Space-time scanning statistics in the prediction and evaluation of dengue epidemic clusters.

Objectives: To detect clusters of dengue hemorrhagic fever in an urbanized district of Hai Phong City, Vietnam using Poisson space-time retrospective and prospective analysis. Methods: A cross-sectional and retrospective study analyzed dengue surveillance data in the period from January 01, 2018, to December 31, 2022. Spatial-temporal scanning statistics were performed using the free software SatScan v10.1.2. Results: A total of 519 cases were recorded. The cumulative incidence per 100,000 inhabitants was 3.37, 127.36, 10.96, 0, and 296.04 in 2018, 2019, 2020, 2021, and 2022, respectively. By retrospective Poisson model-based analysis, seven clusters were detected. Six of these seven detected outbreaks occurred in November and December 2022. The largest cluster had a relative risk (RR) of 1539.5 (P <0.00001). The smallest cluster has a RR of 316.1 (P = 0.006). Prospective analysis using the Poisson model significantly detected four active case clusters at the time of the study. The largest cluster of cases with RR was 47.7 (P <0.00001) and the smallest cluster with RR was 18.2 (P <0.00001). Conclusions: This study provides a basis for improving the effectiveness of interventions and conducting further investigations into risk factors in the study area, as well as in other urban and suburban areas nationwide.

Emergency pancreaticoduodenectomy for complex pancreaticoduodenal damage with multiple organ injuries following blunt abdominal trauma: A case report and literature review.

INTRODUCTION: Pancreaticoduodenectomy is a complex surgical procedure with significant potential for complications such as pancreatic fistula, bile leakage, intra-abdominal abscesses, and hemorrhage. Emergency pancreaticoduodenectomy (EPD) performed for traumatic injuries carries even greater risks due to the patient's severely unstable condition upon admission. While the literature recommends that EPD be reserved for hemodynamically stable trauma patients, there are scenarios where it may be the last resort to save the patient's life. CASE PRESENTATION: A 49-year-old male presented in the emergency department after a collision with a truck. He sustained extensive pancreaticoduodenal deconstruction combined with IVC, liver, right kidney, and right adrenal injuries following blunt abdominal trauma. Despite the patient's hemodynamic instability, the surgical team proceeded with EPD combined with IVC repair, right nephrectomy, adrenalectomy, cholecystectomy, and liver hemostasis. Postoperative complications included biliary leakage and intraabdominal abscess, all of which were successfully conservatively managed. CLINICAL DISCUSSION: Upon entering the abdomen, the priority was rapid identification and control of the significant bleeding, particularly from the injured IVC. While additional procedures like nephrectomy and adrenalectomy were required, continued bleeding from the crushed pancreatic head left EPD as the only viable option to save the patient. CONCLUSION: EPD can be a lifesaving procedure for a small portion of trauma patients with non-reconstructable pancreaticoduodenal injury, even in the setting of hemodynamic instability. However, it should only be performed at high-volume centers and by experienced hepato-pancreato-biliary surgeons.

Chemical Constituents, Biological Activities and Molecular Docking Studies of Root and Aerial Part Essential Oils from Erigeron sublyratus Roxb. ex DC. (Asteraceae).

In this study, the volatile components of Erigeron sublyratus essential oils and their anti-inflammatory and cytotoxic activities were investigated for the first time. Gas chromatography-mass spectrometry (GC-MS) analysis revealed that a total of 28 components were identified in the root and aerial part essential oils. Among them, cis-lachnophyllum ester (53.4-64.2%), followed by germacrene D (5.6-8.6%), trans-ß-ocimene (2.6-7.5%), ß-caryophyllene (4.7-6.8%), ß-myrcene (2.0-6.3%), and (E)-ß-famesene (4.8-5.0%) were principal components. The root essential oil significantly inhibited nitric oxide (NO) production on LPS-induced RAW264.7 cells (IC50 = 1.41 ± 0.10 µg/mL) as compared to standard, dexamethasone (IC50 = 5.43 ± 0.54 µg/mL). Besides, both root and aerial part essential oils exhibited cytotoxic activity against MCF-7, SK-LU-1, and HepG2 (IC50 from 1.11 ± 0.04 to 1.70 ± 0.05 µg/mL). Molecular docking simulation results show that (E)-ß-farnesene exhibits the strongest binding energy among the studied compounds with the VEGFR-2 enzyme (ΔG = -7.295 kcal/mol), while δ-cadinene demonstrates the strongest affinity (ΔG = -8.047 kcal/mol) towards the COX-2 enzyme. Furthermore, hydrophobic interactions were indicated to be the main contributors to the binding ability in the studied protein-ligand complex. These findings proposed that E. sublyratus can be exploited for its anti-inflammatory and anti-cytotoxicity potential.

