Spigelian Hernia: A Clinical Case Report.

Spigelian hernia, also known as lateral ventral hernia, is a type of hernia arising through the Spigelian aponeurosis. Unlike many other ventral hernias that occur beneath the layer of fat and abdominal skin, Spigelian hernia is situated within the abdominal wall muscles. Spigelian hernia often presents with few symptoms and may exist for a long time without being diagnosed or detected. We report a case of Spigelian hernia causing an intestinal obstruction treated with surgical emergency abdominal wall reconstruction using the sublay technique. Identification and evaluation of cases with the potential for hernia occurrence are crucial for the safety of patients undergoing surgery. Spigelian hernia accounts for 1%-2% of all ventral hernia cases. Currently, there are no reports on Spigelian hernia in Vietnam. However, a few reports on surgical management of Spigelian hernia have been published worldwide, with approaches including laparoscopic and open surgery, and these reports have indicated that abdominal wall reconstruction using the sublay technique is feasible as it is associated with fewer postoperative complications and shorter hospital stays. Here, we describe the case of an 87-year-old woman presenting with swelling and pain in the lower left quadrant of the abdomen. A preoperative diagnosis of Spigelian hernia causing intestinal obstruction was established, and we proceeded with abdominal wall reconstruction using the sublay technique. The patient was discharged three days after surgery without any postoperative complications.

RF-EMF Exposure near 5G NR Small Cells.

Of particular interest within fifth generation (5G) cellular networks are the typical levels of radiofrequency (RF) electromagnetic fields (EMFs) emitted by 'small cells', low-power base stations, which are installed such that both workers and members of the general public can come in close proximity with them. In this study, RF-EMF measurements were performed near two 5G New Radio (NR) base stations, one with an Advanced Antenna System (AAS) capable of beamforming and the other a traditional microcell. At various positions near the base stations, with distances ranging between 0.5 m and 100 m, both the worst-case and time-averaged field levels under maximized downlink traffic load were assessed. Moreover, from these measurements, estimates were made of the typical exposures for various cases involving users and non-users. Comparison to the maximum permissible exposure limits issued by the International Commission on Non-Ionizing Radiation Protection (ICNIRP) resulted in maximum exposure ratios of 0.15 (occupational, at 0.5 m) and 0.68 (general public, at 1.3 m). The exposure of non-users was potentially much lower, depending on the activity of other users serviced by the base station and its beamforming capabilities: 5 to 30 times lower in the case of an AAS base station compared to barely lower to 30 times lower for a traditional antenna.

Oro-Dental Health and Primary Nephrotic Syndrome among Vietnamese Children.

Primary nephrotic syndrome (PNS) is common in children, affecting the soft and hard tissues of the oral cavity. This study aimed to investigate the percentage of dental caries, gingivitis, hypertrophic gingivitis, and developmental defects of enamel (DDE) in children with PNS. The association of PNS with these diseases and oral care behavior was also assessed. A total of 407 children with PNS and 407 age- and gender-matched controls were recruited. PNS was diagnosed based on blood and urinary tests. The Simplified Oral Hygiene Index (OHI-S), the Gingival Index (GI), the Gingival Overgrowth Index (GOI), the Decayed, Missing, and Filled Teeth Index (dmft/DMFT), and DDE were collected. The PNS patients showed significantly higher scores of OHI-S, GI, and dmft, and higher proportions of dental caries and DDE than those of the controls (p < 0.001). It is necessary to establish a periodic dental protocol for PNS patients to improve their oral health status.

Laparoscopic Proximal Gastrectomy with Jejunal Interposition for Early Proximal Gastric Cancer.

PURPOSE: Proximal gastrectomy has been more advantageous than total gastrectomy in early cancer in the upper third of the stomach. Jejunal interposition is a novel reconstruction technique to prevent reflux esophagitis and anastomotic stricture in proximal gastrectomy. The combination of these two procedures via laparoscopic approach is not yet widespread. Therefore, this study is to evaluate the feasibility and safety of this surgery. METHODS: This is a retrospective study on eight patients with laparoscopic proximal gastrectomy and jejunal interposition for early proximal gastric cancer. Patients were followed up at 1, 3, and 6 months and then at 6-month intervals to investigate complications, recurrence, metastasis, and survival. RESULTS: All cases were adenocarcinoma in the early stage (cT1N0M0). The median (range) operating time and postoperative hospital stay were 145 min (120-210) and 7 days (6-9), respectively. No complication (including reflux esophagitis and anastomotic stricture) occurred. All patients were alive without any recurrence or metastasis during the median follow-up of 28 months (ranged 6-40 months). CONCLUSION: Laparoscopic proximal gastrectomy with jejunal interposition for early gastric cancer is safe and feasible with good long-term outcomes. Further large studies are required to evaluate the safety and efficacy of this procedure.

