Dynamics of Neutrophil-to-Lymphocyte Ratio (NLR), Lymphocyte-to-Monocyte Ratio (LMR), and Platelet-to-Lymphocyte Ratio (PLR) in Patients with Deep Neck Infection.

Background: Inflammatory biomarkers, including the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR), have been utilized as prognostic factors in various diseases. This study aims to evaluate changes in the NLR, PLR, and LMR in patients diagnosed with a deep neck infections (DNI) to identify useful prognostic markers. Methods: This single-center, retrospective cohort study utilized data from the electronic medical records of patients admitted to the ENT department of a tertiary university hospital between January 2000 and August 2024. Patients diagnosed with a DNI during the study period were enrolled. Preoperative and postoperative inflammatory markers were measured in all patients, and NLR, LMR, and PLR values were calculated and analyzed. Results: The post-treatment NLR was significantly lower than the pre-treatment NLR. Similarly, the post-treatment LMR was significantly higher and the post-treatment PLR was significantly lower compared to pre-treatment values. Patients admitted to the ICU had higher inflammatory markers than those in general wards. Additionally, patients with elevated inflammatory markers had longer hospital stays. Inflammatory markers were also higher in older patients and those who underwent surgical treatment. Conclusions: Significant changes in the NLR, LMR, and PLR in patients diagnosed with a DNI can serve as useful prognostic markers. These findings suggest that monitoring these markers may help to assess and improve the inflammatory status of patients, highlighting their potential role in guiding treatment.

Validating the CHAMPS Score: A Novel and Reliable Prognostic Score of Non-Variceal Upper Gastrointestinal Bleeding.

Introduction: The Charlson Comorbidity Index ≥2, in-Hospital onset, Albumin <2.5 g/dL, altered Mental status, Eastern Cooperative Oncology Group Performance status ≥2, Steroid use (CHAMPS) score is a novel and promising prognostic tool. We present an initial external validation of the CHAMPS score for predicting mortality in acute nonvariceal upper gastrointestinal bleeding (NVUGIB) across multiple clinical outcomes. Methods: A prospective cohort study was conducted on adult patients with NVUGIB admitted to the Department of Gastroenterology between November 2022 and June 2023. The CHAMPS score performance in predicting in-hospital outcomes was evaluated by employing area under the receiver operating characteristic (AUROC) curves, followed by a comparative analysis with five pre-existing scores. Results: A total of 140 patients were included in the study. The CHAMPS score showed its highest performance in predicting mortality rates (AUROC = 0.89), significantly outperforming the Glasgow-Blatchford Bleeding Score (GBS) as well as the Albumin level <3.0 mg/dL, International normalized ratio >1.5, altered Mental status, Systolic blood pressure ≤90 mmHg, and age >65 years (AIMS65) score (AUROC = 0.72 and 0.71, respectively; all p < 0.05). Subgroup analysis for bleeding-related and non-bleeding-related mortality further confirmed the robust predictive capability of the CHAMPS score (AUROC = 0.88 and 0.87, respectively). The CHAMPS score failed to predict rebleeding and intervention reliably, exhibiting AUROC values of 0.43 and 0.55, respectively. The optimal CHAMPS score cutoff value for predicting mortality was 3 points, achieving 100% sensitivity and 71.2% specificity. In the low-risk category defined by both CHAMPS and GBS scores, mortality and rebleeding rates were 0%. However, within the CHAMPS score-based low-risk group, 58.8% required intervention, contrasting with a 0% intervention rate for the GBS score-based low-risk group (GBS score ≤1). Conclusion: The CHAMPS score consistently demonstrated a robust predictive performance for mortality (AUROC > 0.8), facilitating the identification of high-risk patients requiring aggressive treatment and low-risk patients in need of localized treatment or safe discharge after successful bleeding control.

An open dataset on individual perceptions of transport policies.

Many cities are facing challenges caused by the increasing use of motorised transport and Hanoi, Vietnam, is no exception. The proliferation of petrol powered motorbikes has caused serious problems of congestion, pollution, and road safety. This paper reports on a new survey dataset that was created as part of the Urban Transport Modelling for Sustainable Well-Being in Hanoi (UTM-Hanoi) project. The survey of nearly 30,000 respondents gathers data on households' demographics, perceptions, opinions and stated behaviours. The data are informative in their own right and have also been used to experiment with multi-scale spatial statistics, synthetic population generation and machine learning approaches to predicting an individual's perceptions of potential government policies. The paper reports on the key findings from the survey and conducts a technical validation to contrast the outcomes to similar datasets that are available.