Whole-Genome Sequencing Reveals Temporal Trends in Antibiotic Resistance Genes in Escherichia coli Causing Pediatric Urinary Tract Infections in Central Vietnam.

(1) Background: Pediatric urinary tract infections (UTIs) pose significant challenges due to drug-resistant Escherichia coli (E. coli) strains. This study utilizes whole-genome sequencing to analyze temporal trends in antibiotic resistance genes (ARGs) in clinical E. coli isolates from pediatric UTI cases in central Vietnam. (2) Methods: We conducted whole-genome sequencing on 71 E. coli isolates collected from pediatric UTI patients between 2018 and 2020. ARGs were identified, and their prevalence over time was analyzed. Statistical tests were used to correlate ARG presence with antibiotic resistance. (3) Results: Of the 47 E. coli isolates with complete data, 40 distinct ARGs were identified, with a median of 10 resistance genes per isolate. A significant increase in the total number of ARGs per isolate was observed over time, from an average of 8.88 before June 2019 to 11.63 after. Notably, the prevalence of the aadA2 gene (aminoglycoside resistance) rose from 0% to 26.7%, and that of the blaNDM-5 gene (beta-lactam and carbapenem resistance) increased from 0% to 23.3%. Key correlations include blaEC with cephalosporin resistance, blaNDM-5 with carbapenem resistance, and sul2 with sulfamethoxazole/trimethoprim resistance. (4) Conclusions: Whole-genome sequencing reveals complex and evolving antibiotic resistance patterns in pediatric E. coli UTIs in central Vietnam, with a marked increase in ARG prevalence over time. Continuous surveillance and targeted treatments are essential to address these trends. Understanding genetic foundations is crucial for effective intervention strategies.

Clinical and Paraclinical Features, Outcome, and Prognosis of Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type: A Retrospective Study of 31 Vietnamese Patients.

Background: Extranodal natural killer (NK)/T-cell lymphoma, nasal type is a rare, aggressive, and poor prognostic subtype. The concurrent chemoradiotherapy followed by chemotherapy showed a relatively high response rate and the toxicity due to the treatment is acceptable. The study attempted to report the clinicopathological features, the survival outcome, and response rates of stages I-II, nasal type ENKTL patients treated with CCRT followed by adjuvant VIPD chemotherapy in Vietnam. Materials and Methods: The current study was conducted on 31 stage I or II NK/T cell lymphoma, nasal-type patients received by CCRT, followed by adjuvant VIPD chemotherapy. Information on patient demographics, disease stage, clinical symptoms, tumor, and paraclinical characteristics were collected. The primary endpoints of this study were OS and response rates. Results: After CCRT, 26 out of 31 (83.9%) patients had stable disease or response. Overall response rate (ORR) was observed in 80.6% of patients with a complete response rate of 67.7%. Low-risk PINK patients had a higher response rate than the intermediate- risk group (p=0.038). Mean disease-free survival was 44.3±4.5 months (95% CI, 35.4-53.1 months). Mean overall survival was 46.8±4.5 months (95% CI, 37.99-55.8 months). The intermediate-risk PINK patients had a significantly lower OS rate than low-risk patients. Conclusion: Concurrent chemoradiotherapy followed by adjuvant VIPD chemotherapy showed a high response rate and survival benefit in stages I-II, nasal type, and extranodal natural killer (NK)/T-cell lymphoma Vietnamese patients.

[Fetal monitoring: Current limitations and new approaches based on analysis of the fetal autonomic nervous system]. / Surveillance fœtale : limites actuelles et nouvelles pistes basées sur l'analyse du système nerveux autonome fœtal.

