The value of APGA score, fibrosis index for diagnosing liver fibrosis in patients with chronic hepatitis B.

Background: Various non-invasive methods have been studied for assessing the fibrosis stage in patients with chronic hepatitis B. However, the performance of APGA, Fibrosis index in diagnosing liver fibrosis remains unclear globally and specifically in Vietnam. Methods: An analytical cross-sectional study was performed among 242 patients treated at Thong Nhat Hospital. Results: Both the APGA index and Fibrosis index showed good accuracy in diagnosing significant fibrosis (≥ F2), advanced liver fibro-sis (≥ F3), and cirrhosis (F4) with an area under the curve (AUROC) greater than 0.7. AUROC value of APGA index, Fibrosis index for diagnosing signifcant fibrosis (≥ F2) were 0.828, 0.767 respectively. AUROC value of APGA index, Fibrosis index for diagnosing advanced liver fibrosis (≥ F3) were 0.784, 0.755 respectively. AUROC value of APGA index, Fibrosis index for diagnosing cirrhosis (F4) were 0.736, 0.782 respectively. APGA index and the Fibrosis index were significantly positively correlated with the fibrosis stage (p < 0.001), with the APGA index showing the strongest correlation (r = 0.51, p < 0.001). Conclusions: The APGA values of 6.23, 7.88, and 8.99 can serve as cutoff points for the diagnosis of significant fibrosis (≥F2), advanced fibrosis (≥F3), and cirrhosis (F4) when combined with ARFI data.

The effectiveness of diffusion kurtosis imaging metrics for distinguishing between brainstem glioma and cerebellar medulloblastoma.

Background: In some clinical situations, distinguishing between cerebellar medulloblastoma and brainstem glioma is important. We assessed whether diffusion kurtosis imaging (DKI) metrics could be used to distinguish cerebellar medulloblastomas from brainstem gliomas in children. Patients and methods: This prospective study was approved by the institutional review board. Seventy patients were separated into two groups according to eventual diagnosis: brainstem glioma (n = 30) and cerebellar medulloblastoma (n = 40). Both groups underwent brain magnetic resonance imaging (MRI), including DKI. The Kurtosis value for the tumor region and the ratio between Kurtosis values between the tumor and the normal parenchyma (rKurtosis) were compared between groups using the Mann-Whitney U test. Receiver operating characteristic curve analysis and the Youden's Index were applied to identify a cutoff value for distinguishing between the two tumor types, and the area under the curve (AUC), sensitivity, and specificity for the selected cutoff value were calculated. Results: Compared with brainstem gliomas, cerebellar medulloblastomas had significantly higher Kurtosis and rKurtosis values (p < 0.05). Medulloblastoma could be differentiated from brainstem gliomas using a Kurtosis value of 0.91 or an rKurtosis value of 0.90, both of which achieved 100% sensitivity, 96.7% specificity, and AUC values of 0.990. Conclusions: DKI measurements can contribute to distinguishing between cerebellar medulloblastoma and brainstem glioma in children.

Evaluation of anatomical factors affecting stress urinary incontinence in female patients via dynamic pelvic floor magnetic resonance imaging.

Objective: To evaluate the anatomical factors affecting stress urinary incontinence (SUI) in female patients via dynamic pelvic floor magnetic resonance imaging (DP-MRI). Methods: This prospective study was conducted on 43 female patients, including 22 patients with SUI (disease group) and 21 patients without SUI (control group). All patients underwent DP-MRI. The length, volume, transverse/anteroposterior diameter, and outer/inner layer thickness of the urethra were measured on static (T2W) pulse sequences. Urethral angle, posterior urethro-vesical angle (PUVA), bladder neck-pubococcygeal angle, and position of the bladder neck and cervix relative to the pubococcygeal line were measured on dynamic (Cine) pulse sequences at rest and during evacuation phase. These parameters were compared between the groups to evaluate which anatomical factors affected SUI. The area under the ROC curve (AUC) and threshold of the sensitivity and specificity of these parameters for the diagnosis of SUI were calculated. Results: The mean age of the patients was 57.3±13.8 years (disease group: 53.9±12.6 years; control group: 60.8±14.4 years). The mean number of childbirths was 2.2±0.65, and vaginal delivery accounted for 73% in each group. There was no significant difference between the two groups in terms of length, transverse diameter, outer layer thickness of the urethra, urethral angle, bladder neck-pubococcygeal angle, position of bladder neck relative to the pubococcygeal line in both resting and evacuation phases (p>0.05). There was a significant difference between the two groups regarding volume (p=0.014), anteroposterior diameter (p=0.01), inner layer thickness of the urethra (p=0.04), and PUVA (p<0.001) at rest and evacuation phases and cervix position at evacuation phase (p=0.001). The AUC of the PUVA for SUI diagnosis was 0.9 at rest and 0.98 during evacuation phases. For the threshold 133.5° at rest phase and 153.5° at evacuation phase, the sensitivity and specificity of PUVA were 0.86 and 0.86 at rest phase and 0.91 and 0.95 at evacuation phase, respectively. Conclusions: PUVA was the anatomical factor that had the greatest effect on SUI and provided high sensitivity and specificity for SUI diag-nosis.

