Antibiotic resistance and heteroresistance in Helicobacter pylori isolates from symptomatic Vietnamese children: A prospective multicenter study.

BACKGROUND: Antibiotic resistance of Helicobacter pylori (H. pylori) is increasing worldwide, with geographical variations, impacting the treatment outcomes. This study assessed the antibiotic resistance patterns of H. pylori in Vietnamese children. MATERIALS AND METHODS: Symptomatic children undergoing gastroduodenoscopy at two tertiary Children's Hospitals in Ho Chi Minh City were recruited. Antral and corpus biopsies were obtained and cultured separately. Susceptibility to amoxicillin (AMO), clarithromycin (CLA), metronidazole (MET), levofloxacin (LEV), and tetracycline (TET) was determined using E-test. Polymerase chain reaction was performed on another antral biopsy to detect the urease gene, cytotoxin-associated gene A (cagA), vacuolating cytotoxin A (vacA) genotypes, and 23S rRNA mutations conferring CLA resistance. RESULTS: Among 123 enrolled children, a high primary resistance rate was found for CLA (68.5%, 61/89), followed by LEV (55.1%), MET (31.5%), AMO (25.8%), and TET (1.1%). Secondary resistance rates were 82.1% (7/28), 71.4%, 53.6%, and 3.6% for CLA, LEV, MET, and TET, respectively. Multidrug resistance was frequent (67.7%), with common patterns including CLA + LEV (20.3%) and CLA + MTZ + LEV (15.2%). Heteroresistance was detected in eight children (6.5%). The A2143G mutation was detected in 97.5% (119/122) of children. 86.1% of children had positive cagA strains and 27.9% had multiple vacA genotypes. No factor was significantly associated with antibiotic resistance. CONCLUSIONS: The alarming rate of antibiotic resistance for H. pylori, especially for CLA, with emerging multi- and hetero-resistant strains, pose a major treatment challenge that precludes CLA use as empirical therapy. Biopsies from both antrum and corpus can improve H. pylori culture, allowing tailored treatment based on antimicrobial susceptibility.

A fair and interpretable network for clinical risk prediction: a regularized multi-view multi-task learning approach.

In healthcare domain, complication risk profiling which can be seen as multiple clinical risk prediction tasks is challenging due to the complex interaction between heterogeneous clinical entities. With the availability of real-world data, many deep learning methods are proposed for complication risk profiling. However, the existing methods face three open challenges. First, they leverage clinical data from a single view and then lead to suboptimal models. Second, most existing methods lack an effective mechanism to interpret predictions. Third, models learned from clinical data may have inherent pre-existing biases and exhibit discrimination against certain social groups. We then propose a multi-view multi-task network (MuViTaNet) to tackle these issues. MuViTaNet complements patient representation by using a multi-view encoder to exploit more information. Moreover, it uses a multi-task learning to generate more generalized representations using both labeled and unlabeled datasets. Last, a fairness variant (F-MuViTaNet) is proposed to mitigate the unfairness issues and promote healthcare equity. The experiments show that MuViTaNet outperforms existing methods for cardiac complication profiling. Its architecture also provides an effective mechanism for interpreting the predictions, which helps clinicians discover the underlying mechanism triggering the complication onsets. F-MuViTaNet can also effectively mitigate the unfairness with only negligible impact on accuracy.

Investigation on Methylene Blue Dye Adsorption in Aqueous by the Modified Mussel Shells: Optimization, Kinetic, Thermodynamic and Equilibrium Studies.

This study assessed the methylene blue adsorption using natural and modified mussel shell powders in the aqueous solution. The mussel shell samples were processed in a NaClO solution then modified with sodium dodecyl sulfate and ethylenediaminetetraacetic acid. The characteristics of mussel shell samples before and after modification were demonstrated using infared spectroscopy, thermogravimetric analysis, scanning electron microscopy, nitrogen adsorption/desorption, energy dispersive X-ray, water contact angle, and dynamic light scattering methods. Some factors such as the pH of the medium, adsorption temperature, and adsorption time had a significant effect on the methylene blue adsorption of mussel shell samples. The adsorption isotherm models and kinetics of methylene blue adsorption by mussel shell samples were also studied. A quadratic regression equation was selected with experimental planning following the Box-Behnken model combined with Design Expert 11.1.0.1 software to optimize the methylene blue adsorption process by mussel shell samples. These results open a promising direction for using naturally derived materials to remove organic pollutants from contaminated water.

