Cone Beam CT Assessment of Mandibular Foramen and Mental Foramen Positions as Essential Anatomical Landmarks: A Retrospective Study in Vietnam.

INTRODUCTION: The mandibular foramen (MnF) and the mental foramen (MF) are essential anatomical landmarks that should be considered before any surgical procedures in the mandible. This study aimed to investigate the characteristics of the MnF and MF in relation to adjacent anatomical structures, as well as age and gender differences, using cone beam computed tomography (CBCT) projections. METHODS: The study was conducted from August 2023 to January 2024 at the Can Tho University of Medicine and Pharmacy Hospital, Vietnam. In this retrospective study, 50 CBCT images of Vietnamese patients were randomly taken for various clinical purposes. Furthermore, relevant data, such as gender and age groups, were selected to evaluate the correlations, along with specific inclusion criteria. Patients within the age range of 18-69 with a symmetrical mandible were included. RESULTS: The distance of the MnF-MN was 29.6±5.0 mm (right) and 30.1±4.6 mm (left) in males and 25.0±4.2 mm (right) and 26.3±5.0 mm (left) in females. The distance of the MnF-posterior border of the ramus (P) was 16.2±3.6 mm (right) and 15.0±2.3 mm (left) in males. For females, it was 17.1±2.9 mm (right) and 13.8±1.7 mm (left). The distance of the MF-body mandible (MB) was 15.4±2.4 mm (right) and 15.6±2.0 mm (left) in males and 14.0±2.1 mm (right) and 14.3±1.6 mm (left) in females. The distance of the MF-mandibular midline (MM) was 27.0±2.6 mm (right) and 27.0±2.9 mm (left) in males and 25.3±2.0 mm (right) and 25.1±2.2 mm (left) in females. These distances showed statistically significant differences depending on gender (P<0.05). CONCLUSION: It can be said that CBCT provides comprehensive information about the MnF and the MF for dentists in research and clinical practice.

The Applicability of the Moyers, Tanaka-Johnston, and Gross-Hasund Analysis and a New Formula for the Vietnamese Population.

Aim: Our aim is to determine the applicability of other analyses and develop a new formula appropriate for the Vietnamese population. Materials and Methods: A cross-sectional descriptive analysis was conducted on a total of 120 dental arch samples (18-25 years old, 60 males, and 60 females) with <5 mm of tooth crowding, complete teeth on the dental arch, no missing teeth, and no fillings on the mesial or distal sides. Each study sample will be imprinted and measured using conventional as well as digital methods. Result: There was a significant discrepancy between the overall mesiodistal width from canine to second premolar in the maxilla and mandibular measured with electronic calipers on the cast model and the values calculated by the Moyer, Tanaka - Johnston, Gross - Hasund formulae in the mandibular, and measured by digital scanning and results calculated by the Gross-Hasund formula for maxilla and mandibular and the Moyers, Tanaka-Johnston formula for mandibular. The values obtained were compared with those calculated using the Moyers, Tanaka-Johnston, and Gross-Hasund formulae for the mandibular. Additionally, measurements were taken by digital scanning, and the results were calculated using the Gross-Hasund formula for both the maxilla and mandibular, and the Moyers and Tanaka-Johnston formulae for the mandibular. When used to estimate space analysis in the Vietnamese population, the estimation formula for each gender had greater accuracy and reliability than other widely used methods. Conclusions: As the central incisor and first molar are the first permanent teeth to erupt, the mesiodistal width may be readily measured. This new formula may be used to predict the width in the early stages of the mixed dentition.

Platelet-rich plasma's (PRP) impacts on accelerated canine movement.

OBJECTIVE: To investigate the impact of platelet-rich plasma (PRP) on canine movement acceleration. METHODS: Randomized clinical trial split-mouth study with a double-blind design and controlled group on 31 orthodontic patients, which had been indicated bilateral maxillary first premolar extraction. Each patient recorded clinical features, analyzed lateral cephalometric film, and evaluated the acceleration on dental models at every specific interval. RESULT: The cumulative distance to the distal canines was larger for the PRP injection group than for the control group at three time points (4 weeks, 8 weeks, and 12 weeks), all of which were statistically significant. The PRP injection group's canine distal width increased from the first 4 weeks (ΔT1) to the highest in the middle 4 weeks (ΔT2 = 1.78 ± 0.11 mm/month), and then it gradually decreased in the last 4 weeks (ΔT3). The speed of the PRP-injected canine was faster than the control group by 1.51 times. CONCLUSION: PRP can accelerate the speed of canine movement in orthodontics and can be applied for severe cases, for example, impacted tooth retraction, molar protraction or retraction, and other cases.

