Reconstruction of Postburn Bone Exposed Defect in the Head and Face Using Two Separate Anterolateral Thigh Chimeric Flap: A Case Report.

Reconstruction of soft-tissue defects in the head and face region requires attention to both functional and aesthetic outcomes. In general, large postburn scars are still a daunting challenge for plastic surgeons. Various types of free flaps were previously performed for head and face reconstruction, including the anterolateral thigh (ALT) flap. However, to fully cover large and complex defects, the skin pedicle needs a sufficient width. Thus, we have combined dual ALT flaps that were harvested from both the lateral thighs. In this article, we described the case of a 49-year-old female who was presented with a severe scar on the right side of the head and face and zygomatic along with the exposure of temporal bones after extensive burns. Two ALT flaps were supplied by perforators of the descending branches of lateral circumflex femoral arteries. These two source arteries were anastomosed end-to-end to merge into a chimeric flap. The 6-month follow-up revealed an acceptable aesthetic outcome. The effectiveness of the ALT chimeric flap for reconstructing head and face postburn contracture is discussed.

Expansion of KPC-producing Enterobacterales in four large hospitals in Hanoi, Vietnam.

OBJECTIVES: The incidence of carbapenem resistance among nosocomial Gram-negative bacteria in Vietnam is high and increasing, including among Enterobacterales. In this study, we assessed the presence of one of the main carbapenemase genes, blaKPC, among carbapenem-resistant Enterobacterales (CRE) from four large hospitals in Hanoi, Vietnam, between 2010 and 2015, and described their key molecular characteristics. METHODS: KPC-producing Enterobacterales were detected using conventional PCR and were further analysed using S1 nuclease pulsed-field gel electrophoresis (S1-PFGE), Southern blotting and whole-genome sequencing (WGS) for sequence typing and genetic characterisation. RESULTS: blaKPC genes were detected in 122 (20.4%) of 599 CRE isolates. blaKPC-carrying plasmids were diverse in size. Klebsiella pneumoniae harbouring blaKPC genes belonged to ST15 and ST11, whereas KPC-producing Escherichia coli showed more diverse sequence types including ST3580, ST448, ST709 and ST405. Genotypic relationships supported the hypothesis of circulation of a population of 'resident' resistant bacteria in one hospital through the years and of transmission among these hospitals via patient transfer. WGS results revealed co-carriage of several other antimicrobial resistance genes and three different genetic contexts of blaKPC-2. Among these, the combination of ISEcp1-blaCTX-M and ISKpn27-blaKPC-ΔISKpn6 on the same plasmid is reported for the first time. CONCLUSION: We describe the dissemination of blaKPC-expressing Enterobacterales in four large hospitals in Hanoi, Vietnam, since 2010, which may have started earlier, along with their resistance patterns, sequence types, genotypic relationship, plasmid sizes and genetic context, thereby contributing to the overall picture of the antimicrobial resistance situation in Enterobacterales in Vietnam.

From Vietnamese plants to a biflavonoid that relieves inflammation by triggering the lipid mediator class switch to resolution.

Chronic inflammation results from excessive pro-inflammatory signaling and the failure to resolve the inflammatory reaction. Lipid mediators orchestrate both the initiation and resolution of inflammation. Switching from pro-inflammatory to pro-resolving lipid mediator biosynthesis is considered as efficient strategy to relieve chronic inflammation, though drug candidates exhibiting such features are unknown. Starting from a library of Vietnamese medical plant extracts, we identified isomers of the biflavanoid 8-methylsocotrin-4'-ol from Dracaena cambodiana, which limit inflammation by targeting 5-lipoxygenase and switching the lipid mediator profile from leukotrienes to specialized pro-resolving mediators (SPM). Elucidation of the absolute configurations of 8-methylsocotrin-4'-ol revealed the 2S,γS-isomer being most active, and molecular docking studies suggest that the compound binds to an allosteric site between the 5-lipoxygenase subdomains. We identified additional subordinate targets within lipid mediator biosynthesis, including microsomal prostaglandin E2 synthase-1. Leukotriene production is efficiently suppressed in activated human neutrophils, macrophages, and blood, while the induction of SPM biosynthesis is restricted to M2 macrophages. The shift from leukotrienes to SPM was also evident in mouse peritonitis in vivo and accompanied by a substantial decrease in immune cell infiltration. In summary, we disclose a promising drug candidate that combines potent 5-lipoxygenase inhibition with the favorable reprogramming of lipid mediator profiles.