Virtual screening and rational design of antioxidant peptides based on tryptophyllin L structures isolated from the Litoria rubella frog.

Discovery of natural antioxidants has been carried out for decades relying mainly on experimental approaches that are commonly associated with time and cost demanding biochemical assays. The maturation of quantitative structure activity relationship (QSAR) modelling has provided an alternative approach for searching and designing antioxidant compounds with alleviated costs. As a contribution to this approach, this work aimed to establish a fragment-based 3D-QSAR procedure to discover and design potential antioxidants based on tryptophyllin L structures isolated from the red tree frog Litoria rubella. A force field and a Gaussian 3D-QSAR model were built to screen for potential antioxidants from tripeptide fragments covering all sequences of tryptophyllin L database. Among those, PWY(NH2 ) corresponding tryptophyllin L 4.1 was predicted to have the highest 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) radical cation (ABTS+ ·) scavenging capability. Two newly designed peptides PYW and PYW(NH2 ) together with PWY(NH2 ), tryptophyllin L 4.1, and the reference peptide PWY were synthesized and subjected to two antioxidant assays including ABTS scavenging and ferric reducing antioxidant power assays. Although the experimental TEAC values of the five peptides were roughly similar to those from predictions, the activity order was not in agreement with the predictions. The dissimilarities were accounted by the difference in the experimental procedures, the deviation of modelling regression, and the synergetic effect of structural and experimental features. The ABTS radical scavenging assays revealed that all the tested peptides were strong ABTS+ · scavengers with the antioxidant capabilities approximately twice as high as trolox and higher than glutathione. The ferric reducing activities of the peptides were, on the other hand, much weaker than that of trolox suggesting different antioxidant mechanisms inserted by trolox and the peptides. This work was a demonstration that 3D-QSAR methods can be employed in conjunction with experimental methods to effectively detect and design antioxidant peptides.

Influences of anthropogenic activities on water quality in the Saigon River, Ho Chi Minh City.

Water quality for the surface water along the Saigon River in Ho Chi Minh City was assessed for four groups of water samples collected at the agricultural, industrial, residential, and less impacted areas. A variety of parameters indicating water quality including physicochemical parameters, nutrients, heavy metals, and antibiotic residues were measured for both the rainy and dry seasons, two main tropical seasons in HCM City using the standard methods. The results showed that the river water in the rainy season was detected with significantly higher values of turbidity, BOD5, PO4-P, NH4-N, NO3-N; and lower values of pH, temperature, conductivity, DO, salinity, Cu, Zn, As, Ni, Hg compared to that in the dry season. Sulfamethoxazole and trimethoprim were highly detected in the industrial areas compared to the agricultural and residential areas. Multivariate analyses suggested that the industrial and residential activities were more important contributors to the pollution of the Saigon River than the agricultural activities in HCM City.

Presence of Hypertrophic Cardiomyopathy Related Gene Mutations and Clinical Manifestations in Vietnamese Patients With Hypertrophic Cardiomyopathy.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is associated primarily with pathogenic mutations in sarcomeric genes. The aim of this study was to identify the prevalence and distribution of disease-causing mutations in HCM-associated genes and the genotype-phenotype relationship in Vietnamese patients with HCM.Methods and Results:Genetic testing was performed by next-generation sequencing in 104 unrelated probands for 23 HCM-related genes and in 57 family members for the mutation(s) detected. Clinical manifestations were recorded for genotype-phenotype correlation analysis. Mutation detection rate was 43.4%. Mutations inMYBPC3accounted for 38.6%, followed byTPM1(20.5%),MYH7(18.2%),TNNT2(9.1%),TNNI3(4.5%) andMYL2(2.3%). A mutation inGLAassociated with Fabry disease was found in 1 patient. A mutation inTPM1(c.842T>C, p.Met281Thr) was identified in 8 unrelated probands (18.2%) and 8 family members from 5 probands. Genotype-positive status related toMYH7,TPM1, andTNNT2mutations was associated with severe clinical manifestations.MYH7-positive patients displayed worse prognosis compared withMYBPC3-positive patients. Interestingly,TPM1c.842T>C mutation was associated with high penetrance and severe HCM phenotype. CONCLUSIONS: We report for the first time the prevalence of HCM-related gene variants in Vietnamese patients with HCM.MYH7,TPM1, andTNNT2mutations were associated with unfavorable prognosis.