Beneficial effects of pulmonary embolism response team establishment in patients with pulmonary embolism in a developing country: a single-center experience.

Objective: The impact of establishing a pulmonary embolism response team (PERT) in patients with pulmonary embolism (PE) has been proven in many developed countries. However, the efficacy of a PERT largely depends on expertise and infrastructure. This study explored the benefit of establishing a PERT in developing countries with limited healthcare resources by comparing the outcomes of patients with acute PE before and after PERT establishment at University Medical Center Ho Chi Minh City in Vietnam. Methods: We conducted a single-center observational study from January 1, 2019, to August 1, 2021. All patients with PE confirmed on computed tomography were included. Patients admitted before PERT establishment were treated by cardiologists alone, while those hospitalized after PERT establishment were managed by the PERT. Results: A total of 130 patients were included (pre-PERT estab-lishment: 51 patients; post-PERT establishment: 79 patients). The demographic characteristics, severity of PE, and clinical and laboratory findings were similar between the two groups. The post-PERT establishment group had a lower incidence rate of major and clinically relevant nonmajor bleeding (11.3% vs. 31.4%, p = 0.005) and required more interventional therapies (16.5% vs. 3.9%, p = 0.046) than did the pre-PERT establishment group. The in-hospital mortality rate decreased in the post-PERT establishment group compared with that in the pre-PERT establishment group (8.9% vs. 21.6%, p = 0.041). Conclusions: Involvement of the PERT in PE management was associated with improved outcomes of patients with PE, including reduced bleeding and mortality rates in a resource-constrained hospital.

Value of ultrasound-guided synovial biopsy for the diagnosis of infectious arthritis.

Objectives: To determine the value of ultrasound (US)-guided synovial biopsy for the diagnosis of infectious arthritis that could not be detected by other modalities. Material and methods: This descriptive study was conducted among 37 patients with arthritis (3 with shoulder arthritis, 2 with elbow arthritis, 7 with wrist arthritis, 15 with hip arthritis, 4 with knee arthritis, and 5 with ankle arthritis) who underwent US-guided synovial biopsy at Hanoi Medical University Hospital for the diagnosis of infec-tious arthritis that could not be detected by infection laboratory tests, imaging, and/or joint fluid culture. The results of US-guided synovial biopsy were positive for infectious arthritis when those of pathologi-cal analyses, bacterial cultures, and/or polymerase chain reaction test for tuberculosis were positive. The final diagnosis established when the patients were discharged from the hospital was compared with the US-guided synovial biopsy results to calculate the sensitivity and specificity for the diagnosis of infectious arthritis. Results: The median age of the patients was 60 years (range: 22-79 years), and two thirds were women. Infectious arthritis was determined as the final diagnosis in 18 patients. There was no significant difference in the infection laboratory test results, synovial thickness, or magnetic resonance imaging features apart from soft tissue abscess between the infectious and non-infectious arthritis groups (P > 0.05). The US-guided synovial biopsy results were positive in 17 patients. Compared with the sensitivity and specificity of the final diagnosis, those of the US-guided synovial biopsy results for the diagnosis of infectious arthritis were 94.4% and 100%, respectively. The Numerical Rating Scale score was ≤3 in most patients. There were neither vascular nor neurologic complications among the patients. Conclusion: Imaging features and laboratory test results are non-specific for infectious arthritis. US-guided synovial biopsy is a well-tolerated, safe method that has a high value for the diagnosis of infectious arthritis. This modality should then be recommended for patients with unclassified arthritis.

