Objective Jejunal interposition is an important option for restoring gastrointestinal continuity in patients with complex esophageal cancer in whom the stomach is unavailable for reconstruction due to previous gastrectomy, tumor involvement, failed gastric conduit, or other constraints. Although the jejunum offers a caliber similar to the esophagus, a rich blood supply, and preserved peristaltic function, anatomical variations in mesenteric length and vascular arcades render long-segment and high-level reconstruction susceptible to excessive tension, mesenteric torsion, venous congestion, and inadequate distal perfusion. This consensus aims to provide standardized recommendations for the application of jejunal interposition in this specific patient population. Methods This consensus was developed in accordance with the WHO Handbook for Guideline Development and Chinese national guideline development standards, with reference to the Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREE Ⅱ), Reporting Items for Practice Guidelines in Healthcare (RIGHT), and Scientific, Transparent and Applicable Rankings (STAR) checklists. The project was registered on the international practice guidelines registry platform (PREPARE-2026CN1384). The working group systematically searched Chinese and English evidence addressing 12 clinical questions. Evidence was graded using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2009 system, with structured appraisal of risk of bias, inconsistency, indirectness, and imprecision. Recommendations were formulated through two rounds of Delphi surveys and a face-to-face consensus meeting, with an agreement threshold of ≥75%. Results The consensus generated 12 recommendations covering indications, selection between jejunum and colon, preoperative assessment, surgical approach and reconstruction route, pedicled jejunal interposition (PJI), supercharged pedicled jejunal interposition (SPJ), indocyanine green (ICG) perfusion assessment, perioperative nutrition, management of anastomotic leakage, long-term follow-up, and special treatment scenarios. Given that the available direct evidence is predominantly derived from single-center retrospective cohorts and case series, recommendations extrapolated from general esophagectomy or other gastrointestinal surgical evidence are deliberately phrased with caution. Conclusion Jejunal interposition is a safe and effective approach for digestive tract reconstruction in patients with complex esophageal cancer in whom the stomach is unavailable. This consensus emphasizes that clinical decision-making should be individualized based on the patient's prior treatment history, reconstruction height, vascular anatomy, technical availability, and institutional experience in the Chinese context.

INTRODUCTION: Preterm birth (PTB) remains a leading cause of perinatal morbidity and mortality worldwide. Understanding Singapore's PTB trends and associated risk factors can inform effective strategies for screening and intervention. This study analyses PTB trends in Singapore from 2017 to 2023, identifies risk factors in this multi-ethnic population and evaluates a predictive model for PTB. METHOD: A retrospective analysis of all PTBs between 22+0 and 36+6 weeks of gestation, from 1 January 2017 to 31 December 2023, was performed by extracting maternal and neonatal data from electronic medical records. These PTBs were taken from the registry of births for Singapore and SingHealth cluster data. Cochran- Armitage trend test and multinomial logistic regression were used. An extreme gradient boosting (XGBoost) model was developed to test and predict the risk of PTB. RESULTS: The PTB rate in Singapore did not show a significant change. However, there was modest downward trend in the SingHealth population from 11.3% to 10.2%, mainly in late spontaneous PTBs (sPTBs). sPTBs accounted for ∼60% of PTBs. Risk factors for very/extreme sPTB included Chinese ethnicity, age ≥35 years, body mass index (BMI) ≥23 kg/m², being unmarried, primiparity, twin pregnancy and maternal blood group AB. The XGBoost model achieved an area under the receiver operating characteristic curve of 0.75, indicating moderate ability to predict PTB. CONCLUSION The overall PTB rate in Singapore has not improved. This study underscores the importance of local factors, particularly advanced maternal age, BMI, primiparity, unmarried, Chinese ethnicity and maternal blood group AB influencing PTB risk. Artificial intelligence methods show promise in improving PTB risk stratification, ultimately supporting personalised care and intervention.
Humans ; Singapore/epidemiology* ; Retrospective Studies ; Female ; Risk Factors ; Premature Birth/ethnology* ; Pregnancy ; Adult ; Infant, Newborn ; Asian People/statistics & numerical data* ; Gestational Age ; Body Mass Index ; Maternal Age ; Logistic Models ; Ethnicity