Malignancies in Immunoglobulin G4-related ophthalmic disease.

PURPOSE: Clinical phenotypes in Immunoglobulin G4-related disease (IgG4-RD) according to the patterns of affecting organs have different risks of malignancies. We attempt to determine the association of malignancies with IgG4-related ophthalmic disease (IgG4-ROD). DESIGN: Retrospective cohort study. METHODS: Review of medical records, orbital images and histopathology reports in a territory-wide cohort of biopsy proven IgG4-ROD patients from 2005-2019. FINDINGS: Among 122 patients who had biopsies taken from adnexal lesions including lacrimal glands (n = 108), orbital mass (n = 30), infiltrated orbital fat (n = 10), conjunctiva (n = 2) or extraocular muscles (n = 3), 13% (16/122) developed malignancies over 73 ± 48months' follow-up. There were 9 cases of ocular adnexal lymphoma (OAL) and 7 extra-orbital malignancies. Compared with the general population, the incidence of OAL was significantly higher (standardized incidence ratios, SIRs = 10.0, 95%CI = 4.5-17.6) while that of extra-orbital malignancies was similar. The SIRs was highest within the first year (SIR = 46.7, 95%CI = 18.5-87.6) when 7 OAL were concomitantly diagnosed. Patients who developed OAL or extra-orbital malignancies were older than other patients at IgG4-ROD diagnosis (64.9 ± 7.1, 68.3 ± 8.5 versus 55.2 ± 15.0 years, P < 0.05). Asymmetric lacrimal gland enlargement (78% versus 13%), lack of frontal (0% versus 12%) or infraorbital nerve enlargement (0% versus 36%) were associated with OAL (all P < 0.05). Pre-treatment serum IgG4 level or extra-orbital IgG4-RD involvement was similar among patients with or without malignancies. CONCLUSION: In this biopsy-proven IgG4-ROD cohort, 7% developed OAL which was 10 times higher than the general population. Patients with asymmetric lacrimal gland enlargement or without trigeminal nerves involvement radiologically were associated with OAL.

Risk Factors for Death of Burn Patients With Acute Respiratory Distress Syndrome.

The aim of this study was to investigate factors independently affecting outcomes of post-burn ARDS patients at the time of ARDS onset. A prospective study was conducted on 66 patients with ARDS, treated in the ICU at the Le Huu Trac National Burns Hospital in Hanoi, Viet Nam, from 2014 to 2017. Patients were divided into a survivor and non-survivor group. Demographic criteria, burn severity, inhalation injury, clinical and subclinical features at ARDS onset were compared between the two groups. The results showed that overall mortality of ARDS patients was 62.12%. Logistic regression analysis indicated that at the time of ARDS onset, serum lactate level (OR=6.71), blood platelet count (OR=.99), static lung compliance (OR=.73) and driving pressure (OR=1.69) were independent risk factors for death, while patients' demographics, burn severity and ARDS severity did not significantly affect the mortality rate.

Le but de cette étude est d'évaluer les facteurs indépendants influençant le pronostic d'un SDRA survenant chez un brûlé, présents dès sa survenue. Il s'agit d'une étude prospective conduite sur 66 patients hospitalisés en réanimation de l'hôpital brûlologique national Le Huu Trac de Hanoi entre 2014 et 2017, répartis en groupes survivants et décédés. Nous avons comparé les données démographiques, la gravité de la brûlure, l'existence d'une inhalation de fumée, les données cliniques comme paracliniques au moment du diagnostic de SDRA. La mortalité globale était de 62,12%. En régression logistique, la lactatémie (OR 6,71), le compte de plaquettes (OR 0,99), la compliance pulmonaire statique (OR 0,73) et la pression de travail (OR 1,69) sont des facteurs indépendants de mortalité quand ni les données-patient, ni la sévérité de la brûlure ou celle du SDRA lui-même n'affectent la mortalité.

Cost Analysis and Influencing Factors Amongst Severe Burn Patients.