OBJECTIVE: Currently, fetal monitoring during labor is based on visual analysis of the fetal heart rate (FHR). This test is imperfect, with high intra- and inter-observer variability and a moderate to poor prediction of the occurrence of neonatal acidosis or anoxic-ischaemic encephalopathy. In situations where there is an intermediate risk of acidosis, it is possible to use second-line tests such as blood scalp sampling (with pH or lactate measurement) or ST segment analysis of the fetal ECG. However, these invasive tests have many limitations and their place is debated. Some authors suggest a more physiological approach to FHR assessment. The main actor in maintaining fetal homeostasis is the autonomic nervous system (ANS). Its activity can be assessed by analysing heart rate variability (HRV). The aim is to assess whether HRV can be used to identify situations at risk of acidosis. MATERIALS AND METHODS: Our team has developed an index, the Fetal Stress Index, to measure HRV. To test it in a situation of acidosis, we used a pregnant ewe model. We also developed in parallel a human fetal ECG recording system. RESULTS: In our experimental model, we have shown that this index reflects variations in the parasympathetic system and correlates with the onset of acidosis. As its use in clinical practice requires the acquisition of a beat-to-beat FHR signal, we have also developed an abdominal patch that allows highly accurate analysis of the fetal ECG. CONCLUSION: The future is therefore to validate the FSI as a marker of acidosis in a prospective cohort using the signal obtained from our patch. This could be a new tool for fetal monitoring during labor.

Prognostic Factors in Patients Diagnosed with Gallbladder Cancer over a Period of 20 Years: A Cohort Study.

BACKGROUND: Gallbladder cancer (GBC) is an uncommon cancer. This study aimed to determine the outcomes of GBC in relation to geographic, demographic, and clinical factors in a Canadian province from 2000 to 2019. METHODS: This population-based retrospective cohort study included all patients diagnosed with gallbladder cancer (GBC) in Saskatchewan, Canada, from 2000 to 2019. Cox proportional multivariate regression analysis was conducted to identify factors associated with poorer outcomes. RESULTS: In total, 331 patients with a median age of 74 years and male-female ratio of 1:2 were identified. Of these patients, 305 (92%) had a pathological diagnosis of GBC. Among patients with documented staging data, 64% had stage IV disease. A total of 217 (66%) patients were rural residents, and 149 (45%) were referred to a cancer center. The multivariate analysis for patients with stage I-III GBC showed that stage III disease [hazard ratio (HR), 2.63; 95% confidence interval (CI), 1.09-6.34)] and urban residence (HR, 2.20; 95% CI, 1.1-4.39) were correlated with inferior disease-free survival. For all patients, stage IV disease (HR, 3.02; 95% CI, 1.85-4.94), no referral to a cancer center (HR, 2.64; 95% CI, 1.51-4.62), lack of surgery (HR, 1.63; 95% CI, 1.03-2.57), a neutrophil-lymphocyte ratio of >3.2 (HR, 1.57; 1.05-2.36), and age of ≥70 years (HR, 1.51; 95% CI, 1.04-2.19) were correlated with inferior overall survival. CONCLUSIONS: In this real-world context, the majority of patients with GBC were diagnosed at a late stage and were not referred to a cancer center. For those with early-stage GBC, living in an urban area and having stage III disease were linked to worse outcomes. Across all stages of GBC, stage IV disease, older age, absence of surgery, lack of referral to a cancer center, and a high neutrophil-to-lymphocyte ratio were associated with poorer survival.

PanKA: Leveraging population pangenome to predict antibiotic resistance.

Machine learning has the potential to be a powerful tool in the fight against antimicrobial resistance (AMR), a critical global health issue. Machine learning can identify resistance mechanisms from DNA sequence data without prior knowledge. The first step in building a machine learning model is a feature extraction from sequencing data. Traditional methods like single nucleotide polymorphism (SNP) calling and k-mer counting yield numerous, often redundant features, complicating prediction and analysis. In this paper, we propose PanKA, a method using the pangenome to extract a concise set of relevant features for predicting AMR. PanKA not only enables fast model training and prediction but also improves accuracy. Applied to the Escherichia coli and Klebsiella pneumoniae bacterial species, our model is more accurate than conventional and state-of-the-art methods in predicting AMR.

Different Biocompatibility and Radioprotective Activity of Squid Melanin Nanoparticles on Human Stromal Cells.