The prevalence of depression and associated risk factors among medical students: An untold story in Vietnam.

BACKGROUND: Depression is a common mental health problem in medical students worldwide. The association between depression and motivation in Vietnamese medical students is not well-documented. OBJECTIVES: To estimate the prevalence of self-reported depression and to identify associated risk factors among medical students at Hanoi Medical University (HMU). METHOD: A cross-sectional study was conducted on medical students with clinical experience at HMU from November 2015 to January 2016. We used the multistage cluster random sampling technique to select and invite students to complete a questionnaire including demographic characteristics, Patient Health Questionnaire 9 (PHQ-9), Academic Motivation Scale (AMS), and International Physical Activity Questionnaire Short Form (IPAQ). RESULTS: Among 494 participants (78.8% response rate), the prevalence of self-reported depression was 15.2% (95%CI:12.0%-19.0%), and suicidal ideation was 7.7% (95%CI:6.2%-9.5%). Self-reported depression was significantly associated with perceived financial burden, physical inactivity, being senior student, perceived negative influence of night shifts, and non-self-determined motivation profile. Suicidal ideation was significantly associated with perceived financial burden and non-self-determined motivation profile. In the multivariable regression models, significant risk factors for self-reported depression were non-self-determined motivation (PR = 2.62, 95%CI:1.68-4.07), perceived financial burden (PR = 1.95, 95%CI:1.39-2.73), and vigorous level of physical activity (PR = 0.43, 95%CI:0.20-0.942). For suicidal ideation, non-self-determined motivation (PR = 2.33, 95%CI:1.13-4.80) and perceived financial burden (PR = 1.91, 95%CI:1.16-3.13) were significant risk factors. STRENGTHS AND LIMITATIONS: The strengths of our study included a representative sample, a good response rate, and using a good depression screening tool. However, the PHQ-9 only allowed us to screen for depression, and the translation of the AMS and IPAQ into Vietnamese could potentially decrease these tools' validity. CONCLUSION: The prevalence of self-reported depression and suicidal ideation in medical students is notably higher compared to the general population in Vietnam. Non-self-determined motivation and financial burden were the prominent risk factors for both the depression and suicidal ideation in medical students.

Liquid lipase-catalyzed hydrolysis of gac oil for fatty acid production: Optimization using response surface methodology.

Fatty acids are valuable products because they have wide industrial applications in the manufacture of detergents, cosmetics, food, and various biomedical applications. In enzyme-catalyzed hydrolysis, the use of immobilized lipase results in high production cost. To address this problem, Eversa Transform lipase, a new and low-cost liquid lipase formulation, was used for the first time in oil hydrolysis with gac oil as a triglyceride source in this study. Response surface methodology was employed to optimize the reaction conditions and establish a reliable mathematical model for predicting hydrolysis yield. A maximal yield of 94.16% was obtained at a water-to-oil molar ratio of 12.79:1, reaction temperature of 38.9 °C, enzyme loading of 13.88%, and reaction time of 8.41 h. Under this optimal reaction condition, Eversa Transform lipase could be reused for up to eight cycles without significant loss in enzyme activity. This study indicates that the use of liquid Eversa Transform lipase in enzyme-catalyzed oil hydrolysis could be a promising and cheap method of fatty acid production. © 2018 American Institute of Chemical Engineers Biotechnol. Prog., 2018.

Guidance on radiation dose limits for the lens of the eye: overview of the recommendations in NCRP Commentary No. 26.

PURPOSE: This review summarizes the conclusions and recommendations of the new National Council on Radiation Protection and Measurements (NCRP) Commentary No. 26 guidance on radiation dose limits for the lens of the eye. The NCRP addressed radiation protection principles in respect to the lens of the eye, discussed the current understanding of eye biology and lens effects, reviewed and evaluated epidemiology, and assessed exposed populations with the potential for significant radiation exposures to the lens while suggesting monitoring and protection practices. CONCLUSIONS: Radiation-induced damage to the lens of the eye can include the loss of clarity resulting in opacification or clouding several years after exposure. The impact is highly dependent on the type of radiation, how the exposure of the lens was delivered, the genetic susceptibilities of the individual exposed, and the location of the opacity relative to the visual axis of the individual. The preponderance of epidemiological evidence suggests that lens damage could occur at lower doses than previously considered and the NCRP has determined that it is prudent to reduce the recommended annual lens of the eye occupational dose limit from an equivalent dose of 150 mSv to an absorbed dose of 50 mGy. Significant additional research is still needed in the following areas: comprehensive evaluation of the overall effects of ionizing radiation on the eye, dosimetry methodology and dose-sparing optimization techniques, additional high quality epidemiology studies, and a basic understanding of the mechanisms of cataract development.