Application of Nano-SiO2 and Nano-Fe2O3 for Protection of Steel Rebar in Chloride Contaminated Concrete: Epoxy Nanocomposite Coatings and Nano-Modified Mortars.

The effect of incorporating nanoparticles on the corrosion resistance of epoxy-coated steel in salt contaminated mortars was investigated using potentiodynamic polarization and electrochemical impedance spectroscopy. Researchers conducted electrochemical monitoring of the coated steel embedded in mortar over 100 days of immersion in 0.1 M NaOH solutions. The chloride permeability and microstructure of Portland cement mortar with admixed nano-materials (at 1% by weight of cement) were examined using an electromigration test and field emission scanning electron microscopy (FESEM). Electrochemical monitoring showed that nano Fe2O3 improved the corrosion resistance of the coated rebar. The incorporation of a small amount of nano Fe2O3 (1% by total weight of resin and hardener) into the epoxy coating reduced the corrosion current of the epoxy-coated steel in chloride-contaminated mortar (0.3% chloride by weight of cement). After 100 days of immersion, the nanoparticles reduced the corrosion current of epoxy-coated steel by a factor of 6. The FESEM test revealed that admixing of nano-materials not only led to denser cement mortar but also changed the morphology of cement hydration products. The test results of compressive strength showed that nanoparticles increased the strength of cement mortar. The electromigration test showed that the incorporation of nanoparticles improved the chloride penetration resistance of the mortar, as indicated by the reduced apparent diffusion coefficients of the chloride anion. When nano-SiO2 and nano-Fe2O3 were admixed into fresh cement mortar at 1% by weight of cement, the value of D(Cl−) was decreased by 83%, from 7.35×10(−11) m²/s (control specimen) to 1.21×10(−11) m²/s and 1.36×10(−11) m²/s, respectively.

Occurrences and Characterization of Antibiotic-Resistant Bacteria and Genetic Determinants of Hospital Wastewater in a Tropical Country.

Wastewater discharged from clinical isolation and general wards at two hospitals in Singapore was examined to determine the emerging trends of antibiotic resistance (AR). We quantified the concentrations of 12 antibiotic compounds by analysis using liquid chromatography-tandem mass spectrometry (LC-MS/MS), antibiotic-resistant bacteria (ARB), the class 1 integrase gene (intI1), and 16 antibiotic resistance genes (ARGs) that confer resistance to 10 different clinically relevant antibiotics. A subset of 119 antibiotic-resistant isolates were phylogenetically classified and tested for the presence of ARGs encoding resistance to ß-lactam antibiotics (blaNDM, blaKPC, blaSHV, blaCTX-M), amikacin [aac(6')-Ib], co-trimoxazole (sul1, sul2, dfrA), ciprofloxacin (qnrA, qnrB), and the intI1 gene. Among these resistant isolates, 80.7% were detected with intI1 and 66.4% were found to carry at least 1 of the tested ARGs. Among 3 sampled locations, the clinical isolation ward had the highest concentrations of ARB and the highest levels of ARGs linked to resistance to ß-lactam (blaKPC), co-trimoxazole (sul1, sul2, dfrA), amikacin [aac(6')-Ib], ciprofloxacin (qnrA), and intI1 We found strong positive correlations (P < 0.05) between concentrations of bacteria resistant to meropenem, ceftazidime, amikacin, co-trimoxazole, and ciprofloxacin and abundances of blaKPC, aac(6')-Ib, sul1, sul2, dfrA, qnrA, and intI1 genes.

Temporal Trends in Strut-Level Optical Coherence Tomography Evaluation of Coronary Stent Coverage: A Systematic Review and Meta-Analysis.

