Impact of hyperkalaemia on renin-angiotensin-aldosterone (RAAS) inhibitor reduction or withdrawal following hospitalisation.

Background: Inhibitors of the renin-angiotensin-aldosterone system (RAAS), such as ACE inhibitors (ACEi), angiotensin-II receptor blockers and mineralocorticoid receptor antagonists, reduce morbidity and mortality in hypertension, congestive heart failure and chronic kidney disease. However, their use can lead to hyperkalaemia. We examined the proportions of RAAS inhibitor (RAASi) reduction or withdrawal, across GFR strata, following hospitalisation and the effect on patient mortality.

Cost-Effectiveness of Laparoscopic vs Open Liver Resection: A Propensity Score-Matched Single-Center Analysis of 920 Cases.

Background: This study compared the clinical and economic outcomes of laparoscopic (LLR) and open liver resection (OLR) for all hepatectomies, including minor and major hepatectomies.

Study Design: This retrospective study included 920 consecutive elective patients undergoing liver resection from 2017 to 2023. Patient demographics, postoperative surgical outcomes, postoperative length of stay (LOS), and costs were compared between LLR and OLR before and after propensity score matching (PSM).

Childhood acute flaccid myelitis, including the first confirmed cases of enterovirus D68 myelitis, in Singapore and Southeast Asia.

Aim: We report the epidemiology, treatment and outcomes of acute flaccid myelitis (AFM), including the first two cases of enterovirus (EV) D68 myelitis, in Singapore.

Methods: Retrospective observational study from a paediatric hospital in Singapore, from January 2012 to December 2022. Clinical, laboratory, neuroimaging and outcome data were analysed.

An Online Resource for Monitoring 24-Hour Activity in Children and Adolescents: Observational Analysis.

Background: The Singapore integrated 24-hour activity guide for children and adolescents was introduced to promote healthy lifestyle behaviors, including physical activity, sedentary behavior, sleep, and diet, to enhance metabolic health and prevent noncommunicable diseases. To support the dissemination and implementation of these recommendations, a user-friendly online resource was created to help children and adolescents adopt these behaviors in Singapore.

Objective: This study aimed to assess the acceptability of the online resource in the adoption of healthier lifestyle behaviors, and the change in the users' behaviors with the use of this online resource.

The salience of an agency experience influences its ability to improve memory.

Previous work reported that having a strong sense of agency can enhance memory for acted-upon items: Memory enhancement is evident when there is a strong sense of agency, but not when there is only a weak sense of agency. However, because of the way trials are distributed across conditions in typical studies, it is often the case that a strong sense of agency may also be very salient because it is experienced only infrequently within the context of the experiment. In this study, we examined the importance of salience in determining the memory enhancement potential of a sense of agency.

Hyperglycemia-triggered lipid peroxidation destabilizes STAT4 and impairs anti-viral Th1 responses in type 2 diabetes.

Patients with type 2 diabetes (T2D) are more susceptible to severe respiratory viral infections, but the underlying mechanisms remain elusive. Here, we show that patients with T2D and coronavirus disease 2019 (COVID-19) infections, and influenza-infected T2D mice, exhibit defective T helper 1 (Th1) responses, which are an essential component of anti-viral immunity. This defect stems from intrinsic metabolic perturbations in CD4 T cells driven by hyperglycemia.

Antimicrobial surface coating in the emergency department as protective technology for infection control (ASEPTIC): a pilot randomized controlled trial.

Study Objective: We examined the effectiveness of an antimicrobial surface coating for continual disinfection of high touch-frequency surfaces in the emergency department (ED).

Methods: Following a preliminary observation identifying stretcher rails as the surface with highest touch-frequency in the ED, we conducted a pilot randomized controlled trial involving 96 stretcher rails. The stretchers were randomized to receive an antimicrobial surface coating or placebo coating.

Matrix stiffening from collagen fibril density and alignment modulates YAP-mediated T-cell immune suppression.

T-cells are essential components of the immune system, adapting their behavior in response to the mechanical environments they encounter within the body. In pathological conditions like cancer, the extracellular matrix (ECM) often becomes stiffer due to increased density and alignment of collagen fibrils, which can have a significant impact on T-cell function. In this study, we explored how these ECM properties-density and fibrillar alignment-affect T-cell behavior using three-dimensional (3D) collagen matrices that mimic these conditions.

Optimal treatment strategies for gallbladder disease in pregnancy: a systematic review with dual network meta-analyses.

Background: This study sought to determine the optimal treatment strategy and timing for cholecystectomy in managing gallbladder diseases during pregnancy. It evaluated the effectiveness of conservative management (CM), laparoscopic cholecystectomy (LC), and open cholecystectomy (OC) in pregnancy and compared cholecystectomy outcomes across three trimesters.