This study analyzed the structure and determined the factors affecting the cost of treatment of severe burns patients. The results showed that the average total costs for a patient was 3275.9 USD. The daily cost of hospitalization was 113.3 USD, the treatment cost for 1% burn surface area was 109.5 USD with the highest proportion for medication and consumable medical equipment (43.2%), followed by surgery and procedures (30.2%). The treatment costs increased with increasing age, burn extent and deep burn area (p < .05) and were significantly higher in the group of patients with inhalation injury, electrical burns and in non-survivors (p < .01). Multivariate regression analysis found that burn extent, deep burn area and inhalation injury independently influenced the treatment cost of burn patients.

Cette étude a analysé le coût global de la prise en charge d'un brûlé grave ainsi que les imputations et les paramètres associés aux dépenses. Le coût moyen est de 3 275,9$ (113,3$/ % SB/j). Les médicaments et les consommables représentent 43,2 % du total ; le coût des chirurgies 30,2 %. Le coût augmente avec l'âge, la surface brûlée et la profondeur (p < 0,05). Il est significativement plus élevé en cas d'inhalation de fumées, de brûlure électrothermique et en cas de brûlure fatale (p < 0,01). En analyse multivariée, la surface brûlée, la profondeur et l'inhalation de fumée sont des facteurs indépendants d'augmentation du coût de traitement.

Identification of virus-specific B-cell epitopes by convalescent plasma from COVID-19 patients.

Identification of immunologic epitopes against SARS-CoV-2 is crucial for the discovery of diagnostic, therapeutic, and preventive targets. In this study, we used a pan-coronavirus peptide microarray to screen for potential B-cell epitopes and validated the results with peptide-based ELISA. Specifically, we identified three linear B-cell epitopes on the SARS-CoV-2 proteome, which were recognized by convalescent plasma from COVID-19 patients. Interestingly, two epitopes (S 809-823 and R1ab 909-923) strongly reacted to convalescent plasma collected at the early phase (< 90 days) of COVID-19 symptom onset, whereas one epitope (M 5-19) reacted to convalescent plasma collected > 90 days after COVID-19 symptom onset. Neutralization assays using antibody depletion with the identified spike (S) peptides revealed that three S epitopes (S 557-571, S 789-803, and S 809-823) elicited neutralizing antibodies in COVID-19 patients. However, the levels of virus-specific antibody targeting S 789-803 only positively correlated with the neutralizing rates at the early phase (<60 days) after disease onset, and the antibody titers diminished quickly with no correlation to the neutralizing activity beyond two months after recovery from COVID-19. Importantly, stimulation of peripheral blood mononuclear cells from COVID-19-recovered patients with these SARS-CoV-2 S peptides resulted in poor virus-specific B cell activation, proliferation, differentiation into memory B cells, and production of immunoglobulin G (IgG) antibodies, despite the B-cells being functionally competent as demonstrated by their response to non-specific stimulation. Taken together, these findings indicate that these newly identified SARS-CoV-2-specific B-cell epitopes can elicit neutralizing antibodies, with titers and/or neutralizing activities declining significantly within 2-3 months in the convalescent plasma of COVID-19 patients.

Plasma biomarkers for systemic inflammation in COVID-19 survivors.

BACKGROUND: While the majority of COVID-19 patients fully recover from the infection and become asymptomatic, a significant proportion of COVID-19 survivors experience a broad spectrum of symptoms lasting weeks to months post-infection, a phenomenon termed "post-acute sequelae of COVID-19 (PASC)." The aim of this study is to determine whether inflammatory proteins are dysregulated and can serve as potential biomarkers for systemic inflammation in COVID-19 survivors. METHODS: We determined the levels of inflammatory proteins in plasma from 22 coronavirus disease 2019 (COVID-19) long haulers (COV-LH), 22 COVID-19 asymptomatic survivors (COV-AS), and 22 healthy subjects (HS) using an Olink proteomics assay and assessed the results by a beads-based multiplex immunoassay. RESULTS: Compared to HS, we found that COVID-19 survivors still exhibited systemic inflammation, as evidenced by significant changes in the levels of multiple inflammatory proteins in plasma from both COV-LH and COV-AS. CXCL10 was the only protein that significantly upregulated in COV-LH compared with COV-AS and HS. CONCLUSIONS: Our results indicate that several inflammatory proteins remain aberrantly dysregulated in COVID-19 survivors and CXCL10 might serve as a potential biomarker to typify COV-LH. Further characterization of these signature inflammatory molecules might improve the understanding of the long-term impacts of COVID-19 and provide new targets for the diagnosis and treatment of COVID-19 survivors with PASC.