Synthesis and Characteristics of Polymer-Mediated Curcumin Molecular Imprinting for Quantitative Determination of Curcumin in Food Samples.

In this study, a molecularly imprinted polymer (MIP)-based extraction process for determining curcumin in food samples was carried out. MIP and NIP were thermally synthesized in acetonitrile solvent (porogen) using methacrylic acid as a functional monomer, ethylene glycol dimethacrylate as a cross-linking agent, azobisisobutyronitrile as an initiator, and curcumin as a template molecule. Parameters affecting the synthesis process, such as temperature, the ratio of the components in the reaction, and the extraction solvent, were investigated. The characteristics of the synthesized material were examined using infrared spectroscopy and scanning electron microscopy. The maximum adsorption capacity of the material was found to be 1.34 mg/g MIP with an adsorption efficiency of 89.96% for MIP and 12.35% for NIP. The MIP material exhibited high selectivity for curcumin compared to other compounds such as quercetin (18.00%), rutin (14.74%), and ketoconazole (0.00%). The analysis method for curcumin using the MIP material was performed with validated parameters including linear range (1 - 25 mg/L, r2 = 0.9997), accuracy (recovery rate of 90.90 %), precision (RSDR = 0.338 %, RSDr = 1.591 %), detection limit (0.051 mg/L), and quantification limit (0.156 mg/L). The validation results indicated that the HPLC-DAD method was entirely suitable for analyzing the curcumin content in food samples.

Evaluating M2BPGi as a Marker for Liver Fibrosis in Patients with Chronic Hepatitis B.

BACKGROUND: The accurate evaluation of liver fibrosis is crucial for the treatment and follow up of chronic hepatitis B (CHB) patients. AIM: We examined the efficiency of serum Mac-2 Binding Protein Glycosylation isomer (M2BPGi) in diagnosing liver fibrosis stages in CHB patients. METHODS: A cross-sectional study was conducted on 177 adult CHB patients visiting the University Medical Center Ho Chi Minh City, Vietnam between October 2019 and December 2021. M2BPGi, ARFI, APRI, and FIB-4 were tested against FibroScan® for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The optimal M2BPGi cut-off values were identified based on the area under the receiver operating characteristic (AUROC) curve. RESULTS: There was a strong agreement between M2BPGi and FibroScan® (r = 0.77, P < 0.001). The optimal M2BPGi cut-off index (C.O.I) for detecting significant fibrosis (F ≥ 2) was 0.79 with an AUROC of 0.77, 67.3% sensitivity, 70% specificity, 60.6% NPV, and 75.3% PPV. Compared with APRI (61%) and FIB-4 (47%), M2BPGi had the greatest sensitivity for diagnosing F ≥ 2. M2BPGi combined with APRI yielded highest diagnosis performance for F ≥ 2 with an AUROC of 0.87. The optimal cut-off index of M2BPGi for diagnosing cirrhosis (F4) was 1.3 with an AUROC of 0.91, 88% sensitivity, 87.4% specificity, 97% NPV, and 61% PPV. The AUROC of M2BPGi for diagnosing F4 was comparable to that of ARFI (0.93). CONCLUSIONS: With cut-off values of 0.79 C.O.I and 1.3 C.O.I, M2BPGi could be an effective method for diagnosing significant fibrosis and cirrhosis in CHB patients, respectively.

Deficient Mismatch Repair Proteins in Gastric Mixed Neuroendocrine Non-Neuroendocrine Neoplasm: A Rare Case Report.