Methods: Studies comparing CM, LC, and OC or evaluating cholecystectomy outcomes across trimesters were included in a literature search until February 2024.

Neutrophil plasticity in liver diseases.

The liver has critical digestive, metabolic, and immunosurveillance roles, which get disrupted during liver diseases such as viral hepatitis, fatty liver disease, and hepatocellular carcinoma. While previous research on the pathological development of these diseases has focused on liver-resident immune populations, such as Kupffer cells, infiltrating immune cells responding to pathogens and disease also play crucial roles. Neutrophils are one such key population contributing to hepatic inflammation and disease progression.

Investigating urinary characteristics and optimal urine white blood cell threshold in paediatric urinary tract infection: A prospective observational study.

Introduction: While the definitive diagnosis of urinary tract infection (UTI) requires a positive urine culture, the likelihood of UTI can be determined by urinalysis that includes white blood cell (WBC) count. We aimed to determine the optimal urine WBC threshold in urinalysis to predict UTIs in children presenting at the emergency department (ED).

Method: We performed a prospective observational study in the ED at KK Women's and Children's Hospital for children below 18 years old who underwent both urine microscopy and urine cultures, between 10 January and 7 November 2022.

Hybrid strategy of drug-eluting stent and drug-coated balloon in the treatment of de novo coronary artery disease: 1-year clinical outcomes.

Background: The hybrid strategy of drug-eluting stent (DES) and drug-coated balloon (DCB) has been increasingly accepted for the treatment of coronary artery disease. However, data regarding the clinical outcome of this practice in a Southeast Asian population are limited.

Aims: We aimed to investigate the safety and clinical outcome of this hybrid strategy (DES and DCB) in the treatment of coronary artery disease.

A NOVEL FOUR-POINT SCLERAL FIXATION TECHNIQUE WITH A HYDROPHOBIC INTRAOCULAR LENS: The Loop to Optic and Trailing end to Outside Technique.

Purpose: To describe a new surgical technique that combines four-point, flanged polypropylene scleral fixation with a hydrophobic intraocular lens (IOL).

Methods: Using the Envista MX60 and 6.0 polypropylene, scleral four-point fixation was achieved using a flanged-suture technique five times in a model eye and in a case series of eight patients, retrospectively reviewed.

Enhancing clinical data retrieval with Smart Watchers: a NiFi-based ETL pipeline for Elasticsearch queries.

Background: The aim is to develop and deploy an automated clinical alert system to enhance patient care and streamline healthcare operations. Structured and unstructured data from multiple sources are used to generate near real-time alerts for specific clinical scenarios, with an additional goal to improve clinical decision-making through accuracy and reliability.

Methods: The automated clinical alert system, named Smart Watchers, was developed using Apache NiFi and Python scripts to create flexible data processing pipelines and customisable clinical alerts.

Near-Peer Tutoring for Surgical Examination Preparation for Final Year Exam Readiness (Project SEPFYR).

Background: Traditional surgical education often lacks targeted preparation for the interactive components of examinations, such as viva voce and objective structured clinical examination (OSCE) assessments. We present our approach and explore the efficacy of a near-peer tutoring program aimed at enhancing final-year students' readiness for such assessments.

Methods: Project SEPFYR (surgical exam prep for final year exam readiness) was conducted within a near-peer tutoring framework and comprised interactive discussions of selected case scenarios focusing on viva voce techniques and OSCE responses.

Metroticket approach in a retrospective cohort study to predict overall survival after surgical resection for hepatocellular carcinoma.

Background: Surgical resection is a curative therapy for early-stage hepatocellular carcinoma (HCC) patients meeting the Milan criteria as well as a widely used therapy in intermediate-stage HCC. However, intermediate-stage HCC encompasses a wide spectrum of disease and there is a lack of good predictive models for the long-term clinical outcome of HCC patients currently. Here, the authors adopt Mazzaferro's Metroticket 2.

Interfacial Reactions in Chemical Recycling and Upcycling of Plastics.

Depolymerization of plastics is a leading strategy to combat the escalating global plastic waste crisis through chemical recycling, upcycling, and remediation of micro-/nanoplastics. However, critical processes necessary for polymer chain scission, occurring at the polymer-catalyst or polymer-fluid interfaces, remain largely overlooked. Herein, we spotlight the importance of understanding these interfacial chemical processes as a critical necessity for optimizing kinetics and reactivity in plastics recycling and upcycling, controlling reaction outcomes, product distributions, as well as improving the environmental sustainability of these processes.