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

Hypertrophic cardiomyopathy (HCM) is a major contributor to cardiovascular diseases (CVD), the leading cause of death globally. HCM can precipitate heart failure (HF) by causing the cardiac tissue to weaken and stretch, thereby impairing its pumping efficiency. Moreover, HCM increases the risk of atrial fibrillation, which in turn elevates the likelihood of thrombus formation and stroke. Given these significant clinical ramifications, research into the etiology and pathogenesis of HCM is intensifying at multiple levels. In this review, we discuss and synthesize the latest findings on HCM pathogenesis, drawing on key experimental studies conducted both in vitro and in vivo. We also offer our insights and perspectives on these mechanisms, while highlighting the limitations of current research. Advancing fundamental research in this area is essential for developing effective therapeutic interventions and enhancing the clinical management of HCM.
Cardiomyopathy, Hypertrophic/physiopathology* ; Humans ; Animals

The minor purchasing process and mode of some hospital were introduced,and the implementation of the hospital's minor purchasing projects in the past year was analyzed.The causes for high failure rate of purchasing were pointed out including long interval between project creation and procurement,unreasonable demand presentation,insufficient demand demonstration and lack of active participation of suppliers.Some suggestions were put forward such as timely adjustment of demands,strengthening of demand demonstration,improvement of supplier motivation and enhancement of procurement process management,which were of great significance for increasing the success rate of minor purchasing of the hospital.[Chinese Medical Equipment Journal,2025,46(8):91-95]

Aim To explore the mechanism of clar-ithromycin in treating inflammatory bowel disease(IBD)by inhibiting Kv1.3 channel protein in colonic epithelial cells.Methods A chronic IBD rat model was induced using dextran sulfate sodium(DSS)in vi-vo experiments,with clarithromycin intervention.The physical signs of each group of rats were observed,and the disease activity index(DAI)score and colonic mu-cosal damage index(CMDI)score were calculated.RT-qPCR was used to detect the levels of relevant cyto-kines in colonic tissue of rats.Flow cytometry was em-ployed to detect the relative proportions of immune cells in the peripheral blood and colonic tissue of each group of rats.Lipopolysaccharide(LPS)was used to establish an inflammation model of colon epithelial cells(NCM460)to clarify the inhibitory effect of clar-ithromycin on Kv1.3 channel protein.Results In vi-vo experiments:compared to the model group,the clar-ithromycin intervention group exhibited a reduced de-gree of weight loss(P＜0.01),and a significant de-crease in DAI scores(P＜0.01).There was an in-crease in colon length,a reduction in weight,and a de-crease in CMDI scores(P＜0.05).Levels of TNF-α,IL-1 β,and IL-6 in colon tissue were significantly re-duced(P＜0.01).The numbers of peripheral blood and colonic regulatory T lymphocytes(Th),cytotoxic T lymphocytes(CTL),natural killer cells(NK),B lym-phocytes(B),and dendritic cells(DC)were signifi-cantly decreased(P＜0.05).Clarithromycin reduced the expression of Kv1.3 channel protein in colon tissue(P＜0.05).In vitro experiments:compared to the model group,the clarithromycin group significantly pro-moted the proliferation of NCM460 cells(P＜0.01)and simultaneously significantly reduced the levels of TNF-α and IL-6 in cells(P＜0.05).Clarithromycin also reduced the expression of Kv1.3 channel protein in NCM460 cells(P＜0.05).Conclusions Clar-ithromycin may play an immunomodulatory role by in-hibiting the expression of Kv1.3 channel protein,re-ducing inflammation in the body,and playing a role in the treatment of IBD.