Mixed neuroendocrine non-neuroendocrine neoplasm (MiNEN) is a rare type of gastric carcinoma with controversial diagnosis and treatment. Recent data implies that deficiency mismatch repair proteins inducing microsatellite instability are considered one of the potential drivers of this disease. Hence, we report a stomach MiNEN with MMR protein loss. An admitted 60-year-old woman complained of epigastric pain. The pathological analysis of the gastro-endoscopic biopsy specimen revealed gastric adenocarcinoma. The radiological staging was cT3N1M0; therefore, she received D2 distal gastrectomy. Suspecting neuroendocrine component admix with adenocarcinoma part on the resected specimen microscopy, applying biomarkers including AE 1/3, synaptophysin, and chromogranin A to confirm the diagnosis of MiNEN. The neuroendocrine part was classified as neuroendocrine tumor grade 2 with Ki 67 at 16.5%. To further understand the molecular characterization of this disease, we evaluated mismatch protein expression by staining MLH1, MSH2, MSH6, and PMS2 antibodies. Interestingly, both components lost MLH1 and PMS2 proteins. Her radical surgery followed oxaliplatin/capecitabine adjuvant chemotherapy. The patient is still well after eight cycles of chemotherapy. dMMR gastric MiNENs and dMMR gastric cancer share many clinical and genetic characteristics. Further studies are necessary to survey the role of dMMR in the prognosis and treatment of this entity.

Dynamic organization of cerebellar climbing fiber response and synchrony in multiple functional components reduces dimensions for reinforcement learning.

Cerebellar climbing fibers convey diverse signals, but how they are organized in the compartmental structure of the cerebellar cortex during learning remains largely unclear. We analyzed a large amount of coordinate-localized two-photon imaging data from cerebellar Crus II in mice undergoing 'Go/No-go' reinforcement learning. Tensor component analysis revealed that a majority of climbing fiber inputs to Purkinje cells were reduced to only four functional components, corresponding to accurate timing control of motor initiation related to a Go cue, cognitive error-based learning, reward processing, and inhibition of erroneous behaviors after a No-go cue. Changes in neural activities during learning of the first two components were correlated with corresponding changes in timing control and error learning across animals, indirectly suggesting causal relationships. Spatial distribution of these components coincided well with boundaries of Aldolase-C/zebrin II expression in Purkinje cells, whereas several components are mixed in single neurons. Synchronization within individual components was bidirectionally regulated according to specific task contexts and learning stages. These findings suggest that, in close collaborations with other brain regions including the inferior olive nucleus, the cerebellum, based on anatomical compartments, reduces dimensions of the learning space by dynamically organizing multiple functional components, a feature that may inspire new-generation AI designs.

Thiourea derivatives containing 4-arylthiazoles and d-glucose moiety: design, synthesis, antimicrobial activity evaluation, and molecular docking/dynamics simulations.

Some substituted glucose-conjugated thioureas containing 1,3-thiazole ring, 4a-h, were synthesized by the reaction of the corresponding substituted 2-amino-4-phenyl-1,3-thiazoles 2a-h with 2,3,4,6-tetra-O-acetyl-ß-d-glucopyranosyl isocyanate. The antibacterial and antifungal activities of these thiazole-containing thioureas were estimated using a minimum inhibitory concentration protocol. Among these compounds, 4c, 4g, and 4h were better inhibitors with MIC = 0.78-3.125 µg mL-1. These three compounds were also tested for their ability to inhibit S. aureus enzymes, including DNA gyrase, DNA topoisomerase IV (Topo IV), and dihydrofolate reductase, and compound 4h was found to be a strong inhibitor with IC50 = 1.25 ± 0.12, 67.28 ± 1.21, and 0.13 ± 0.05 µM, respectively. Induced-fit docking and MM-GBSA calculations were performed to observe the binding efficiencies and steric interactions of these compounds. The obtained results showed that compound 4h is compatible with the active site of S. aureus DNA gyrase 2XCS with four H-bond interactions with residues Ala1118, Met1121, and F:DC11 and also three interactions with F:DG10 (two interactions) and F:DC11 (one interaction). Molecular dynamics simulation in a water solvent system showed that ligand 4h had active interactions with enzyme 2XCS through residues Ala1083, Glu1088, Ala1118, Gly1117, and Met1121.

Colonic Dilatation Complicating Acute Severe Ulcerative Colitis Managed Successfully with Accelerated Infliximab Dosing.

Lately, emerging data suggest an association between the development of inflammatory bowel disease and anti-interleukin-17 therapy. Megacolon is a life-threatening complication of acute severe ulcerative colitis (ASUC), but its treatment has not yet been established in current practice guidelines. We report a rare case of known psoriasis treated by secukinumab in a patient who presented with ASUC and colonic dilatation. Neither steroids nor standard infliximab regimen was effective. Finally, rescue therapy with accelerated infliximab strategy resulted in excellent recovery. In certain cases of steroid-refractory ASUC complicated by megacolon, accelerated infliximab regimen can be an alternative to surgery.