Squid ink melanin nanoparticles (NPs) have recently been demonstrated to have a number of bioactivities; however, their biocompatibility has been poorly investigated. In this study, we aimed to evaluate the effects of this NP on stromal cells, including human fibroblasts (hFBs), human umbilical vein endothelial cells (hUVECs), and human umbilical cord-derived mesenchymal stem cells (UCMSCs), and on the development of zebrafish embryos under normal X-ray irradiation conditions. The NPs showed high biocompatibility with low cytotoxicity, no cell senescence induction, and no effect on cell migration in hFBs or cell differentiation in UCMSCs. Nonetheless, this compound prevented cell movement in UCMSCs and significantly suppressed tube formation in hUVECs at a dose of 25 µg/mL. The NPs successfully penetrated the hUVECs but not the other two stromal cell types. The expression levels of functional genes involved in angiogenesis, apoptosis, antioxidant activity, and radiation sensitivity were altered in NPs subjected to hUVECs but were not affected in hFBs and UCMSCs. Melanin NPs significantly rescued cell viability and gene expression in irradiated hFBs and UCMSCs but not in hUVECs. In vivo treatments of zebrafish embryos showed that melanin NPs were nontoxic whether alone or under X-ray irradiation. These findings suggested that nanosized squid ink melanin had biocompatibility with selective stromal cells and was safe for early development.

Clinical and laboratory characteristics of Toxocara canis infection among children in Ho Chi Minh City, Vietnam.

BACKGROUND: This study determines the clinical and paraclinical characteristics of children with Toxocara canis infection and serum eosinophil cut-off values for predicting toxocariasis in the group displaying symptoms of itching, urticaria and erythema. METHODS: A cross-sectional study was conducted during March and April 2023 with a sample size of 986 children aged 3-15 y. RESULTS: In total, 140 (14.2%) of the 986 participants had anti-T canis antibodies. The most frequently experienced symptoms in this group were itching (10.1%), abdominal pain (8.2%) and urticaria (3.3%). The rate of IgE increased (37%), and the rates of mild and high eosinophilia were 38% and 2.2%, respectively. There were significant differences in IgE concentration and eosinophil count, and for both IgE concentration and eosinophil count between the two groups with and without toxocariasis. The optimal threshold for eosinophil to predict toxocariasis was 0.38 K/µL, with itching, urticaria and erythema resulting in a sensitivity of 61.5%, a specificity of 82.1% and a receiver operating characteristic curve (area under the curve) of 0.71. CONCLUSIONS: This study confirmed a positive association between IgE concentration, eosinophil count and positive serology for T. canis. A general blood count, including eosinophils, is a simple test that can be performed in hospitals. Clinicians should target and screen for T.oxocara canis infection when children display clinical symptoms of itching, urticaria, erythema and eosinophilia. CLINICAL TRIAL REGISTRATION NUMBER: NCT05208333.

Large superconducting diode effect in ion-beam patterned Sn-based superconductor nanowire/topological Dirac semimetal planar heterostructures.

High-quality superconductor/topological material heterostructures are highly desired for realisation of topological superconductivity and Majorana physics. Here, we demonstrate a method to directly draw nanoscale superconducting ß-Sn patterns in the plane of a topological Dirac semimetal (TDS) α-Sn thin film by irradiating a focused ion beam and taking advantage of the heat-driven phase transition of α-Sn into superconducting ß-Sn. The ß-Sn nanowires embedded in a TDS α-Sn thin film exhibit a large superconducting diode effect (SDE), whose rectification ratio η reaches a maximum of 35% when the magnetic field is applied parallel to the current. The results suggest that the SDE may occur at the α-Sn/ß-Sn interfaces where the TDS α-Sn becomes superconducting by a proximity effect. Our work thus provides a universal platform for investigating quantum physics and devices based on topological superconducting circuits of any shape.

How does fetal inflammatory response syndrome change fetal response to hypoxia? An experimental study in a fetal sheep model.

