted to measure the protein expression levels of CHK1, total Ras-related protein 1 (Rap1), NADPH oxidase 4 (Nox4), and Rap1-guanosine triphosphate (Rap1-GTP, the active form of Rap1) in the cardiac tissue of mice in each group. qRT-PCR was used to detect the messenger RNA (mRNA) expression levels of CHK1, collagen type Ⅰ (Coll1), matrix metalloproteinase-2 (Mmp2), alpha-smooth muscle actin (α-SMA), P53, P21, P16, thioredoxin 1 (Trx1), thioredoxin reductase (TrxR), glutathione recluctase (GR), Rap1, and Nox4. Immunofluorescence staining was employed to determine the protein expression levels of P53, P21, and P16, as well as the proportion of histone H2AX phosphorylation-positive cells. Dihydroethidium (DHE) staining was used to detect the relative intensity of DHE. Wheat germ agglutinin staining, HE staining, Masson staining and Sirius red staining were applied to measure the cross-sectional area of cardiomyocytes, cardiac morphology, and myocardial fibrosis area. Mice in the WT-24M and CHK1-TG-24M groups were intraperitoneally injected with the Rap1 activity inhibitor GGTI298 (25 μmol/kg). After injection, the oxidative stress damage in the cardiac tissue of the mice was detected, along with the mRNA expression levels of fibrosis-related indicators (Coll1, Mmp2, and α-SMA) and cell cycle inhibitory proteins (P16, P21, and P53). Results:A concentration of 30 μmol/L was determined as the optimal concentration for establishing an H 2O 2-induced senescence model of myocardial cells in vitro. The expression level of CHK1 in H9C2 cells of the 30 μmol/L H 2O 2 group was lower than that in the control group ( P<0.05). Echocardiographic examination showed that the left ventricular ejection fraction ((61.08±1.13)% vs. (52.55±2.02)%) and fractional shortening ((31.80±1.27)% vs. (25.18±1.59)%) of mice in the CHK1-TG-24M group were higher than those in the WT-24M group (both P<0.05). qRT-PCR and Western blot analysis revealed that, compared with the WT-24M group, mice in CHK1-TG-24M group had higher expression levels of CHK1 and its mRNA, lower expression levels of Nox4 and its mRNA, and higher expression level of Rap1-guanosine triphosphate (Rap1-GTP) (all P<0.05). However, there were no statistically significant differences in the total expression level of Rap1 and its mRNA between the two groups (both P>0.05). In addition, the mRNA expression levels of Coll1, Mmp2, and α-SMA in myocardial tissue of mice in the CHK1-TG-24M group were lower than those in the WT-24M group (all P<0.05). Immunofluorescence staining results showed that the expression levels of P53, P21, and P16 proteins, as well as the proportion of phosphorylated histone H2AX-positive cells in myocardial tissue of mice in the WT-24M group were higher than those in the CHK1-TG-24M group (all P<0.05). qRT-PCR further confirmed that the mRNA expression levels of the above-mentioned proteins in cardiac tissue of mice in the WT-24M group were higher than those in the CHK1-TG-24M group (all P<0.05). DHE staining results indicated that the relative intensity of DHE in cardiac tissue of mice in the CHK1-TG-24M group was lower than that in the WT-24M group ( P<0.05). Meanwhile, the left ventricular internal diameter, cross-sectional area of cardiomyocytes, and myocardial fibrosis area of mice in the CHK1-TG-24M group were all smaller than those in the WT-24M group (all P<0.05). Furthermore, the degree of DNA damage in cardiac tissue as well as the mRNA levels of fibrosis-related indicators (Coll1, Mmp2, and α-SMA) and cell cycle inhibitory proteins (P53, P21, P16) in mice of the WT-24M+GGTI298 group were higher than those in the WT-24M group and the CHK1-TG-24M+GGTI298 group (all P<0.05). Conclusion:CHK1 alleviates oxidative stress-induced damage in mouse cardiomyocytes by activating the Rap1/Nox4 signaling pathway, thereby delaying cardiac aging in mice.