1H-1,2,3-Triazole-4H-chromene-D-glucose hybrid compounds: Synthesis and inhibitory activity against Mycobacterium tuberculosis protein tyrosine phosphatase B.

A series of 1H-1,2,3-triazole-4H-chromene-D-glucose hybrid compounds 7a-w were synthesized using click chemistry of 2-amino-7-propargyloxy-4H-chromene-3-carbonitriles 5a-w. CuNPs@montmorillonite was used as a catalyst in the presence of DIPEA as an additive for this chemistry. All synthesized 1H-1,2,3-triazoles were examined for in vitro inhibition against Mycobacterium tuberculosis protein tyrosine phosphatase B (MtbPtpB). Nine 1H-1,2,3-triazoles, including 7c-e, 7h, 7i, and 7r-t, displayed remarkable inhibitory activity against MtbPtpB with IC50 < 10 µM; compound 7t exhibited the most potent inhibition in vitro with an IC50 value of 0.61 µM. Kinetic studies of the three most active compounds, 7c,h,t, showed their competitive inhibition toward the MtbPtpB enzyme. Induced-fit docking and MM-GBSA studies on the enzyme (PDB: 2OZ5) revealed that the most active compound 7t was more effective against MtbPtpB. Residues Arg64, Arg136, Ash165, Arg166, and Arg63 in the binding pocket were identified as potential ligand-binding hot-spot residues for ligand 7t. The binding free energy calculation by the MM-GBSA approach for ligand 7t indicated that Coulomb, lipophilic, and van der Waals energy terms are major contributors to the inhibitor binding. Furthermore, the stability of the ligand-protein complex and the structural insights into the mode of binding were confirmed by 300-ns molecular dynamics simulation of 7t/2OZ5.

Design, Synthesis, α-Amylase/α-Glucosidase Inhibition Assay, Induced Fit Docking Study of New Hybrid Compounds Containing 4H-Pyrano[2,3-d]pyrimidine, 1H-1,2,3-Triazole and D-Glucose Components.

In this study, the click chemistry between N-propargyl derivatives of substituted 4H-pyrano[2,3-d]pyrimidines and tetra-O-acetyl-α-d-glucopyranosyl azide carried out under catalytic conditions using catalyst CuI@Montmorillonite and additive N,N-diisopropylethylamine (DIPEA). The yields of obtained hybrid compounds having 4H-pyrano[2,3-d]pyrimidine connected to 1H-1,2,3-triazole rings were about 85-94 %. All these synthesized hybrid compounds were examined for in vitro α-amylase (with IC50 values in the range of 103.63±1.13 µM to 295.45±1.11 µM) and α-glucosidase (with IC50 values in the range of 45.63±1.14 µM to 184.52±1.15) inhibitory activity. Amongst this series, ethyl ester 8m showed the best inhibitory activity against α-amylase with IC50 of 103.63±1.13 µM, while ethyl ester 8t exhibited the highest activity against α-glucosidase with IC50 of 45.63±1.14 µM. The kinetics of the inhibition of compound 8t showed the competitive α-glucosidase inhibitor property of this compound. Furthermore, the most potent compounds had any cytotoxicity against human normal cells. Induced fit docking and molecular dynamics simulation calculations indicated that the inhibition potential compounds 8m and 8t had the active interactions with the residues in receptors of corresponding tested enzymes. The calculated binding free energy from MM-GBSA approach showed that the major energy components contributed to the active binding of these studied inhibitors, including Coulomb, lipophilic and van der Waals energy. Further, 300 ns MD simulation showed that studied ligand-protein complexes were stable and indicated the structural observations into mode of binding in these complexes.

Primary invasive ductal carcinoma of axillary accessory breast.

Primary accessory breast cancer is an extremely rare pathology, representing less than 1 % of all breast cancers, and it is found in more than 90 % of cases in the axilla. The diagnosis of accessory axillary breast cancer (AABC) is often late and at an advanced stage with an average delay of 40.5 months. Histological sampling and immunohistochemical results confirm the diagnosis. Most patients are diagnosed with stage II disease or higher, so it is considered to have a poor prognosis. There is no specific management for AABC; it follows the guidelines for orthotopic pectoral breast cancer. We therefore report the case of a 50-year-old woman diagnosed with grade II invasive ductal carcinoma found in accessory axillary breast, treated by wide local resection and sentinel lymph node dissection.