Morphology of the triangular fibrocartilage complex of the Vietnamese adult: a cadaveric study.

Objective: This descriptive study aims to describe various anatomical morphological indicators of the triangular fibrocartilage complex (TFCC) in Vietnamese adults. Materials and methods: We analyzed 30 wrist joints from 15 fresh cadavers. To access the components of the TFCC, the wrist joints were dissected and measured, and anatomical morphological indices, inclu-ding length, width, thickness, origin, and insertion, were recorded. Results: Nine of 30 articular discs had central tears. The average length of the articular disc was 10.05±2.26 mm, while the average width was 12.10±1.39 mm. The average thickness of the articular disk on the ulnar side was 1.56±0.42 mm, while the average thickness of the articular disk on the radial side was 2.63±1.04 mm. Most meniscus homologues (86.6%) were of the narrow opening type according to the Ishii classification, with a horizontal dimension of 6.98±2.05 mm, anteroposterior diameter of 8.94±2.46 mm, and thickness of 1.27±0.41 mm. The volar radioulnar ligament averaged 12.75±2.17 mm in length and 2.54±0.77 mm in width, while the dorsal radioulnar ligament ave-raged 12.82±2.63 mm in length and 2.37±0.65 mm in width. The ulnar collateral ligament averaged 13.59±2.79 mm in length, 3.75±0.80 mm in width, and 0.95±0.46 mm in thickness. The ulnolunate and ulnotriquetral ligaments had average lengths of 7.34±2.87 mm and 5.70±2.98 mm, widths of 3.93±1.55 mm and 4.87±1.06 mm, and thicknesses of 0.96±0.61 mm and 1.43±0.98 mm, respectively. Conclusions: There are no differences in the shape or structure of the adult Vietnamese TFCC. No significant differences were noted in any TFCC component according to wrist side or gender.

Percutaneous transhepatic endoscopic thulium laser vaporesection for management of severe and focal benign biliary strictures.

Background: Biliary lithiasis and strictures in the bile ducts have a causality. Dilation or stent placement is routinely used to treat strictures but fibrosis can lead to their recurrence. Thulium laser vaporesection with percutaneous transhepatic endoscopy is a novel therapeutic modal-ity for managing severe, focal benign biliary strictures (BBSs). There are few reports about this method of treating BBSs. Our study aimed to determine the safety and efficacy of this technique. Methods: Fifteen patients (six males and nine females) with BBSs underwent stricture ablation with thulium laser via percutaneous transhepatic endoscopy. The immediate and short-term technical success and complication rates were evaluated. Results: Biliary strictures appeared in segmental branches of two patients, in the left or right hepatic duct of twelve patients, and in the common bile duct of one patient. The immediate and short-term technical success rates of the thulium laser procedure were 100%. The lumen of the strictures measured 1-3 mm before the procedure and improved to 4-5 mm in six (40%) patients, 5-10 mm in five (33.3%) patients, and 10-15 mm in four (26.7%) patients after the procedure. No mortality and major procedure-related complications were observed. One patient experienced a minor complication (hemobilia). Conclusions: Percutaneous transhepatic endoscopic thulium laser ablation appears to be safe and effective for treating short-segment BBSs. However, further studies with large samples and long follow-up periods are necessary to fully determine the long-term outcomes of this technique.

Comparison of two treatments for atlantoaxial instability injury: C1-C2 transarticular screw fixation versus C1 lateral mass-C2 pedicle screw fixation.