OBJECTIVES: We sought to pool data from all studies with reported strut-level data in human subjects evaluated by optical coherence tomography (OCT) surveillance and to compare the aggregate data of stent strut coverage on a longitudinal temporal timeline from initial implantation for different coronary stent subtypes. BACKGROUND: Delayed strut coverage following drug-eluting stent (DES) implantation is an important contributor to late stent thrombosis (LST). OCT can detect stent strut coverage. METHODS: We conducted a systematic search of published or presented studies reporting OCT stent strut coverage of bare-metal stents (BMS) and DES in PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials to June 2014. Data from 3,515 patients with strut-level data on 731,761 struts were analyzed. RESULTS: The temporal kinetics of strut coverage differed according to stent type. The rate of strut coverage, reflected by the calculated regression coefficient, was found to be the highest in BMS, followed by early generation zotarolimus-eluting stent, everolimus-eluting stent, newer-generation zotarolimus-eluting stent, paclitaxel-eluting stent, and sirolimus-eluting stent (p < 0.0001). CONCLUSIONS: Aggregate rates of stent strut coverage assessed by OCT surveillance differed according to stent type. The clinical implications of these differences require further study but may underlie the differences in rates of stent thrombosis observed in clinical trials with different stent types. © 2015 Wiley Periodicals, Inc.

Antimicrobial Properties of Lysosomal Enzymes Immobilized on NH2Functionalized Silica-Encapsulated Magnetite Nanoparticles.

The immobilization efficiency, antimicrobial activity and recovery of lysosomal enzymes on NH2 functionalized magnetite nanoparticles have been studied under various conditions. The immobi- lization efficiency depends upon the ratio of the amount of enzyme and magnetite and it shows an increase with magnetite concentration which is due to the presence of amine group at the magnetite surface that leads to a strong attraction. The optimized reaction time to immobilize the lysosomal enzymes on magnetite was determined by using a rolling method. The immobilization efficiency increases with reaction time and reached a plateau after 5 minutes and then remained constant for 10 minutes. However, after 30 minutes the immobilization efficiency decreased to 85%, which is due to the weaker electrostatic interactions between magnetite and detached lysosomal enzymes. The recovery and stability of immobilized lysosomal enzymes has also been studied. The antimicrobial activity was almost 100% but it decreased upon reuse and no activity was observed after its reuse for seven times. The storage stability of lysosomal enzymes as an antimicrobial agent was about 88%, which decreased to 53% after one day and all activity of immobilized lysosomal enzymes was maintained after five days. Thus, the lysosomal enzymes immobilized on magnetite nanoparticles could potentially be used as antimicrobial agents to remove bacteria.

Comparison of procedural complications and in-hospital clinical outcomes between patients with successful and failed percutaneous intervention of coronary chronic total occlusions: a meta-analysis of observational studies.

BACKGROUND: Multiple attempts to pass guidewires and balloons across totally occluded segments may result in significant mechanical trauma and higher rates of coronary complications in patients undergoing PCI (percutaneous coronary intervention) for CTOs (chronic total occlusion). It is unknown whether these procedural complications affect short-term survival and in-hospital clinical outcomes after the PCI. The goal of this analysis was to clarify this issue by comparing the rates of adverse in-hospital clinical outcomes between successful and failed CTO-PCI groups. METHODS: We performed a meta-analysis of 25 studies (16,490 patients) to determine the rates of in-hospital death, myocardial infarction (MI), major adverse cardiovascular events (MACE), and urgent CABG (coronary artery bypass grafting) for the successful and failed CTO-PCI groups. RESULTS: Compared to successful CTO PCI, failed CTO PCI procedures were associated with higher in-hospital mortality (1.44% versus 0.5%) [relative risk (RR) of 2.88, 95% confidence interval [CI] (1.96-4.24), P<0.001], a higher risk of in-hospital MACE (8.88% versus 3.75%) [RR of 2.25, CI (1.69-2.98), P<0.001], slightly higher risk of in-hospital MI (3.17% versus 2.4%) [RR of 1.35, CI (1.03-1.78), P=0.03] and increased need for urgent CABG (4.0% versus 0.5%) [RR of 6.67, CI (4.26-10.43), P<0.001]. Furthermore, higher rates of coronary perforations [RR of 5.0, CI (3.93-6.59), P<0.001] and cardiac tamponade [RR of 5.0, CI (1.97-12.69), P<0.001] were observed in the unsuccessful PCI arm. CONCLUSIONS: As compared to successful interventions, failed PCI attempts for CTOs appear to be associated with higher risk of adverse short-term clinical outcomes.