INTRODUCTION: Fetal inflammatory response syndrome associated with acidosis during labor is a high-risk situation for the fetus. This study evaluated hemodynamic, gasometric, and heart rate variability changes during acute fetal inflammatory response syndrome associated with hypoxia, compared with isolated hypoxia. MATERIAL AND METHODS: Acute fetal inflammatory response syndrome was obtained via an intravenously injection of lipopolysaccharide derived from Escherichia coli. Hypoxia was induced by repeated umbilical cord occlusions during three phases: mild, moderate, and severe umbilical cord occlusions. Two groups were created with chronically instrumented near-term fetal sheep: one group with isolated hypoxia, the other with hypoxia and fetal inflammatory response syndrome. Hemodynamic, gas parameters, and fetal heart rate variability were compared between the groups. RESULTS: The hypoxia and fetal inflammatory response syndrome group had a higher mortality rate (n = 4/9) compared with the hypoxia group (n = 0/9). Gasometric state was altered earlier in case of lipopolysaccharide injection (pH = 7.22 (7.12-7.24) vs 7.28 (7.23-7.34) p = 0.01; lactate = 10.3 mmol/L (9.4-11.0) vs 6.0 mmol/L (4.1-8.2) p < 0.001 after mild occlusions). After mild occlusions, the hypoxia and fetal inflammatory response syndrome group had higher values on seven heart rate variability parameters compared with the hypoxia group. After moderate occlusions, two parameters remained significantly higher. CONCLUSIONS: During fetal inflammatory response syndrome, fetal adaptation to hypoxia is impaired. In case of fetal infection, acidosis during labor is likely to become severe more rapidly, requiring closer fetal monitoring during labor.

NANO-GBM trial of AGuIX nanoparticles with radiotherapy and temozolomide in the treatment of newly diagnosed Glioblastoma: Phase 1b outcomes and MRI-based biodistribution.

Background: In glioblastoma (GBM), tumor progression occurs mainly within the irradiated tumor volume. To address this challenge, a radiosensitization strategy with intravenous gadolinium-based theranostic nanoparticles (AGuIX) is being explored in the NANO-GBM phase1b/2R trial (NCT04881032). Here, we present the results of the phase 1b part, which is the first-in-human use of these nanoparticles with radiotherapy and chemotherapy for the treatment of newly diagnosed GBM. Material and Methods: Eligible patients were aged 18 to 75 years with newly diagnosed and histologically confirmed GBM, with incomplete resection (biopsy or partial surgery). The phase 1b part was a dose escalation approach (Time-to-event Continuous Reassessment Method) with three dose levels: 50, 75, and 100 mg/kg. Patients were treated with RT (60 Gy), and concomitant and adjuvant TMZ, and 4 injections of AGuIX (D-3/-7, D1, D8, and D15). Dose-limiting-toxicity (DLT) was defined as any grade 3-4 adverse event (CTCAE v5.0), excluding alopecia, nausea, and rapidly controlled vomiting. Pharmacokinetic (PK), and biodistribution based on MRI were evaluated. Results: Between March 2022 and March 2023, eight patients were enrolled: 1 at 50 mg/kg, 1 at 75 mg/kg, and 6 at 100 mg/kg. All patients received the four AGuIX injections. Only one patient experienced a DLT (at 100 mg/kg): a grade 3 lymphopenia (related to TMZ). The RP2D of AGuIX was determined as 100 mg/kg. AGuIX mean AUC increased with dose. Regions of GBM with moderate (36-123 µM), and high (123-291 µM) or very high (>291 µM) AGuIX concentrations accounted in average for 38.7 and 26.8 %, respectively. Conclusion: These results confirm the lack of AGuIX-related toxicity and the widespread dispersion of nanoparticles throughout GBM. This supports progression to the randomized phase 2 part, utilizing an RP2D of AGuIX of 100 mg/kg (4 injections).

Phytochemical and bioactivities of promising flavonoid glycosides and their content from unmatured fruits of Vicia bungei with their bioactivity.