Improving Treatment Outcome of Pemphigus Vulgaris on Vietnamese Patients by Using Desmoglein Elisa Test.

BACKGROUND: Pemphigus Vulgaris (PV) is a chronic disease, is characterized by the presence of flacid bullous in skin and mucosa. There are 2 main autoantibodies against desmoglein3 (Dsg3) and desmoglein1 (Dsg1). AIM: The aims of this study were to evaluate the before and after treatment outcome with corticosteroid, using Desmoglein ELISA test. METHOD: Forty patients with Pemphigus include 36 PV and 4 PF (28 women, 12 women) were enrolled. The titers of Dsg in pemphigus patients by using ELISA test were done before and 1-month treatment. RESULTS: Both anti-Dsg1 and anti-Dsg3 levels were significantly reduced after treatment (P < 0.05). The severity of skin lesions was correlated with anti-Dsg1 antibody level and the severity of oral lesions was significantly correlated with anti-Dsg 3 antibody levels (p < 0.05). CONCLUSION: It is recommended that we can predict and improve the outcome of treatment by using Desmoglein ELISA test.

Efficacy and Safety of Methotrexate in Combination with Mini Pulse Doses of Methylprednisolone in Severe Alopecia Areata. The Vietnamese Experience.

BACKGROUND: Treatment of severe alopecia areata remains very difficult, especially in alopecia areata totalis and alopecia areata universalis. Methotrexate is known to be effective in the treatment of severe and chronic autoimmune disorders. OBJECTIVE: To assess the effectiveness and safety of MTX in combination with mini pulse dose of methylprednisolone in the treatment of severe alopecia areata. PATIENTS AND METHODS: The open, uncontrolled study compared pre-treatment and after-treatment. Thirty-eight patients (age 16-64) with severity AA (SALT score > 50 %) visiting National hospital of Dermatology and Venereology from April-2004 to September-2015 were enrolled. All patients received oral methylprednisolone 24mg/day for 3 consecutive days of a week in combination with oral MTX 7,5 mg weekly. This regimen is maintained up to 12 weeks and follow-up until to 6 months. RESULTS: After 6 months, 60.5% of patients show complete hair growth (good response) and 18.4% shows the medium response. There is a significant SALT score reduction: mean baseline SALT score 84.39 ± 17.03 compared to mean post-treatment SALT score 24.19 ± 29.42. Good clinical improvement noted in after 3 months. We do not observe any side- effects related to oral MTX and oral methylprednisolone, and no patients had to withdrawal treatment due to side- effects. CONCLUSION: Combination Methotrexate and mini pulse dose of methylprednisolone are effective and safe in treatment severity alopecia areata.