Objective: This study evaluated the effectiveness and safety of C1-C2 transarticular screw fixation (transarticular screw fixation com-bined with bone grafting) and C1 lateral mass-C2 pedicle screw fixation (modified Harms technique) in patients with C1-C2 instability. Materials and methods: This prospective, self-controlled, single-center study evaluated two fixation techniques for the treatment of atlantoaxial instability injury. From June 2006 to February 2017, 118 patients were admitted to our hospital because of atlantoaxial instability injury. These patients were divided into two groups: group 1, including 52 patients who underwent C1-C2 transarticular screw fixation (C1C2-TAS group), and group 2, including 66 patients who underwent C1 lateral mass-C2 pedicle screw fixation (C1LM-C2PS group). Results: There were significant differences in the operation time, blood loss amount, and hospital stay length between the groups (p<0.001). The mean operation time (78.94 vs. 110.91 min; p=0.0003) and hospital stay length (5.31 vs. 8.34 days; p=0.0003) were shorter, and the mean blood loss amount during surgery (122.31 vs. 258.33 mL; p<0.0001) was smaller in the C1C2-TAS group than in the C1LM-C2PS group. The surgical complication rate was low and no vertebral artery injury was observed. After surgery, the clinical presentations were significantly reduced in both groups. The patients showed sati-sfactory internal fixation on postoperative radiography and computed tomography. Conclusion: Both C1-C2 transarticular screw fixation and C1 lateral mass-C2 pedicle screw fixation are effective and safe in treat-ing atlantoaxial instability injury. Notably, C1-C2 transarticular screw fixation yields a shorter operation time and hospital stay length and a smaller intraoperative blood loss amount than does C1 lateral mass-C2 pedicle screw fixation.

Multidimensional Analysis of the Mother-to-child Transmission Risk Factors in Chronic Hepatitis B Virus Infection in Pregnant Women in Vietnam.

Background: Hepatitis B virus (HBV) infection remains a major public health problem. The interaction between HBV and the host inflammatory response is an important factor contributing to liver damage and disease development. We investigate of the correlation between peripheral blood cell levels, HBV DNA, and the risk of transmission to the baby in pregnant women infected with hepatitis B. Methods: A multidimensional analysis was performed on data collected from 60 Vietnamese pregnant women and their babies (cord blood). Results: Taking the risk ratio test results of cord blood HBsAg as a positive probability, the boundary of maternal PBMC concentration is 8.03x106 cells/ml (with negative correlation) and for CBMCs is 6.64x106 cells/ml (with positive correlation). That means that HBsAg positivity in the blood may be related to the increasing of CBMCs and the diminution of maternal PBMCs. When the maternal viral load is higher than 5x107 copies/ml, the risk of being HBsAg-positive in cord blood is 123% (RR=2.23 [1.48,3.36]); when the viral load is lower than this baseline, the risk is decreased by 55% (RR=0.45 [0.30,0.67]) (p<0.001). Conclusions: With several steps of the analysis, this study found maternal peripheral blood cell levels and cord blood positively cor-related in pregnant women with a load lower than 5x107 copies of HBV DNA/ml. The study's results suggest that the role of PBMCs and HBV DNA in vertical infection is essential.

Structural and functional changes in the left ventricle in kidney transplant recipients.

Background: Patients with end-stage chronic kidney disease often exhibit adverse alterations in the geometry of their left ventricle, which may be ameliorated following renal transplantation. The objective of this study was to examine the structural and functional alternations in the heart using echocardiography in patients with end-stage chronic renal failure who undergone kidney transplantation. Patients and methods: A observational retrospective cohort study was conducted, concluding a sample of 47 patients who had undergone kidney transplantation at Cho Ray Hospital, Vietnam between 2013 and 2017. All the participants underwent echocardiography at baseline and one year following the transplantation procedure. Results: Forty-seven patients had the mean age of 36.8 ± 9.0 years old, that 66.0% were men and the median duration of dialysis was 12 months at the time just before kidney transplantation. After trans-plantation, both mean systolic and diastolic blood pressures showed a statistically significant reduction at 12 months post-transplant, with a p-value of <0.001 (135.4 ± 9.8 mmHg versus 119.6 ± 11.2 mmHg for systolic blood pressure; 85.9 ± 7.2 mmHg versus 73.8 ± 6.7 mmHg for diastolic blood pressure). The left ventricular mass index decreased significantly from 175.3 ± 59.4 g/m2 before transplantation to 106.1± 30.8 g/m2 after transplantation (P < 0.001). Conclusions: The findings of the study revealed that kidney transplantation has a beneficial impact on the cardiovascular status of patients suffering from end-stage renal disease, leading to improvements in both structural and functional echocardiographic features.

Spontaneous pregnancies post-microsurgical varicocelectomy in infertile men with severe oligozoospermia: a preliminary vietnamese report.