Status of NCRP Scientific Committee 1-23 Commentary on Guidance on Radiation Dose Limits for the Lens of the Eye.

Previous National Council on Radiation Protection and Measurements (NCRP) publications have addressed the issues of risk and dose limitation in radiation protection and included guidance on specific organs and the lens of the eye. NCRP decided to prepare an updated commentary intended to enhance the previous recommendations provided in earlier reports. The NCRP Scientific Committee 1-23 (SC 1-23) is charged with preparing a commentary that will evaluate recent studies on the radiation dose response for the development of cataracts and also consider the type and severity of the cataracts as well as the dose rate; provide guidance on whether existing dose limits to the lens of the eye should be changed in the United States; and suggest research needs regarding radiation effects on and dose limits to the lens of the eye. A status of the ongoing work of SC 1-23 was presented at the Annual Meeting, "Changing Regulations and Radiation Guidance: What Does the Future Hold?" The following represents a synopsis of a few main points in the current draft commentary. It is likely that several changes will be forthcoming as SC 1-23 responds to subject matter expert review and develops a final document, expected by mid 2016.

Review and evaluation of updated research on the health effects associated with low-dose ionising radiation.

While radiation health risks at low doses have traditionally been estimated from high-dose studies, we have reviewed recent literature and concluded that the mechanisms of action for many biological endpoints may be different at low doses from those observed at high doses; that acute doses <100 mSv may be too small to allow epidemiological detection of excess cancers given the background of naturally occurring cancers; that low-dose radiation research should use holistic approaches such as systems-based methods to develop models that define the shape of the dose-response relationship; and that these results should be combined with the latest epidemiology to produce a comprehensive understanding of radiation effects that addresses both damage, likely with a linear effect, and response, possibly with non-linear consequences. Continued research is needed to understand how radiobiology and epidemiology advances should be used to effectively model radiation worker risks.

Decreased CD154 expression by neonatal CD4+ T cells is due to limitations in both proximal and distal events of T cell activation.

Neonatal CD4(+) T cells express less CD154 protein and mRNA than adult CD4(+) T cells after activation by calcium ionophore and phorbol ester, but the mechanism for this reduced expression and its relevance to the primary immune response remain unclear. We compared expression of CD154 protein and mRNA and CD154 gene promoter activity by purified naive (CD45RA(high)CD45RO(low)) neonatal and adult CD4(+) T cells after activation by calcium ionophore (ionomycin) and phorbol myristate acetate (PMA) treatment or by engagement of alphabeta TCR-CD3 complex. Substantial and consistent reductions in expression by neonatal cells were found in all cases and were paralleled by decreased CD154-dependent activation of a B cell line. CD69 expression by neonatal CD4(+) T cells after alphabeta TCR-CD3 engagement was also reduced compared to adult cells, which suggested that limitations in activation-induced signaling by neonatal CD4(+) T cells occurred at a point upstream of where the signaling pathways leading to CD154 and CD69 expression diverge. Decreased CD154 expression by neonatal cells after alphabeta TCR-CD3 engagement was paralleled by a lower free intracellular calcium concentration, a key event for CD154 gene transcription. Reduced CD154 promoter activity by neonatal cells persisted when proximal signaling events were bypassed using ionomycin and PMA, suggesting an additional and more distal mechanism for decreased transcription. In contrast, CD154 mRNA stability was similar in neonatal and adult cells after either ionomycin and PMA stimulation or engagement of the alphabeta TCR-CD3 complex. We conclude that decreased CD154 production by neonatal CD4(+) T cells is due to limitations in both proximal and distal activation events, which together ultimately limit CD154 gene transcription.

Pulmonary lymphangioleiomyomatosis in Pham Ngoc Thach Hospital: a case report

This rare condition was diagnosed in the stage of a history of resection of left renal tumor of angiomyolipoma and recurrant pneumothrax with PCR of positive tuberculosis bacilla, special chest CT scan with thin wall cyst. These female patients are in reproductive age, using consistantly sex hormone. The prognosis is similar with COPD. Early detection and treatment of the case slowers the progression of disease.