Diagnostic Performance of Acoustic Radiation Force Impulse Imaging in Evaluating Liver Fibrosis in Patients with Chronic Hepatitis B Infection: A Cross-Sectional Study.

Background Acoustic radiation force impulse point shear wave elastography (ARFI-pSWE), measuring shear-wave velocity (SWV), has been utilized to examine the liver stiffness caused by different etiologies. However, information on its reliability in staging liver fibrosis in chronic hepatitis B (CHB) patients is scarce. Purpose The aim of the study is to examine the diagnostic performance of ARFI-pSWE and determine the optimal SWV cut-off values to predict significant fibrosis ( F ≥2) and cirrhosis (F4) in CHB patients. Material and Methods All 114 adult CHB patients visiting the University Medical Center, Ho Chi Minh City, Vietnam between February 2019 and March 2021 underwent liver stiffness measurement using ARFI-pSWE and FibroScan. SWV results were tested against FibroScan for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The area under the receiver operating characteristic (AUROC) curve was used to identify the optimal SWV cut-off values. Results There was a strong agreement between ARFI-pSWE and FibroScan ( r = 0.92, p <0.001). The optimal SWV cut-off value for detecting significant fibrosis was 1.37 m/s with an AUROC of 0.975, sensitivity of 83.3%, specificity of 100%, PPV of 100%, and NPV of 81%. The optimal cut-off value for predicting cirrhosis was 1.70 m/s with an AUROC of 0.986, sensitivity of 97%, specificity of 93%, PPV of 95%, and NPV of 96%. Conclusion ARFI-pSWE could be an effective technique for evaluating liver fibrosis in CHB patients. SWV cut-off values of 1.37 and 1.70 m/s could be used to diagnose significant fibrosis and cirrhosis, respectively.

The willingness to perform first aid among high school students and associated factors in Hue, Vietnam.

BACKGROUND: Adolescents who are willing to perform first aid can help prevent injuries and ultimately death among themselves and others involved in accidents or injuries. This study aims to estimate the prevalence of students' willingness to perform first aid procedures and additionally examine associated factors among high school students in Hue, Vietnam. METHODS: A cross-sectional study utilizing multi-stage stratified random sampling was conducted between April to July 2020 by investigating 798 high school students in Hue, Vietnam. Participants were invited to complete a self-reported questionnaire pertaining to individual demographic characteristics, personal perception of self-efficacy, and willingness to perform first aid. To better interpret these findings, both multivariable linear and Poisson regression models were fitted to evaluate the association between individual student characteristics and the willingness to perform first aid. RESULTS: The prevalence of having willingness to perform first aid (defined as ≥4 points out of 5 to all three questions) was 49.9% (95%CI:28.6-71.2%). The major reported barriers in performing first aid were fear of making mistakes and hurting victims (34.4%, 95%CI:31.9-37.0%), no prior first aid training (29.8%, 95%CI:25.9-33.9%), and forgetting first aid steps (23.0%, 95%CI:15.8-32.2%). By employing the multivariable linear regression model, it was identified that students with high (ß = 0.614, 95%CI:0.009-1.219) or very high (ß = 1.64, 95%CI:0.857-2.422) levels of self-efficacy appeared to be more willing to perform first aid. Similarly, in the Poisson regression models, compared to neutral students, students who reported high (PR = 1.214, 95%CI:1.048-1.407) or very high (PR = 1.871, 95%CI:1.049-3.337) levels of self-efficacy were more willing to perform first aid. CONCLUSIONS: The level of willingness to perform first aid among high school students in this study population was found to be moderate. Therefore, integrating activities to promote self-efficacy in first aid training could be considered a progressive step towards improving a student's willingness to provide such life-saving procedures.

Primary Breast Tuberculosis Mastitis Manifested as Nonhealing Abscess.