Background: This study evaluated whether microsurgical varico-celectomy performed in infertile men with severe oligozoospermia (SO) resulted in improved semen parameters or increased rates of spontaneous pregnancy (SP) and performed a cost-effectiveness analysis comparing intrauterine insemination (IUI), in vitro fertilization (IVF), and varicocelectomy. Methods: This study included 25 patients with SO who underwent microsurgical varicocelectomy between September 2019 and May 2022, which resulted in post-surgical SP in all cases. Men with azoospermia, abnormal karyotype, or Y-chromosome microdeletion were excluded from the study. Serum luteinizing, follicle-stimulating, and testosterone hormones were measured preoperatively. Semen was analyzed every 3 months postoperation. The incidence of SP was recorded at each visit. Cost-effectiveness for assisted reproductive technologies was calculated based on reported costs. Several parameters were evaluated as potential predictors of the response to microsurgical varicocelectomy using univariate and multivariate analyses. Results: After a mean postoperative observation period of 7 months, 25 couples with SP after microsurgical varicocelectomy were recruited. The mean sperm concentration increased from 3 million/mL (interquartile range [IQR]: 2-5 million/mL) to 12 million/mL (IQR: 5-17 million/mL; p<0.05), and mean sperm motility improved from 4% (IQR: 3%-6%) to 7.6% (p<0.05). Total motile sperm count (TMSC) increased to 3.08 million (IQR: 1.02-5.83 million) from a preoperative value of 0.34 million (IQR: 0.16-0.83 million). A cost-effectiveness analysis comparing IVF with varicocelectomy indicates that varicocelectomy may represent a better first-line option for infertile men with very low preoperative TMSC. However, further research remains necessary to confirm this result. Conclusion: Varicocelectomy should be discussed as a treatment option for men with SO and may improve sperm quality and fertility potential, resulting in SP.

Characteristics of oocytes that failed to fertilize after intracytoplasmic sperm injection.

Background: We assessed the morphologies of meiotic spindles in oocytes that failed to fertilize following intracytoplasmic sperm injection (ICSI) and identified factors contributing to failed fertilization. Methods: A total of 225 unfertilized oocytes were collected after ICSI. Oocytes were fixed and stained for tubulin and chromosomes. Meiotic spindle morphologies, chromosome alignment, and sperm nuclear decondensation were assessed to identify contributing factors to fertilization failure. We identified relationships between several factors and both abnormal spindle morphologies and sperm nuclear decondensation in oocytes that failed to fertilize. Results: Three causes for unfertilized oocytes after ICSI were identified: (I) the absence of a sperm nucleus in the ooplasm; (II) failed oocyte activation; and (III) defects in pronucleus formation or migration. The rate of disarranged polar spindles in oocytes collected from women older than 35 years (73.3%; 33/45 oocytes) was significantly higher than that of those collected from women 35 years and younger (50.4%; 68/135 oocytes; odds ratio [OR]: 2.71, 95% confidence interval [CI]: 1.29-5.69, p = 0.009). The proportion of unfertilized oocytes with abnormal spindles and chromosome misalignment was significantly higher in oocytes collected from women older than 35 years than those from women 35 years and younger (62.2% vs. 41.5%, p = 0.016). The proportion of partially decondensed chromatin in the abnormal sperm morphology group was significantly higher than in the normal sperm morphology group (66.7% versus 52.9%, OR: 1.78, 95% CI: 1.01-3.11, p = 0.044). Conclusions: The main contributor to the failure of oocytes to fertilize after ICSI is failed oocyte activation. The ICSI technique used, the maternal age, and sperm morphology are also contributing factors in fertilization failure after ICSI.

Association between nonalcoholic fatty liver disease and carotid intima-media thickness.