The Efficacy of Fetoscopic Laser Surgery in Twin-Twin Transfusion Syndrome: A Preliminary Vietnamese Study.

Background: Twin-twin transfusion syndrome (TTTS) is a severe prenatal complication of monochorionic diamniotic twins (MCDA). If left untreated, TTTS is associated with a high risk of neonatal death and neurological complications. Various treatment methods for TTTS have been proposed, but fetoscopic laser surgery (FLS) is currently the primary treatment for TTTS in global fetal medicine centers. The objective of this study was to evaluate the outcome of TTTS following FLS treatment at Hanoi Obstetrics and Gynecology Hospital (HOGH), a new fetal medicine center in Vietnam. Methods: A prospective study of a series of 33 consecutive TTTS cases prior to 26 weeks of gestation subjected to FLS at HOGH in Vie-tnam between September 2019 to July 2021. Neonates were monitored for at least six months after birth. Results: The survival rate of at least one fetus reached 84.85%. No short-term neurological complications have been reported upon follow-up of the newborn up to six months after birth. There were three stillbirth cases (9.09%), one case of preterm ruptured membra-nes (PROM) (3.03%) after seven days of surgery and three cases of recurrent TTTS after surgery using the Solomon technique (25%). No maternal complications were observed. The mean gestational age at birth was 33.76 ± 4.52 weeks, with a mean interval of 12.24 ± 6.67 weeks between intervention and delivery. Nine cases (30%) were born prematurely before 32 weeks. Additionally, 60% of recipients and nearly 90% of donors weighed less than 2500 grams. Conclusions: FLS leads to high survival rates for fetuses with TTTS. FLS seems to be an effective therapeutic option for TTTS before 26 weeks of gestation.

Schwann cells in the subcutaneous adipose tissue have neurogenic potential and can be used for regenerative therapies.

Stem cell therapies for nervous system disorders are hindered by a lack of accessible autologous sources of neural stem cells (NSCs). In this study, neural crest-derived Schwann cells are found to populate nerve fiber bundles (NFBs) residing in mouse and human subcutaneous adipose tissue (SAT). NFBs containing Schwann cells were harvested from mouse and human SAT and cultured in vitro. During in vitro culture, SAT-derived Schwann cells remodeled NFBs to form neurospheres and exhibited neurogenic differentiation potential. Transcriptional profiling determined that the acquisition of these NSC properties can be attributed to dedifferentiation processes in cultured Schwann cells. The emerging population of cells were termed SAT-NSCs because of their considerably distinct gene expression profile, cell markers, and differentiation potential compared to endogenous Schwann cells existing in vivo. SAT-NSCs successfully engrafted to the gastrointestinal tract of mice, migrated longitudinally and circumferentially within the muscularis, differentiated into neurons and glia, and exhibited neurochemical coding and calcium signaling properties consistent with an enteric neuronal phenotype. These cells rescued functional deficits associated with colonic aganglionosis and gastroparesis, indicating their therapeutic potential as a cell therapy for gastrointestinal dysmotility. SAT can be harvested easily and offers unprecedented accessibility for the derivation of autologous NSCs from adult tissues. Evidence from this study indicates that SAT-NSCs are not derived from mesenchymal stem cells and instead originate from Schwann cells within NFBs. Our data describe efficient isolation procedures for mouse and human SAT-NSCs and suggest that these cells have potential for therapeutic applications in gastrointestinal motility disorders.

Risk Factors For Death And Prognosis Value Of Revised Baux Score For Burn Patients With Inhalation Injury.

A retrospective study was conducted on 314 burn patients with inhalation injury admitted to the National Burn Hospital during the period 2015-2019. The results showed that adult and male was predominant (81.9% and 77.7%), with burns mostly caused by flame (93.6%) and burn extent of 68.6±24.3% and deep burn area of 44.6±25.2% total body surface area. Rate of required mechanical ventilation patients was 95.22%. Common complications were multiple organ failure (41.9%), pneumonia (29.9%), ARDS (25.5%) and septic shock (23.8%), with a mortality rate of 85.4%. Multivariate logistic analysis indicated that burn extent and age were independent risk factors for death of patients with inhalation injury. SMR of rBaux score was 1.01 with AUC of 0.84, Youden index 113, sensitivity 82.09%, specificity 70.21%. The SMR of adult and elderly patients was relatively close to 1 (1 and .97 respectively). In addition, the AUC value for the elderly was highest (.95) followed by adult patients (.84). However, predicting the value of rBaux on children with inhalation injury was quite low (SMR=1.57; AUC = 0.4). There is a need to determine an optimal prognosis score for children with inhalation injury.