This paper summarizes Professor LIU Fengbin's clinical experience in treating autoimmune liver disease （AILD） using the method of nourishing yin and removing stasis based on stage differentiation. He believes that the pathogenesis of AILD generally involves both deficiency in essence and excess in manifestation， with essence deficiency often presenting as liver and kidney yin deficiency， which may progress to spleen deficiency and yang deficiency over time. The excess manifestation commonly includes qi stagnation， blood stasis， damp-heat， and phlegm toxicity. Clinically， he advocates for the treatment principle of nourishing yin and removing stasis. On the foundation of nourishing liver and kidney yin， different pathological factors causing stasis are eliminated according to their nature. Treatment is also tailored to different stages of AILD. In the early and asymptomatic stages， liver qi stagnation and spleen deficiency are prominent， warranting a therapeutic approach of soothing the liver， regulating qi and strengthening the spleen. The modified Chaishao Qizhi Decoction （柴芍气滞汤） is used. During the symptomatic stage， pathogenic factors become more pronounced， often accompanied by a significant deficiency of vital qi， with damp-heat， water retention， and phlegm toxicity as key pathological features. The treatment should focus on strengthening the spleen and dispelling dampness， using modified Sijunzi Decoction （四君子汤） combined with Yinchen Wuling Powder （茵陈五苓散）. In the liver function decompensation stage， vital qi is severely deficient while pathogenic factors persist， with damp-heat， phlegm toxicity， and blood stasis obstructing the liver collaterals. Treatment should focus on nourishing blood， softening the liver， strengthening the spleen， and resolving stasis， using the modified Ruangan Yangxue Decoction （软肝养血汤）. Throughout the treatment process， emphasis is placed on tonifying the liver and kidneys while protecting yin fluids.

INTRODUCTION: In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) virus emerged and caused a worldwide pandemic, leading to measures being imposed by many countries to reduce its transmission. Singapore implemented the 'circuit breaker', which restricted all movements except for access to necessities and healthcare services. We aimed to investigate the impact of lockdown measures on the pattern of trauma and its effects. METHODS: An observational, retrospective, single-centre descriptive study was conducted using the trauma registry in Singapore General Hospital. It included patients above 18 years old who presented to the emergency department with trauma and were subsequently admitted. Patients admitted from 1 February 2020 to 31 July 2020 and those admitted during the same timeframe in 2019 were studied. Subgroup analyses were performed for patients aged ≥65 years and those <65 years. RESULTS: A total of 1,037 patients were included for analysis. A 17.6% increase in trauma presentations was seen from 2019 to 2020. Patients aged ≥65 years accounted for the rise in admissions. The predominant mechanism of injury was falls at home for older patients and vehicular accidents in patients <65 years. There were no significant differences in injury severity score, intensive care/high-dependency unit admission rates, length of stay, mortality rate, and subsequent need for inpatient rehabilitation. CONCLUSION Our study provided information on differences in trauma presentations before and during the COVID-19 pandemic. Further studies are required to better inform on additional precautionary measures needed to reduce trauma and improve safety during future lockdowns and pandemics.
Humans ; COVID-19/prevention & control* ; Aged ; Retrospective Studies ; Singapore/epidemiology* ; Male ; Female ; Wounds and Injuries/epidemiology* ; Aged, 80 and over ; Middle Aged ; SARS-CoV-2 ; Hospitalization/statistics & numerical data* ; Adult ; Emergency Service, Hospital/statistics & numerical data* ; Registries ; Accidental Falls/statistics & numerical data* ; Pandemics ; Patient Admission/statistics & numerical data* ; Length of Stay ; Accidents, Traffic/statistics & numerical data*

INTRODUCTION: The primary objective of this guideline is to establish evidence-based recommendations for the clinical use of parenteral nutrition (PN) in adult patients within the acute hospital setting in Singapore. METHOD: An expert workgroup, consisting of healthcare practitioners actively involved in clinical nutrition support across all public health institutions, systematically evaluated existing evidence and addressed clinical questions relating to PN therapy. RESULTS: This clinical practice guideline developed 30 recommendations for PN therapy, which cover these key aspects related to PN use: indications, patient assess-ment, titration and formulation of PN bags, access routes and devices, and monitoring and management of PN-related complications. CONCLUSION This guideline provides recommendations to ensure appropriate and safe clinical practice of PN therapy in adult patients within the acute hospital setting.
Humans ; Singapore ; Parenteral Nutrition/adverse effects* ; Adult