Antidiabetic and antioxidant activities of red seaweed Laurencia dendroidea

Objective: To investigate antidiabetic and antioxidant activities of the extract and fractions from Vietnamese red seaweed Laurencia dendroidea. Methods: The seaweed Laurencia dendroidea was extracted by using microwave-assisted extraction method in 80％ methanol. The seaweed extract was then fractionated using different solvents (n-hexane, chloroform, ethyl acetate, butanol and water). These obtained fractions were evaluated for α-glucosidase inhibitory and antioxidant activities. Antioxidant activities were tested using DPPH, nitric oxide radical scavenging and metal chelating assays. The enzyme inhibition mode was determined using Lineweaver-Burk plot. For acidic and thermal stabilities, the ethyl acetate fraction was treated at pH 2.0 and 100 ℃, respectively. The residual inhibitory activity of the fraction was calculated based on the initial inhibitory activity. For in vivo antidiabetic activity, mice were divided into four groups, including normal control, diabetic control, diabetic mice treated with ethyl acetate fraction and diabetic mice treated with gliclazide. Blood glucose level of treated mice during acute and prolonged treatments was measured. To evaluate the toxicity of the ethyl acetate fraction, the body weight changes and activities of liver function enzymes (aspartate transaminase, alanine transaminase and gammaglutamyl transferase) were carried out. Results: The extract of Laurencia dendroidea showed strong α-glucosidase inhibitory and DPPH radical scavenging activities. Methanolic concentrations affected both α-glucosidase inhibitory and antioxidant activities. A 80％ aqueous methanol was the suitable solvent for extraction of enzyme inhibitors and antioxidants. Among solvent fractions, ethyl acetate fraction had the highest inhibitory activities against α-glucosidase with a mixed type of inhibition and the strongest antioxidant activities, and was stable under acidic and thermal conditions. The ethyl acetate fraction treated diabetic mice significantly reduced blood glucose level compared with the diabetic control group (13.16 mmol/L vs. 22.75 mmol/L after 3 hours of treatment). Oral administration of ethyl acetate fraction did not exhibit toxicity at a dose of 100 mg/kg body weight as determined by body weight changes and liver biochemical parameters. Conclusions: Laurencia dendroidea could be a potential source for production of antidiabetic and antioxidative agents.

Water Supply, Sanitation, and Medical Waste Treatment and Disposal at Commune Health Centers in Vietnam.

Water hygiene, sanitation, and proper management of health care wastes at health care facilities are important in preventing infections and improving health and the environment. This article describes the access to safe water and sanitation facilities and the disposal of medical wastes at commune health centers (CHCs) in Vietnam. Data was extracted from the 2015 World Bank Vietnam District and Commune Health Facility Survey. Bivariate and multivariate logistic regression was applied to identify associations of CHCs' access to improved water and sanitation and their medical waste management. Overall, 72.76% CHCs had access to both improved water and sanitation facilities, and better access was found in the richest communes. Rural CHCs had higher prevalence of appropriate wastewater treatment. The majority of CHCs combusted medical solid wastes by specialized incinerations, contracted out with sanitation companies, or transported them to district health centers. However, the data was insufficient to give in-depth analysis and conclusion on water and sanitation conditions and the management of medical wastes at CHCs. More information should be collected for further analysis and conclusion.

Reconstruction of neck and face scar contractures using occipito-cervico-dorsal supercharged "super-thin flaps": A retrospective analysis of 82 cases in Vietnam.

BACKGROUND: The concept of the "super-thin flap" (also known as the subdermal vascular network flap) was introduced in Japan in 1994. Its distinctive characteristic is its extreme thinness: it is thinned to the point that the subdermal vascular network (subdermal plexus) can be seen through the minimal fat layer. Since 2006 in Vietnam, we have used circumflex scapular artery-supercharged occipito-cervico-dorsal (OCD) super-thin flaps to reconstruct cases of neck and face scar contracture. MATERIALS AND METHODS: This case series comprised all 82 patients with neck and face scar contracture who underwent reconstruction with an OCD supercharged super-thin flap from 2006-2015 at the Vietnam National Institute of Burns. The flap was thinned and anastomosed at the distal area after elevation. All patients received one flap. RESULTS: Of the 82 flaps, 77 survived completely. The remaining five developed distal superficial necrosis (n=3) and interruption of the sutures due to infection; these required resuturing (n=2). In two of the three necrosis cases, the necrotic area affected 50% of the flap. Eighty of the eighty-two patients were satisfied with both the functional and aesthetic results. CONCLUSIONS: The OCD super-thin flap has clear benefits, and although it is thin, its vasculature is reliable. Thus, it may be one of the best choices for reconstruction of neck and face scar contractures.

Exposure to Tobacco Advertising, Promotion Among the Adult Population in Vietnam and Its Implications for Public Health.