Oculo-facio-cardio-dental (OFCD) syndrome: a case report.

BACKGROUND: Oculo-facio-cardio-dental (OFCD) syndrome is a rare condition that affects the eyes, face, heart, and teeth of patients. One notable dental characteristic of OFCD is radiculomegaly, or root gigantism, which highlights the role of dentists in detecting this syndrome. OFCD is an X-linked dominant syndrome that results from a variant in the BCOR gene. Our study presents the first documented case of OFCD in Vietnam and reports a novel BCOR gene variant observed in this case. CASE PRESENTATION: A 19-year-old Vietnamese female patient with an extremely long root with an abscess was clinically examined for the expression of OFCDs. The radiograph and the variant in BCOR gene were also evaluated. We identified abnormalities in the teeth, as well as ocular, facial, and cardiac features, with radiculomegaly of the canines being a specific symptom for OFCDs. The patient's genetic analysis revealed a pathogenic heterozygous deletion at intron 11 of the BCOR gene, representing a novel variant. CONCLUSION: Oculo-facio-cardio-dental syndrome (OFCD) is an extremely rare condition characterized by abnormalities in the eyes, face, heart, and teeth, often caused by variants in the BCOR gene. Radiculomegaly, or enlarged dental roots, is a key diagnostic feature of OFCD, and early detection is crucial for preventing future dental complications.

Tailoring hierarchical structures in cellulose carbon aerogels from sugarcane bagasse using different crosslinking agents for enhancing electrochemical desalination capability.

Sugarcane bagasse is one of the most common Vietnamese agricultural waste, which possesses a large percentage of cellulose, making it an abundant and environmentally friendly source for the fabrication of cellulose carbon aerogel. Herein, waste sugarcane bagasse was used to synthesize cellulose aerogel using different crosslinking agents such as urea, polyvinyl alcohol (PVA) and sodium alginate (SA). The 3D porous network of cellulose aerogels was constructed by intermolecular hydrogen bonding, which was confirmed by Fourier transform infrared (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM) and nitrogen adsorption/desorption. Among the three cellulose aerogel samples, cellulose - SA aerogel (SB-CA-SA) has low density of 0.04 g m-3 and high porosity of 97.38%, leading to high surface area of 497.9 m2 g-1 with 55.67% micropores of activated carbon aerogel (SB-ACCA-SA). The salt adsorption capacity was high (17.87 mg g-1), which can be further enhanced to 31.40 mg g-1 with the addition of CNT. Moreover, the desalination process using the SB-ACCA-SA-CNT electrode was stable even after 50 cycles. The results show the great combination of cellulose from waste sugarcane bagasse with sodium alginate and carbon nanotubes in the fabrication of carbon materials as the CDI-utilized electrodes with high desalination capability and good durability.

Effects of percutaneous revascularization of chronic total occlusions on clinical outcomes: a meta-analysis comparing successful versus failed percutaneous intervention for chronic total occlusion.