Objective To explore the current situation,hot spots and trends of clinical research on the treatment of carotid atherosclerosis(CAS)with traditional Chinese medicine.Methods Search CNKI,Wanfang,VIP,Web of Science core collection database related literature,using Python 3.9.6 cleaning data,using CiteSpace and VOSviewer for visual analysis of authors,institutions,keywords,etc.Results 910 Chinese literatures and 5 English literatures were included.The most published authors were Wang Changyin and Yin Chunping,and the institution was Handan Hospital of Traditional Chinese Medicine,Hebei Province.The cooperation between institutions was independent and regional.Research focus on:phlegm stasis interjunction,dyslipidemia,inflammatory factors,vascular endothelial function,nerve function defect,Banxia Baizhu Tianma decoction,coronary heart disease and so on;The treatment of CAS from"interjunction of phlegm and blood stasis"will continue to become a research hotspot in this field.Conclusion The clinical research of traditional Chinese medicine in the treatment of CAS should be closely combined with the observation of curative effect and the revelation of mechanism,and the law of traditional Chinese medicine in the treatment of CAS should be explored.In the future,the treatment of CAS should focus on the treatment of"phlegm and blood stasis",and the pathogenesis principle of"phlegm and blood stasis",the efficacy and mechanism of resolving phlegm and removing blood stasis in the treatment of CAS should be systematically and deeply explored.

The minor purchasing process and mode of some hospital were introduced,and the implementation of the hospital's minor purchasing projects in the past year was analyzed.The causes for high failure rate of purchasing were pointed out including long interval between project creation and procurement,unreasonable demand presentation,insufficient demand demonstration and lack of active participation of suppliers.Some suggestions were put forward such as timely adjustment of demands,strengthening of demand demonstration,improvement of supplier motivation and enhancement of procurement process management,which were of great significance for increasing the success rate of minor purchasing of the hospital.[Chinese Medical Equipment Journal,2025,46(8):91-95]

Aim To explore the mechanism of clar-ithromycin in treating inflammatory bowel disease(IBD)by inhibiting Kv1.3 channel protein in colonic epithelial cells.Methods A chronic IBD rat model was induced using dextran sulfate sodium(DSS)in vi-vo experiments,with clarithromycin intervention.The physical signs of each group of rats were observed,and the disease activity index(DAI)score and colonic mu-cosal damage index(CMDI)score were calculated.RT-qPCR was used to detect the levels of relevant cyto-kines in colonic tissue of rats.Flow cytometry was em-ployed to detect the relative proportions of immune cells in the peripheral blood and colonic tissue of each group of rats.Lipopolysaccharide(LPS)was used to establish an inflammation model of colon epithelial cells(NCM460)to clarify the inhibitory effect of clar-ithromycin on Kv1.3 channel protein.Results In vi-vo experiments:compared to the model group,the clar-ithromycin intervention group exhibited a reduced de-gree of weight loss(P＜0.01),and a significant de-crease in DAI scores(P＜0.01).There was an in-crease in colon length,a reduction in weight,and a de-crease in CMDI scores(P＜0.05).Levels of TNF-α,IL-1 β,and IL-6 in colon tissue were significantly re-duced(P＜0.01).The numbers of peripheral blood and colonic regulatory T lymphocytes(Th),cytotoxic T lymphocytes(CTL),natural killer cells(NK),B lym-phocytes(B),and dendritic cells(DC)were signifi-cantly decreased(P＜0.05).Clarithromycin reduced the expression of Kv1.3 channel protein in colon tissue(P＜0.05).In vitro experiments:compared to the model group,the clarithromycin group significantly pro-moted the proliferation of NCM460 cells(P＜0.01)and simultaneously significantly reduced the levels of TNF-α and IL-6 in cells(P＜0.05).Clarithromycin also reduced the expression of Kv1.3 channel protein in NCM460 cells(P＜0.05).Conclusions Clar-ithromycin may play an immunomodulatory role by in-hibiting the expression of Kv1.3 channel protein,re-ducing inflammation in the body,and playing a role in the treatment of IBD.