INTRODUCTION: The Law on Tobacco Control and the Law on Advertisement prohibit the advertising of any tobacco product in Vietnam. Tobacco promotion and marketing are alsostrictly prohibited. However, the violation of tobacco adverting and promotion is still common in Vietnam. OBJECTIVES: This article aims at describing the exposure to tobacco advertising and promotion among the population aged 15+ years in Vietnam based on the data from the Global Adult Tobacco Survey 2015 from the view of the community, identifying any possible associations between the exposure to tobacco advertising and promotion and other individual factors, and discussing its possible public health implications. METHOD: A cross-sectional study with the nationwide scale. Secondary data from the Global Adult Tobacco Survey 2015 was explored and analyzed. Chi-square test and multivariate logistic regressions were applied in the data analysis. RESULTS: The most common type of adults' exposure to tobacco advertising and promotion was points of sale (8.6%); 9.8% adults exposure to one source of tobacco advertising and 4.0% of them exposed to one source of tobacco promotion. Around 13.3% of Vietnamese adults were exposed to tobacco advertisement, while 2.0% were exposed to tobacco promotion, 5.3% were exposed to both tobacco advertising and promotion, and 16.6% were exposed to tobacco advertising or promotion. Gender, educational level, age, occupation, marital status, socioeconomic status, location (urban, rural), and current smoking status were associated with the exposure to tobacco advertising, tobacco promotion, tobacco advertising and promotion, and tobacco advertising or promotion. CONCLUSION AND RECOMMENDATION: Although there are comprehensive bans on tobacco advertising and promotion in Vietnam, adults aged 15+ years still reported their exposure to tobacco advertising and promotion. There should be a strict enforcement of the ban on tobacco advertising and promotion in Vietnam.

Bipedicled "Superthin" Free Perforator Flaps for Facial Burn Scar Reconstruction: Expanded Scope of Superthin Flaps: A Case Series.

BACKGROUND: "Superthin flap" is a distinctively thin flap that is thinned primarily to the point that the subdermal vascular network can be seen through a minimal fat layer. Reconstruction of severely disfigured neck and face can be performed using the occipito-cervico-dorsal superthin flap that is harvested from the dorsal region and supercharged by the circumflex scapular vessels. We used bipedicled superthin free perforator flaps to reconstruct scar contractures on half of the face, whole face, or the whole chin-neck area in 17 postburn patients. METHODS: This case series report includes all 17 cases. Flaps in the dorsal area were designed. In all cases, one pedicle consisted of the circumflex scapular vessels. In 11, 5, and 1 flaps, the second pedicle consisted of contralateral posterior intercostal perforators (type 1), ipsilateral posterior intercostal perforators (type 2), and ipsilateral circumflex scapular vessels (type 3), respectively. Four patients underwent whole-face reconstruction after acid burn with type 1 or type 3 perforator. The recipient vessels were the superficial temporal vessels and contralateral or ipsilateral facial vessels. Intraoperatively, all adipose tissue in the flap, including between the 2 pedicles, was thinned by scissors before the pedicles were detached from the donor sites. Maximum flap size was 35 × 15 cm. Donor sites were covered by a split full-thickness skin graft. Flap survival and functional and cosmetic results were assessed retrospectively. RESULTS: Fifteen of the 17 flaps survived completely. Two developed partial necrosis due to perforator thrombosis. Some patients developed hypertrophic scars around the flap, but these improved naturally over time. All patients were satisfied with both the cosmetic and functional outcomes of the reconstruction. CONCLUSION: Bipedicled superthin free perforator flaps may be an excellent choice for reconstruction of severe neck scar contracture. This report expands the scope of previously used "superthin flaps."

Optimization of lipase-catalyzed synthesis of caffeic acid phenethyl ester in ionic liquids by response surface methodology.