Nous avons réalisé une étude rétrospective sur 314 patients ayant inhalé des fumées hospitalisés dans le CTB national entre 2015 et 2019. Les hommes (77,71%), les adultes (81,85%) et les brûlés par flamme (93,6%) étaient majoritaires dans ce groupe. La surface brûlée moyenne était de 68,6 +/- 24,3% dont 44,6 +/-25,2% de profond. Une ventilation mécanique a été nécessaire dans 95,22% des cas. Les complications les plus fréquentes étaient les défaillances multiviscérales (41,9%), les pneumonies (29,9%), le SDRA (25,5%) et les chocs septiques (23,8%). La mortalité était de 85,4%. En analyse multivariée, l'âge et la surface brûlée ressortaient comme des facteurs de risque indépendants de mortalité. Le Baux modifié avait un SMR de 1,01; une AUCROC de 0,84; un index de Youden à 113, une sensibilité de 82,09% et une spécificité de 70,21%. Les SMR étaient proches de 1 chez les adultes (1) et les sujets âgés (0,97). La valeur la plus élevée de l'AUC (0,95) correspondait à la cohorte «sujets âgés¼, suivie de la cohorte «adultes¼ (0,84). Le Baux modifié est peu efficace chez l'enfant (SMR 1,57 ; AUC 0,4). Il est nécessaire de développer un score pronostique pour les enfants brûlés ayant inhalé des fumées.

How the ARCH Project Could Contribute to Strengthening ASEAN Regional Capacities on Disaster Health Management (DHM).

OBJECTIVE: The Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) developed Regional Collaboration Drills (RCDs) and is proposing an ASEAN Academic Network to strengthen capacity in disaster health management (DHM) in ASEAN Member States (AMS), as well as developing a standard training curriculum in DHM. This study aims to clarify the impacts and sustainability of the ARCH Project. METHODS: The four previous RCDs and the enhancement of academic activities were reviewed. RESULTS: The ARCH Project developed the RCDs with simulation exercises based on possible disaster scenarios in each host country to test and validate the capacity of AMS International Emergency Medical Teams (I-EMTs), the Standard Operating Procedure (SOP) for I-EMT coordination, and regional tools, as well as the relevant domestic SOPs of the host countries for receiving international assistance. Following the RCD in Thailand, three AMS: Viet Nam, Philippines, and Indonesia, all of which are considered disaster-prone, successfully hosted RCDs with significant improvements. The project also established a sub-working group (SWG) to develop a standard curriculum in DHM. Two curricula developments, the Basic Course on DHM and In-Country Course for Coordination on EMTs, are on-going as part of the project activity. The establishment of the ASEAN Academic Network and the ASEAN Institute for DHM (AIDHM) are currently in the endorsement process of the ASEAN health sector. CONCLUSION: The RCDs are very effective to test and to validate the SOP and regional tools developed, providing opportunities for AMS I-EMT to familiarize the tools, as well as for host countries to assess their coordination capacity for receiving international assistance and identifying the country's specific challenges, and verifying ASEAN regional coordination mechanism. The development of the standard curriculum can enhance regional capacity both in supporting disaster-affected countries and in receiving international assistance. A sustainable capacity development mechanism in DHM is envisaged through the establishment of the ASEAN Academic Network and AIDHM toward the goal of One ASEAN One Response.

Tamoxifen administration alters gastrointestinal motility in mice.

BACKGROUND: Tamoxifen is widely used for Cre-estrogen receptor-mediated genomic recombination in transgenic mouse models to mark cells for lineage tracing and to study gene function. However, recent studies have highlighted off-target effects of tamoxifen in various tissues and cell types when used for induction of Cre recombination. Despite the widespread use of these transgenic Cre models to assess gastrointestinal (GI) function, the effect of tamoxifen exposure on GI motility has not been described. METHODS: We examined the effects of tamoxifen on GI motility by measuring total GI transit, gastric emptying, small intestinal transit, and colonic contractility in wild-type adult mice. KEY RESULTS: We observed a significant delay in total GI transit in tamoxifen-treated mice, with unaltered gastric emptying, accelerated small intestinal transit, and abnormal colonic motility. CONCLUSION: Our findings highlight the importance of considering GI motility alterations induced by tamoxifen when designing protocols that utilize tamoxifen as a Cre-driver for studying GI function.