Background: Many non-invasive methods have been studied for assessing the severity of fatty liver disease and carotid intima-media thickness (CIMT). However, the correlation between hepatic steatosis and CIMT has not been fully studied, either globally or in Vietnam. This study investigated the association between nonalcoholic fatty liver disease (NAFLD) and CIMT. Methods: A cross-sectional study was performed on 125 patients at the Cardiology Department, the Emergency Interventional Cardiology Department, and the Internal Cardiology Clinic of Thong Nhat Hospital. Results: Among the 125 patients in our study population, NAFLD was diagnosed in 56%, and the mean CIMT was 0.89 ± 0.48 mm. Normal CIMT was measured in 21% of patients, whereas 79% had an elevated CIMT. The NAFLD rates were significantly different between patients with normal and increased CIMT, at 26.9% and 69.6%, respectively (p = 0.001). Conclusions: Our study revealed a strong association between NAFLD and CIMT. NAFLD is currently considered a feature of metabolic syndrome, and an increase in the prevalence of NAFLD might result in an increase in the incidence of cardiovascular disease.

Correlation between nonalcoholic fatty liver disease and coronary atherosclerosis.

Background: Various non-invasive methods have been studied for assessing the severity of fatty liver disease and coronary atherosclero-sis. However, the correlation between hepatic steatosis and coronary atherosclerosis has not been fully studied, either globally or specifically in Vietnam. This study investigated the association between nonalcoholic fatty liver disease (NAFLD) and coronary atherosclerosis using coronary computed tomography angiography (CCTA). Methods: An analytical cross-sectional study was performed, including 223 patients treated by the Cardiology Department, the Emergency Interventional Cardiology Departments, and the Internal Cardiology Clinic of Thong Nhat Hospital. Results: In our cohort of 223 patients, the NAFLD was detected in 66% of the population, the mean coronary artery stenosis (CAS) was 44.54% ± 20.23%, and the mean coronary artery calcium score (CACS) was 3569.05 ± 425.99, as assessed using the Agatston method. The proportion of patients with significant atherosclerotic plaque (CAS 50%) >was 32%, whereas the remaining 68% had insignificant stenosis. Among our study population, 16% had no coronary artery calcification, 38% had mild calcification, and 46% had moderate to severe calcification. In the group of NAFLD patients, 33.3% had significant atherosclerotic plaque, which was not significantly different from the rate in individuals without NAFLD (p = 0.51). Mild coronary artery calcification was detected in 37.4% of NAFLD patients, and moderate to severe calcification was detected in 48.3% (p = 0.45). Conclusions: NAFLD was not found to be strongly associated with coronary atherosclerosis in this study. More studies with larger sample sizes remain necessary to verify whether any correlation exists.

The efficiency of chemical-shift MRI for the evaluation of thymoma in patients with myasthenia gravis.

Purposes: This research aimed to evaluate the efficiency of using chemical-shift magnetic resonance imaging (MRI) to differentiate thy-moma from non-thymoma in patients with myasthenia gravis (MG). Methods: A total of 137 subjects were split into thymoma and non-thymoma groups. The qualitative parameters and the chemical-shift ratio (CSR) were compared between the two groups, using the Chi-square test and the Student's t-test, respectively. Logistic regression was performed to investigate the significant factors associated with both the qualitative parameters and CSR values that can be used to predict thymoma. The discriminative capability of CSR was defined by the area under the receiver operating characteristic (ROC) curve (AUROC), which was used to compute an optimal cut-off point for thymoma distinction. Results: Although significant differences between groups were identified by univariate analyses for most of the qualitative parameters, during the multivariate logistic regression, only CSR was significant for the distinction between two groups, with an odds ratio (OR) of 9.700 [95% confidence interval (CI): 1.874-50.200, p = 0.007). The CSR values for the thymoma and non-thymoma groups were 1.020 ± 0.073 and 0.604 ± 0.126, respectively. With an optimal cut-off point defined at 0.825, the AUROC of CSR was 0.982. When applying this cut-off point, the sensitivity and specificity of chemical-shift MRI for the detection of thymoma were 100% and 97.22%, respectively. Conclusions: CSR values, calculated from chemical-shift MRI, was exceedingly valuable for distinguishing thymoma from non-thymoma in patients with MG.

Mechanical thrombectomy treatment of basilar artery occlusion within 24 hours of symptom onset: A Single-Center Experience.