Lipase-catalyzed caffeic acid phenethyl ester (CAPE) synthesis in ionic liquid, 1-ethyl-3-methylimidazolium bis[(trifluoromethyl)sulfonyl]imide ([Emim][Tf(2)N]), was investigated in this study. The effects of several reaction conditions, including reaction time, reaction temperature, substrate molar ratio of phenethyl alcohol to caffeic acid (CA), and weight ratio of enzyme to CA, on CAPE yield were examined. In a single parameter study, the highest CAPE yield in [Emim][Tf(2)N] was obtained at 70 °C with a substrate molar ratio of 30:1 and weight ratio of enzyme to CA of 15:1. Based on these results, response surface methodology (RSM) with a 3-level-4-factor central composite rotatable design (CCRD) was adopted to evaluate enzymatic synthesis of CAPE in [Emim][Tf(2)N]. The four major factors were reaction time (36-60 h), reaction temperature (65-75 °C), substrate molar ratio of phenethyl alcohol to CA (20:1-40:1), and weight ratio of enzyme to CA (10:1-20:1). A quadratic equation model was used to analyze the experimental data at a 95 % confidence level (p < 0.05). A maximum conversion yield of 99.8 % was obtained under the optimized reaction conditions [60 h, 73.7 °C, substrate molar ratio of phenethyl alcohol to CA (27.1:1), and weight ratio of enzyme to CA (17.8:1)] established by our statistical method, whereas the experimental conversion yield was 96.6 ± 2 %.

Anatomical and clinical studies of the supraclavicular flap: analysis of 103 flaps used to reconstruct neck scar contractures.

BACKGROUND: The supraclavicular flap is an excellent flap that has been used widely, but its vascular reliability remains unclear. In this article, the authors report the results of their anatomical studies on 40 flaps from 20 preserved cadavers and their clinical studies of 103 supraclavicular flaps in 101 patients. METHODS: In their anatomical study, the authors analyzed the important anatomical features that are useful for harvesting flaps. In their clinical study, the authors analyzed the cases in terms of flap reliability. RESULTS: The supraclavicular artery branched from the transverse cervical artery in all 40 specimens (100 percent). Although it arose from the middle third of the clavicle in 90 percent of the specimens, it arose from the lateral third of the clavicle in four specimens (10 percent). Moreover, the transverse cervical artery originated from the subclavian artery in two of 40 specimens (5 percent) rather than from the thyrocervical trunk. The origins of the supraclavicular and transverse cervical arteries were on average 4.12 cm apart (range, 3 to 5.5 cm). In our clinical study, 101 of the 103 flaps (98.1 percent) were (vascular-pedicled) island flaps and five (4.9 percent) were transferred under a skin tunnel. We also performed a supercharged flap transfer using posterior circumflex humeral vessels. Of the 103 flaps, 97 survived completely (94.2 percent), but four and two exhibited superficial distal necrosis (3.9 percent) and total necrosis (1.9 percent), respectively. CONCLUSIONS: Supraclavicular flaps are reliable, but vascular anomalies exist. In the authors' experience, the posterior circumflex humeral artery could be used for supercharging the supraclavicular flap.

Reconstruction of neck scar contractures using supraclavicular flaps: retrospective study of 30 cases.

BACKGROUND: The supraclavicular flap is used to cover chin and neck region defects. Its main vascular supply is the supraclavicular artery, and it can be harvested as either a skin pedicled flap or an island flap (vascular pedicled flap). The island flap has a wide rotation arc, and both the color and texture match are better for reconstructing contour-sensitive areas such as the chin and neck than those of free flaps harvested from distant sites. METHODS: Between March of 2001 and November of 2004, 32 supraclavicular flaps were used for reconstructions in 30 patients at the authors' hospital. If circumstances demanded it, the authors transferred the flaps through skin tunnels to reduce continuous scar formation between the donor and recipient sites. RESULTS: Twenty-eight of the 32 flaps survived completely, but there were three cases of distal necrosis and one case of 90 percent necrosis. Twenty-nine of the 30 patients were satisfied with both the functional and aesthetic results. CONCLUSIONS: The benefits of the supraclavicular island flap are clear: it is thin but reliable, and easy to harvest.