Increasing sample diversity in psychiatric genetics - Introducing a new cohort of patients with schizophrenia and controls from Vietnam - Results from a pilot study.

OBJECTIVES: Genome-Wide Association Studies (GWAS) of Schizophrenia (SCZ) have provided new biological insights; however, most cohorts are of European ancestry. As a result, derived polygenic risk scores (PRS) show decreased predictive power when applied to populations of different ancestries. We aimed to assess the feasibility of a large-scale data collection in Hanoi, Vietnam, contribute to international efforts to diversify ancestry in SCZ genetic research and examine the transferability of SCZ-PRS to individuals of Vietnamese Kinh ancestry. METHODS: In a pilot study, 368 individuals (including 190 SCZ cases) were recruited at the Hanoi Medical University's associated psychiatric hospitals and outpatient facilities. Data collection included sociodemographic data, baseline clinical data, clinical interviews assessing symptom severity and genome-wide SNP genotyping. SCZ-PRS were generated using different training data sets: (i) European, (ii) East-Asian and (iii) trans-ancestry GWAS summary statistics from the latest SCZ GWAS meta-analysis. RESULTS: SCZ-PRS significantly predicted case status in Vietnamese individuals using mixed-ancestry (R2 liability = 4.9%, p = 6.83 × 10-8), East-Asian (R2 liability = 4.5%, p = 2.73 × 10-7) and European (R2 liability = 3.8%, p = 1.79 × 10-6) discovery samples. DISCUSSION: Our results corroborate previous findings of reduced PRS predictive power across populations, highlighting the importance of ancestral diversity in GWA studies.

Influence Of "Open Lung" Recruitment On Ards In Burn Patients With Inhalation Injury.

The aim of this study was to determine the safety and impact of open lung strategy ventilation on inhalation injury patients complicated with ARDS. A prospective study was conducted in 33 inhalation injury patients with ARDS who were randomly divided into a control group (ventilated as ARDS net) and a study group (ventilated with open lung strategy). All patients were ventilated with volume control mode until weaning. The results indicated that open lung procedure was safe in most patients with optimal PEEP of 14.31±1.89 cm H2O. Within the first week of ventilation, respiratory system static compliances and PaO2/FiO2 ratio significantly increased in both groups (p<.05) but at a faster rate for the study group (p<.05). Ventilation duration and length of ICU stay were not significantly different across groups (p>.05). Duration time from ARDS onset to death and from admission to death were remarkably longer in the study group (p<.05). However, mortality rate and cause of death were not significantly different within 28 days post burn injury. Open lung recruitment is feasible and could be applied for inhalation injury induced ARDS to improve oxygenation and survival time. Further trials need to be conducted to find out the effectiveness of this strategy on mortality.

Le but de cet étude était de déterminer l'efficacité et l'innocuité d'une stratégie de ventilation « poumon ouvert ¼ sur le SDRA consécutif à une inhalation de fumées chez les patients brûlés. Elle concernait 33 patients brûlés, ayant inhalé des fumées, en SDRA, séparés après tirage au sort en 1 groupe témoin (T) ventilé selon les recommandations actuelles et 1 groupe (PO) ventilé selon une stratégie à poumon ouvert, les 2 groupes étant sous ventilation contrôlée jusqu'au sevrage. La stratégie PO s'est avérée sans risque pour la majorité des patients. La PEP optimale était de 14,31 +/- 1,89 cm H2O. Pendant la première semaine, la compliance statique et P/F augmentaient significativement (p<0,05) dans les 2 groupes, plus rapidement dans le groupe PO (p<0,05). Ni la durée de ventilation ni celle du séjour en réanimation ne différaient, pas plus que le pourcentage de mortalité, ou sa cause (à J28). En revanche, la mort, quand elle survenait, était plus tardive (comptée à partir de l'entrée ou de la survenue du SDRA) dans le groupe PO (p<0,05). La stratégie de ventilation à poumon ouvert est possible chez le brûlé en SDRA après inhalation de fumés. Elle pourrait améliorer l'oxygénation et retarder le décès mais des études complémentaires sont nécessaires pour déterminer si elle est à même de réduire la mortalité.