Background: To evaluate the efficacy, safety, and predictive factors for clinical outcomes of mechanical thrombectomy (MT) performed within 24 hours of stroke onset in patients with basilar artery occlusion (BAO). Method: A prospective, single-center study collected clinical and imaging data from 49 patients with BAO treated with MT within 24 hours of stroke symptom onset. Direct suction using the Penumbra system and thrombus retrieval by Solitaire stent were the primary endovascular techniques used to restore basilar artery flow. Outcomes included angiographic recanalization success, improvement National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) at discharge and after 3 months, and occurrence of symptomatic intracerebral hemorrhage (sICH) complications. Results: The mean age was 67.6 ± 10.4 years (range, 47-88 years). The mean NIHSS and Glasgow Coma Scale (GCS) on admission were 22.9 ± 11.2 (range, 6-40) and 10.4 ± 3.1 (range, 5-15), respectively. The major etiologic risk factors were large artery atherosclerosis (83.7%), followed by cardioembolism (16.3%). Successful recanalization (thrombolysis in cerebral infarction [TICI] ≥ 2b) was achieved in all patients (100%), and TICI 3 was achieved in 93.9% of patients. Of the total sample, 6.1% (3/49) of patients showed NIHSS improve-ments of 0 points at discharge, and 24.9% (12/49) of patients showed NIHSS improvements of 10 points at discharge. After 3 months, 22 patients (44.9%) had favorable clinical outcomes (mRS 0-2), whereas 7 (14.3%) had poor outcomes (mRS 3-5); overall mortality was 40.8% (20/49). Complications of sICH were documented in 15.6% of patients. Univariate analysis identified atrial fibrillation (P = 0.016), NIHSS on admission < 15 (P = 0.032), and GCS on admission > 8 (P = 0.010) as predictive factors for favorable outcomes. Conclusions: The current study suggests that MT treatment of BAO has high recanalization rates and good outcomes.

Detection of Arterial Injuries in Blunt Abdominopelvic Trauma: The Value of Computed Tomography.

Background: This study aims to evaluate the value of computed tomography (CT) in detecting arterial injuries in abdominopelvic trauma compared with digital subtraction angiography (DSA). Methods: A retrospective study was performed on 83 patients (67 men, 16 women with a mean age of 38.2 years) who were hospitalized with abdominopelvic trauma and were diagnosed by CT with arterial injuries including active extravasation (AE), pseudoaneurysm (PA), and arteriovenous fistula (AVF). The findings on the CT images were interpreted and its value as a diagnostic modality was analyzed compared with images taken from patients who underwent DSA from June 2020 to November 2021. Results: A total of 94 arterial lesions were observed on CT (54 AE, 37 PA, and 3 AVF). The sensitivity (Se), specificity (Sp), positive predictive values (PPV), and negative predictive values (NPV) on the arterial phase when diagnosing AE were 88.9%, 90%, 92.3%, and 85.7%, respectively, and 86.1%, 91.4 %, 86.1%, and 91.4%, respectively, when diagnosing PA. On the portal venous phase, the Se, Sp, PPV, NPV for AE were 88.9%, 92.5%, 94.1%, and 86.0%, respectively, and 75%, 91.4%, 84.4%, and 85.5%, respectively, for PA. On the dual phase, the Se, Sp, PPV, and NPV for AE were 92.6%, 90%, 92.6%, and 90%, respectively, 88.9%, 91.4%. 86.5%, and 93%, respectively, for PA, and 75%, 100%, 100%, and 98.9%, respectively for AVF. Conclusions: Our study showed that CT is a useful, non-invasive modality for detecting arterial injuries in abdominopelvic trauma. A dual-phase scan combined with arterial and portal venous phases gives the optimal performance.

Percutaneous nephrolithotomy with ultrasonography-guided renal access in the modified lateral position with extended legs.

Purpose: This study was to evaluate the safety and efficacy of ultrasound-guided percutaneous nephrolithotomy (US-guided PCNL) in a modified lateral position with extended legs for kidney stones. Methods: This prospective study included 46 patients underwent PCNL with US-guided renal access in the modified lateral position with extended legs from 2020 to 2021. The outcomes included the rate of successful access, complete stone clearance, operative characteristics, postoperative complications, and the need for an additional procedure. Results: Median age was 54.5 years and males were 56.5%. Median stone burden was 2,660 mm3 and 93.5% of all patients were graded as 1 or 2 regarding the Guy's stone score. Twenty-four patients required one puncture and 14 patients required 2 punctures. Six patients had a concomitant ureteroscopic lithotripsy. Median access duration, fluoroscopy duration and hospital length of stay were 2.0 minutes, 14.5 seconds and 3 days respectively. Successful renal access rate was 100% and complete stone clearance rate was 93.5%. Complications occurred in 5 patients without mortality. Three patients required an additional procedure. Conclusion: US-guided PCNL in the modified lateral position with extended legs is safe and effective for kidney stones. The exposure to radiation is reduced significantly. We advocate using this approach and try to perform PCNL under X-ray free US guidance.