Primary breast tuberculosis (TB) is a rare extrapulmonary TB mainly affecting young women of childbearing age from endemic countries. Its incidence is increasing in immunocompromised and HIV-infected people and with the emergence of drug-resistant strains of Mycobacterium tuberculosis (MTB). There are no specific clinical signs suggestive of this disease, it often presents as a hard mass or breast abscess. There is an overlap of features with other inflammatory, infectious, benign lesions, fat necrosis and malignant neoplasms of the breast. The detection of MTB remains the gold standard for diagnosis. Several other diagnostic modalities are used, with varying lack of sensitivity and specificity, and with a range of false negatives. A quarter of cases were treated solely on the basis of clinical, imaging or histological suspicion, without confirmation of the diagnosis. Therefore, we report the case of a young Vietnamese woman, presented for a nonhealing breast abscess, and diagnosed with breast TB based on the patient's ethnicity, histological findings, lack of clinical response to conventional antibiotic therapy, and a good clinical response to anti-TB treatment.

Mutations in the HBV PreS/S gene related to hepatocellular carcinoma in Vietnamese chronic HBV-infected patients.

BACKGROUND: Chronic hepatitis B virus (CHB) infection is a major health problem and leading cause of hepatocellular carcinoma (HCC) worldwide. Several point and deletion mutations on the PreS/S gene have been intensively considered associated with HCC. This study aimed to describe the characteristics of HBV PreS/S mutations in Vietnamese CHB-infected patients and their association with HCC. METHODS: This cross-sectional study was conducted from 02/2020 to 03/2021, recruited Vietnamese CHB-infected patients with HBV-DNA >3 log10-copies/mL and successful PreS/S gene sequencing. Mutations were detected by direct Sanger sequencing. RESULTS: 247 CHB-infected patients were recruited, characterized by 68.8% males, 54.7% HBV genotype B, 57.5% HBeAg positive, 23.1% fibrosis score ≥F3 and 19.8% HCC. 61.8% amino acid replacements were detected throughout the PreS1/PreS2/S genes. The most common point-mutations included N/H51Y/T/S/Q/P (30.4%), V68T/S/I (44.9%), T/N87S/T/P (46.2%) on PreS1 gene; T125S/N/P (30.8%), I150T (42.5%) on PreS2 gene; S53L (37.7%), A184V/G (39.3%), S210K/N/R/S (39.3%) on S gene. The rates of case(s) with any point-mutation on the Major Hydrophylic Region (MHR) and the "a" determinant region were 63.6% and 39.7%, respectively. Most of S point-mutations were presented with low rates such as T47A/E/V/K (9.3%), P120S/T (8.5%), G145R (2%). On multivariable analysis, males (OR = 4.51, 95%CI 1.78-11.4, p = 0.001), age≥40 (OR = 5.5, 95%CI 2.06-14.68, p = 0.001), W4P/R/Y on PreS1 (OR = 11.56, 95%CI 1.99-67.05, p = 0.006) and 4 S point-mutations as: T47A/E/V/K (OR = 3.67, 95%CI 1.19-11.29, p = 0.023), P120S/T (OR = 3.38, 95%CI 1.09-10.49, p = 0.035), S174N (OR = 29.73, 95%CI 2.12-417.07, p = 0.012), P203R (OR = 8.45, 95%CI 1.43-50.06, p = 0.019) were associated with HCC. CONCLUSIONS: We detected 61% amino acid changes on PreS/S regions in Vietnamese CHB patients. One point-mutation at amino acid 4 on PreS1 gene and 4 point-mutations at amino acids 47, 120, 174, and 203 on S gene were associated with HCC. Further investigations are recommended to further clarify the relationship and interaction between mutations in HBV genome and HCC progression.

Network analysis of psychological factors related to academic pressure faced by medical students in the central and highland regions of Vietnam.