Epidemiology And Risk Factors For Death Of Pediatric Burns In A Developing Country. An Experience From The National Burn Hospital.

This retrospective study investigated burn features and predicted factors for death of pediatric burn patients in Vietnam. The results showed that pediatric burn accounted for 48.1% of total admitted burn patients. Preschool children and boys were predominant, burns were mostly caused by scald (76.2%) and the majority of patients lived in a rural area (64.1%). In addition, 94.5% had burn size less than 30% total body surface area and deep burn injury was seen in 45.5% patients. Moreover, a significantly higher incidence of deep burn injury was recorded in preschool age, patients living in a rural area, and non-scald burn. Overall LA50 was 81.5% and a significantly higher mortality rate was seen in non-scald burns, older children, extensive burn and inhalation injury. Multivariate logistic analysis indicated that only burn extent and inhalation injury were independent risk factors for death. An increased 1% of burn extent resulted in a .7 probability unit of death (OR=1.08) and this was 2.16 in the case of inhalation injury (OR=8.67). This health issue should be highlighted in order to develop appropriate policies and intervention measures in developing countries.

Cette étude rétrospective s'est penchée sur les caractéristiques et les facteurs de risque de mortalité des brûlures de l'enfant au Vietnam. Ces brûlres représentent 48,1% des hospitalisations dans notre centre. Les garçons d'âge préscolaire sont la sous- population prédominante. Les ébouillantements sont majoritaires (76,2%), de même que l'origine ruale (64,1%). L'immense majorité (94,5%) des brûlures touche moins de 30% SCT et l'atteinte n'est profonde que dans 45,5% des cas. Les brûlures sont plus profondes chez les patients ruraux préscolaires non ébouillantés. La SL (Surface Létale) 50 était de 81,5% ; les facteurs de risque de mortalité étant l'âge et la surface plus élevés, l'inhalation de fumées et la brûlure non due à un liquide. En analyse multivariée, seules la surface et l'inhalation de fumée ressortaient. Ainsi, l'augmentation de 1% de SB la probabilté de décès de 0,7 (OR 1,08) quand l'inhalation de fumée l'augmente de 2,16 (OR 8,67). Ce problème de santé publique doit être mis en avant afin de développer une législation et des mesures de protection adaptées dans les pays en développement.

Assessment Of Creatine Phosphokinase (CPK) Changes In Patients With High-Voltage Burns.

The aim was to evaluate change in creatine phosphokinase (CK) enzyme in high-voltage burn patients. A retrospective study was conducted of 104 patients (aged from 16 to 83 years old) who suffered from burns due to high voltage and were treated as inpatients at the National Burns Hospital. Patients were divided into two groups: patients with limb amputations in group A and patients without limb amputations in group B. Analysis was conducted on medical records of testing for plasma CK level immediately upon admission and during treatment. Testing of CK plasma enzyme was performed on an AU480 machine manufactured by Beckman Coulter. Data were processed using SPSS 20.0 software. Average plasma CK index increased on the first day of admission. In group B, plasma CK enzyme index increased from 5.5 to 22.4 times, and in group A this index increased from 5.6 to 46.5 times compared with the plasma CK index of normal people (170 U/l). The mean plasma CK enzyme index in the amputation group (n=20) was higher than in the non-amputation group (n=84). In patients with limb amputations, CK levels significantly decreased after deep necrosis incision and after amputation (p=0.00001). In patients with burns due to high voltage, plasma CK levels rise in the first days after burns. Increased plasma CK enzyme levels are directly proportional to total burn surface area (TBSA) and burn depth. After escharotomy and amputation, plasma CK levels decreased significantly compared to preoperation levels.

Cette étude rétrospective a pour but d'évaluer les variations des concentrations de CPK cez 104 patients (de 16 à 83 ans) hospitalisés dans l'hôpital brûlologique national après une électrisation par haut voltage. Ils ont été répartis en 2 groupes, selon qu'ils aient subi (groupe A, 20 patients) ou non (groupe B, 84 patients), une amputation de membre. Nous avons récupéré dans les dossiers et étudié les analyses de CPK, faites par le AU480 de Bekman- Coulter (normale ≤170UI/L), effectuées à l'entrée et durant le séjour. L'analyse statistique a utilisé SSPS 20.0. La concentration de CPK était multipliée par 5,6 à 46,5 chez les amputés, par 5,5 à 22,4 chez les autres. Les concentrations de CPK diminuaient significativement après aponévrotomies et amputations (p=0,00001), comparativement à leur niveau pré- opératoire. Les CPK augmententdans les jours qui suivent l'électrisation et sont proportionnel à la surface atteinte ainsi qu'à la profondeur des lésions.