BACKGROUND: Chronic total occlusions (CTOs) represent the most complex and challenging coronary lesions for percutaneous coronary intervention (PCI). PCI for a CTO is a high-risk procedure and the long-term benefits of a successful percutaneous CTO recanalization over the medical management (as a result of failed PCI) are not clear, as the studies have shown conflicting results in the past. The goal of this analysis was to clarify this issue by performing a meta-analysis of the available literature. METHODS: Using major electronic databases, we searched for studies (randomized or observational) comparing death, major adverse cardiovascular events (MACE), myocardial infarction (MI), and target vessel revascularization (TVR) between patients who underwent PCI recanalization of CTOs versus those treated with medical management as a result of failed PCI attempts. RESULTS: We identified 23 observational studies comparing the desired clinical parameters between patients with successful CTO recanalization and those managed conservatively as a result of attempted but failed PCI. The total number of patients observed in all of the studies was 12,970 and the mean time of follow up was 3.7 ± 2.1 years. Our results indicated that successful recanalization of a CTO results in improved all-cause mortality (relative risk [RR] of 0.54, 95% confidence interval [CI] (0.45-0.65), P-value < 0.001), lower rates of MACE (RR of 0.70, 95% CI 0.60-0.83, P-value < 0.001) and reduced needs for subsequent bypass surgery (RR of 0.25, 95% CI (0.21-0.30), P-value < 0.001). The difference in long-term mortality remained statistically significant even after the adjustment for procedure related complications and in-hospital deaths. CONCLUSION: As compared to conservative management (as a result of failed intervention), successful PCI recanalization of a CTO appears to be associated with improved long-term clinical outcomes; however, randomized controlled trials (RCTs) are needed to further confirm these results.

Fairness and Accuracy Under Domain Generalization.

As machine learning (ML) algorithms are increasingly used in high-stakes applications, concerns have arisen that they may be biased against certain social groups. Although many approaches have been proposed to make ML models fair, they typically rely on the assumption that data distributions in training and deployment are identical. Unfortunately, this is commonly violated in practice and a model that is fair during training may lead to an unexpected outcome during its deployment. Although the problem of designing robust ML models under dataset shifts has been widely studied, most existing works focus only on the transfer of accuracy. In this paper, we study the transfer of both fairness and accuracy under domain generalization where the data at test time may be sampled from never-before-seen domains. We first develop theoretical bounds on the unfairness and expected loss at deployment, and then derive sufficient conditions under which fairness and accuracy can be perfectly transferred via invariant representation learning. Guided by this, we design a learning algorithm such that fair ML models learned with training data still have high fairness and accuracy when deployment environments change. Experiments on real-world data validate the proposed algorithm. Model implementation is available at https://github.com/pth1993/FATDM.

Hedyocoronins A and B: two new oleanane saponins from the aerial parts of Hedyotis coronaria.

Two new oleanane saponins, hedyocoronin A (1) and hedyocoronin B (2), were isolated from the aerial parts of Hedyotis coronaria (Kurz) Craib, Rubiaceae, collected at Da Oai district, Lam Dong province in Vietnam. Their chemical structures were elucidated by HR-MS, 1D and 2D-NMR spectra, along with the comparison with those reported in the literature. Compounds 1 and 2 showed weak cytotoxicity against KB and HeLa-S3 cancer cell lines with IC50 values of more than 54 µM.

Advances in long-acting slow effective release antiretroviral therapies for treatment and prevention of HIV infection.

Adherence to daily oral antiretroviral therapy (ART) is a barrier to both treatment and prevention of human immunodeficiency virus (HIV) infection. To overcome limitations of life-long daily regimen adherence, long-acting (LA) injectable antiretroviral (ARV) drugs, nanoformulations, implants, vaginal rings, microarray patches, and ultra-long-acting (ULA) prodrugs are now available or in development. These medicines enable persons who are or at risk for HIV infection to be treated with simplified ART regimens. First-generation LA cabotegravir, rilpivirine, and lenacapavir injectables and a dapivirine vaginal ring are now in use. However, each remains limited by existing dosing intervals, ease of administration, or difficulties in finding drug partners. ULA ART regimens provide an answer, but to date, such next-generation formulations remain in development. Establishing the niche will require affirmation of extended dosing, improved access, reduced injection volumes, improved pharmacokinetic profiles, selections of combination treatments, and synchronization of healthcare support. Based on such needs, this review highlights recent pharmacological advances and a future treatment perspective. While first-generation LA ARTs are available for HIV care, they remain far from ideal in meeting patient needs. ULA medicines, now in advanced preclinical development, may close gaps toward broader usage and treatment options.

'Most people have no idea what autism is': Unpacking autism disclosure using social media analysis.