The impact of ADC-histogram parameters on the discrimina-tion between medulloblastoma, ependymoma, and pilocytic astrocytoma.

Purpose: Histograms can be determined throughout tumors, relying partly on existing tumor microstructure knowledge and the sampling effect from area of interest analyses. We aimed to investigate the impact of ADC histogram parameters in discriminating medulloblastoma, ependymoma, and pilocytic astrocytoma. Methods: This study received approval from the Institutional Ethics Review Committee of Children's Hospital 02. Processes were conducted according to relevant laws and regulations, and requirements for written informed consent were fulfilled. The study involved 24 patients at Children's Hospital 02 from February-December 2019. Group 1 included 12 children with medulloblastoma, group 2 included 5 with ependymoma, and group 3 included 7 with pilocytic astrocytoma. All patients underwent MRI followed by surgery or biopsy to obtain histopathological confirmations. Results: Our analysis indicated that AUC, sensitivity, and specificity were 96.7%, 91.7%, and 100%, respectively when ADCkurtosis (cut-off point = 2.34) was taken to differentiate between medulloblasto-mas and ependymomas. To distinguish between medulloblastomas and pilocytic astrocytomas, the cut-off points of ADCmean, ADCmedian, ADCmax, ADCmin, rADCmean, rADCmax, and rADCmin of 0.985, 0.910, 1.305, 0.710, 1.349, 1.738, and 1.251, were taken respectively with AUC, sensitivity, and specificity elicited at 100%. To discriminate between ependymomas and pilocytic astrocytomas, the cut-off points of ADCmean, ADCmedian, ADCmax, ADCmin, rADCmean, rADC-median, rADCmax and rADCmin were 1.010, 0.930, 1.270, 0.735, 1.346, 1.324, 1.676, and 1.273, respectively, with AUC, sensitivity, and specificity at 100%. Conclusion: ADC histograms can facilitate differentiation among juvenile medulloblastoma, ependymoma, and pilocytic astrocytoma, providing reliable, objective evidence of tumor differentiation.

Effect of mechanical thrombectomy with vs. without intravenous thrombolysis in acute ischemic stroke.

Background: The results of mechanical thrombectomy (MT), wi-thout or with intravenous thrombolysis, were evaluated and compared in 178 patients with acute ischemic stroke (AIS) due to large vessel occlusions (LVO) at Bach Mai Hospital. Methods: A total of 178 patients with AIS due to LVO were assigned to undergo MT alone (MT-alone group) or MT preceded by intravenous alteplase (the combined group), at a dose of 0.9 mg per kilogram, administered within 4.5 hours after symptom onset (combined group). The successful recanalization rate (assessed as thrombolysis in cerebral infarction [TICI] classification of 2b-3) and the incidence of good clinical recovery outcomes (modified Rankin Scale [mRS] ≤2) after 3 months were analyzed in both groups and compared. Results: A total of 178 patients were enrolled (median age, 65 years; 55% men; median National Institutes of Health Stroke Scale [NIHSS]: 14.3). Favorable outcomes were reported in 76 patients (66.7%) in the MT-alone group and 42 patients (65.6%) in the com-bined group, with no significant between-group difference (P = 0.31 for noninferiority). However, MT alone was associated with a lower percentage of patients with successful reperfusion after MT compared with the combined group (87.7% vs. 90.6%). Mortality at 90 days was 12.2% (14 patients) in the MT-alone group and 17.2% (11 patients) in the combined group. The incidence of symptomatic intracerebral hemorrhage was not significantly different between groups (6 [5.3%] vs. 1 [1.6%]; P = 0.42). Conclusion: Among patients with AIS due to LVO in our study, MT alone was noninferior in terms of functional outcomes compared with MT preceded by the administration of intravenous alteplase within 4.5 hours after symptom onset.