Flavonoids have extensive biological qualities that support human health. A molecular networking strategy produced representative networks despite mass fragmentation of spectra of untargeted data-dependent acquisition approach to target flavonoid glycosides from Vicia bungei by using UHPLC-MS guided isolation. Using contemporary methods, seven chemicals were extracted and identified. Antioxidative and anti-inflammatory effects of these isolates were assessed in vitro on free radicals and inflammatory mediators, cytokines, enzymatic proteins. Two active compounds, apigenin 6-C-ß-D-galactopyranosyl-8-C-ß-D-xylopyranoside, and sphaerobioside, were further assessed for their binding affinity to target protein in in silico study. The molecular mechanism of sphaerobioside was found to involve suppression of LPS-stimulated inflammation by NF-κB inactivation by inhibiting nuclear translocation of p65 and prevention of phosphorylation of κB inhibitor α (IκBα) and IκB kinase (IKKα/ß). Furthermore, an analytical method was successfully established and employed to quantify the total extract using these seven chemicals present in this plant as markers.

Cytokine profiles and their roles in development of provoked vulvodynia.

Provoked, localized, vulvodynia (PVD) is the main subtype of vulvodynia. Although the etiology of PVD is still a topic of debate, inflammation caused by cytokines responding to a dysregulated microbiome is one of the leading proposed theories. Therefore, the purpose of our study is to further explore the cytokine profiles in the study group with PVD using multiplex immunoassays based on electrochemiluminescence. We compared a panel of 26 distinct cytokines levels in the study group with PVD (n = 23) to the control group (n = 18) and cytokine concentrations were measured using MESO QuickPlex SQ 120 instrument with 5 different multiplex assays. Statistical analysis used the Mann-Whitney U test, two-sided p-values, and a significance level of α = 0.05. Differences in cytokine concentrations are described as negligible, small, medium, or large based on Cliff's δ. Concentrations of three cytokines were significantly lower in the PVD group: a large difference in IP-10 (p = 0.029*) and medium differences in IL-1RA4 (p = 0.030*) and IL-12 (p = 0.034*). One cytokine level was significantly higher in the PVD group: a medium difference for IL-6 (p = 0.037*). Due to the lack of consistency in elevation of inflammatory profiles, it is not enough to support persistent inflammation as the etiology behind PVD. However, these findings may indicate there is a possible immune response deficiency in some patients who have PVD. The resemblance of cytokine profile in our study to cytokine profile of people with chronic yeast infection further support this proposed mechanism behind PVD. Future studies involving history and testing for yeast infection are necessary to explore this possibility further.

Infiltrating lobular carcinoma of LUMB HER2+ subtype with rhabdoid feature coexisting with synchronous malignant transformation of phyllodes tumor: An exceedingly rare clinicopathological characteristic in Vietnam.

The transformation of a benign phyllodes tumor (PT) into a malignant PT and/or carcinoma is extremely uncommon. We present a case of a 66-year-old female with a huge mass on the left breast which was successfully removed by surgical resection. The pathological diagnosis was infiltrating lobular carcinoma with pure rhabdoid features and the malignant transformation of a benign phyllodes tumor. The first time this rare case was reported, it is demonstrated a special phenomenon through the synchronous transformation of PT grades and the carcinomatous transformation of PT.

Sociodemographic determinants of HPV vaccine awareness, uptake, and intention among parents of adolescents in France 2021-22.

Human Papillomavirus (HPV) vaccine coverage was <50% in France in 2022 and even lower among socially disadvantaged populations. We aimed to evaluate socio-demographic determinants of HPV vaccine awareness, uptake, and intention among parents of adolescents, and related attitudes and knowledge items. Parents of adolescents attending middle schools across France, who participated in a randomized trial responded to an anonymous baseline survey, conducted between November 2021 and February 2022. We used logistic regression models adjusting for a child's age and sex to explore sociodemographic determinants (including at-home multilingualism, occupational categories, local deprivation index and urbanity) of HPV vaccine awareness, uptake, and intention. Among the 1889 participants from 61 schools, parents working as factory workers/farmers had significantly lower odds of vaccine awareness compared to executives/professionals, both if they reported (OR = 0.07; 0.03-0.15) or not (OR = 0.20; 0.11-0.36) speaking also another language than French at home. Parents in lower occupational categories with multilingual families were less likely to have the intention to vaccinate their child (OR = 0.19; 0.07-0.56). Recent physician visit or vaccine offer was strong positive determinants of awareness, uptake and intention. A substantial gradient across occupational categories was observed for attitudes and knowledge around HPV vaccine usefulness, safety, and accessibility. This study confirms the disparities on HPV vaccine uptake in France and provides insight into mechanisms of social disparities in HPV vaccine awareness, access and intention.