LAY ABSTRACT: Autism disclosure - that is sharing their autism diagnosis or identity with a person or people - is a difficult decision for many autistic people. While telling people they are autistic can be positive and helpful, it can also create a lot of problems. What we have learnt is that disclosure is really complicated. Rather than asking research participants questions about what might happen, we looked at what people were saying on public social media posts (Reddit and Twitter) about what did happen. We used three years of posts that were related to autism disclosure from a wide range of adults (autistic and non-autistic). Four main ideas were created from our data, with the key finding being that society does not understand autism. This lack of understanding creates problems for autistic people in work, dating, healthcare and mental health. The remaining ideas were that autistic people should have privacy and be treated with respect, that autistic representation can help society and that non-autistic people need to do more to help autistic people. Our findings support that society needs to do more through autism advocacy, better media representation and more public role models. Increasing the accuracy of understanding of autism across society will mean that autistic people can feel safer to disclose if they want to.

Association of diabetes mellitus with early-onset colorectal cancer: A systematic review and meta-analysis of 19 studies including 10 million individuals and 30,000 events.

BACKGROUND AND AIMS: Early-onset colorectal cancer (EoCRC) constitutes 2%-10% of all colorectal cancers and is becoming more common globally. Diabetes mellitus (DM) has increased substantially in younger adults; however, its involvement in EoCRC remains unclear. We conducted a systematic review and meta-analysis of observational studies to (1) explore the prevalence of DM in individuals with EoCRC and (2) investigate the association between DM and EoCRC. METHODS: A systematic literature search was conducted to identify studies published before May 2022 that evaluated the association between DM and EoCRC risk in four databases, including Medline (PubMed), Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. Results from the studies were summarized in meta-analyses using random effects models. RESULTS: Nineteen eligible studies were included. A total of 33,359 EoCRC cases and 14,259,289 controls in 12 studies were included in the meta-analysis. The pooled odds ratio [OR] of 1.43 (95% confidence interval [CI]: 1.08-1.8) indicated significant positive association between DM and increased risk of EoCRC. Subgroup analysis demonstrated that diabetes severity was significantly associated with unmanaged DM (OR = 1.28, 95% CI: 1.02-1.6), but not with managed DM (OR = 1.04, 95% CI: 0.84-1.28). CONCLUSION: Our results suggest that DM is a risk factor for EoCRC, and the higher prevalence of DM among younger adults may contribute to the increasing incidence of EoCRC. Interventions to reduce this bidirectional risk should be further investigated for the development of effective prevention and treatment strategies. PROSPERO registration: CRD42022306347.

Helicobacter pylori Eradication Rate Using Stool Antigen Test in Vietnamese Children: A Prospective Multicenter Study.

Objectives: This study assessed the diagnostic value of a monoclonal immunoassay stool antigen test (HpSA) for Helicobacter pylori (H. pylori) infection and the eradication outcomes. Methods: Children undergoing digestive endoscopy at 2 Children's Hospitals in Ho Chi Minh City were recruited. Treatment was offered to H. pylori-infected children. Stool samples were collected on the same day as the endoscopy procedure and after 6 weeks post-treatment for HpSA. Diagnostic value and optimal cutoff of HpSA were assessed using biopsy-based tests as the gold standard. Eradication was defined as a negative HpSA post-treatment. Ethical approval was obtained, and informed consent was signed by the participants. Results: In total, 394 patients participated in the study. The most common symptoms were epigastric pain (74.6%) and vomiting (37.3%). H. pylori status was positive in 78% of patients (306/394), doubtful in 10.1%, and negative in 12.2%. HpSA was positive in 73.2% (142/194). Excluding doubtful infections, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of HpSA were 87.4%, 95.2%, 99.2%, 51.3%, and 88.4%, respectively. The optimal cutoff value of 0.148 provided similar accuracy to the recommended cutoff. The eradication rate was 56.1% in per-protocol analysis and 27.9% in intention-to-treat analysis. Treatment success was higher in boys, but lower among malnourished children and those infected with cagA+ strains. Conclusions: The HpSA is reliable for identifying H. pylori infection in epidemiological studies and assessing eradication outcomes. The low eradication rate highlights the need for an appropriate intervention strategy in Vietnamese children.