Medical students experience extensive pressure during their undergraduate courses. Given the complex associations between psychological factors in association with academic pressure. We investigated the study with objectives: To examine psychological factors related to academic pressure by analysing interactions between 'study motivation', 'study environment', 'study conditions', 'teacher quality', 'training programme', 'management system', 'evaluation', and 'extracurricular activities' using a network analysis approach. A total of 878 medical students majoring in general medicine from the first, third, and fifth years of a six-year course at the largest medical university in central and highland regions of Vietnam were involved in this cross-sectional study. The approach used was convenient cluster sampling with a self-administered questionnaire by the participants. Network analysis for pairwise correlations between psychological factors was estimated . Important factors in the network analysis were calculated using centrality indices including node strength (S), closeness (C), and betweenness (B). The higher score of S, C, and B indicate the more importance of the node. The results obtained from the network analysis of eight psychological factors showed that 'teaching quality' was mostly connected with other factors overall, while the 'training programme' was seen in both genders and freshman students. 'Study conditions' and 'training programme' were mostly connected with other factors in junior and senior students, respectively. The strong pairwise correlation was confirmed: management system and evaluation activity, followed by study environment and study conditions, and teaching quality and training programme. Additionally, nodes with high centrality were shown to be 'management system' (S = 0.97, C = 0.019, B = 1), and 'training programme' (S = 0.96, C = 0.021, B = 4). Our study findings indicate that satisfaction with the training programme amongst eight psychological factors is the most important factor affecting academic pressure among medical students. The training programme is linked with teaching quality, whereas the management system is correlated with evaluation activity.

Vietnam Association of Gastroenterology (VNAGE) consensus on the management of Helicobacter pylori infection.

Helicobacter pylori (H. pylori) infection is prevalent and has a rapidly increasing antibiotic resistance rate in Vietnam. Reinfection is quite common, and gastric carcinoma remains one of the most common malignancies, which is not uncommon to develop after successful eradication. The purpose of this consensus is to provide updated recommendations on the management of H. pylori infection in the country. The consensus panel consisted of 32 experts from 14 major universities and institutions in Vietnam who were invited to review the evidence and develop the statements using the Delphi method. The process followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The consensus level was defined as ≥80% for agreement on the proposed statements. Due to the limited availability of high-quality local evidence, this consensus was also based on high-quality evidence from international studies, especially those conducted in other populations in the Asia-Pacific region. The panel finally reached a consensus on 27 statements after two voting rounds, which consisted of four sections (1) indications for testing and selection of diagnostic tests (2), treatment regimens, (3) post-treatment confirmation of H. pylori status, and (4) reinfection prevention methods and follow-up after eradication. Important issues that require further evidence include studies on third-line regimens, strategies to prevent H. pylori reinfection, and post-eradication follow-up for precancerous gastric lesions. We hope this consensus will help guide the current clinical practice in Vietnam and promote multicenter studies in the country and international collaborations.

Adult-Onset Primary Intestinal Lymphangiectasia With Liver Enzymes Elevation.

Primary intestinal lymphangiectasia is a rare disorder that may result in protein-losing enteropathy. We report a 21-year-old man with malabsorption syndrome, an unintentional weight loss of 30 kg over 10 months, lymphocytopenia, and hepatic aminotransferase elevation. His diagnosis was established by a combination of enteroscopy, histopathology, and secondary etiology exclusion. Institution of parenteral nutrition, followed by a low-fat diet, medium-chain triglycerides, and octreotide, resulted in the resolution of his symptoms and laboratory abnormalities and led to weight gain. Aminotransferase abnormalities are an atypical finding in primary intestinal lymphangiectasia and were most likely due to nonalcohol steatohepatitis after rapid weight loss. Primary intestinal lymphangiectasia should be considered in patients with protein-losing enteropathy and lymphocytopenia.

Incidental finding of solitary fibrous tumor of male breast: case report and review of literature.

Solitary fibrous tumor (SFT) of the breast is a rare mesenchymal tumor composed of spindle-shaped tumor cells with collagen and large blood vessels in the shape of a "staghorn". It is discovered anywhere in the human body, usually incidentally or through nonspecific symptoms. A combination of clinical, histological, and immunohistochemical features is required to establish a diagnosis. There are no proper guidelines for the treatment of SFTs because of their rarity; however, wide surgical excision remains the "gold standard". A multidisciplinary team approach is recommended. They are mostly benign with a 5-year survival rate of 89%. Following a PubMed-indexed English literature review, only six publications presenting nine cases of breast SFT in a male patient were found. The following is the case of a 73-year-old man who presented with dry cough. A SFT in the right breast was discovered incidentally during the investigative work up, and the patient was referred to our Breast Clinic at the Jules Bordet Institute, Brussels, Belgium, for appropriate treatment. The patient's presentation, imaging, and histological sample all supported the diagnosis, and he underwent uneventful surgical resection. Here, we present the first case of an incidental finding of a SFT of the male breast, with its diagnosis and therapeutic challenges.