Characteristics And Outcome Influence Of Increased Plasma Triglyceride Level In Severely Burned Adult Patients.

The aims of this study were to investigate the profile of serum triglyceride level and its influence on outcomes in adult patients with severe burns. An observational study was conducted on 62 patients with burn extent from and over 20% TBSA. Results indicated that serum triglyceride level steadily increased from 1.9mmo/l on the 3rd day to 2.5 mmol/l on the 14th day before reducing on the 21st day after burn. Remarkably higher triglyceride level was seen in patients with full thickness burn area >20% TBSA and in inhalation injury (p < .05). Liver size significantly increased over time and was greater in increased triglyceride patients, but the difference was not significant (p > .05). In addition, patients with elevated serum triglyceride level had significantly higher rates of multiple organ failure and death compared with the remaining group. Further studies need to be conducted to understand and determine intervention for increased plasma triglyceride levels in severely burned patients.

Le but de cette étude était d'évaluer les triglycéridémies et leur influence sur le devenir d'adultes sévèrement brûlés. Il s'agit d'une étude observationnelle réalisée auprès de 62 patients brûlés sur > 20% SCT. La triglycéridémie augmente régulièrement, de 1,9 mmol/L à J3 jusqu'à 2,5 mmol/L à J14 pour diminuer à partir de J21. Des taux particulièrement élevés étaient observés en cas d'atteinte profonde et d'inhalation de fumées (p < 0,05). La taille du foie augmentait au cours du temps et semblait plus élevés chez les patients hypertriglycéridémiques, sans être significative. En outre, les patients hypertriglycéridémiques développaient plus fréquemment une défaillance multiviscérale et leur mortalité était plus élevée. D'autres études sont nécessaires pour comprendre le mécanisme de cette hypertriglycéridémie et proposer une conduite à tenir pour ces patients.

SARS-CoV-2 specific memory T cell epitopes identified in COVID-19-recovered subjects.

The COVID-19 pandemic caused by SARS-CoV-2 infection poses a serious threat to public health. An explicit investigation of COVID-19 immune responses, particularly the host immunity in recovered subjects, will lay a foundation for the rational design of therapeutics and/or vaccines against future coronaviral outbreaks. Here, we examined virus-specific T cell responses and identified T cell epitopes using peptides spanning SARS-CoV-2 structural proteins. These peptides were used to stimulate peripheral blood mononuclear cells (PBMCs) derived from COVID-19-recovered subjects, followed by an analysis of IFN-γ-secreting T cells by enzyme-linked immunosorbent spot (ELISpot). We also evaluated virus-specific CD4 or CD8 T cell activation by flow cytometry assay. By screening 52 matrix pools (comprised of 315 peptides) of the spike (S) glycoprotein and 21 matrix pools (comprised of 102 peptides) spanning the nucleocapsid (N) protein, we identified 28 peptides from S protein and 5 peptides from N protein as immunodominant epitopes. The immunogenicity of these epitopes was confirmed by a second ELISpot using single peptide stimulation in memory T cells, and they were mapped by HLA restrictions. Notably, SARS-CoV-2 specific T cell responses positively correlated with B cell IgG and neutralizing antibody responses to the receptor-binding domain (RBD) of the S protein. Our results demonstrate that defined levels of SARS-CoV-2 specific T cell responses are generated in some, but not all, COVID-19-recovered subjects, fostering hope for the protection of a proportion of COVID-19-exposed individuals against reinfection. These results also suggest that these virus-specific T cell responses may induce protective immunity in unexposed individuals upon vaccination, using vaccines generated based on the immune epitopes identified in this study. However, SARS-CoV-2 S and N peptides are not potently immunogenic, and none of the single peptides could universally induce robust T cell responses, suggesting the necessity of using a multi-epitope strategy for COVID-19 vaccine design.

Enteric mesenchymal cells support the growth of postnatal enteric neural stem cells.

Interplay between embryonic enteric neural stem cells (ENSCs) and enteric mesenchymal cells (EMCs) in the embryonic gut is essential for normal development of the enteric nervous system. Disruption of these interactions underlies the pathogenesis of intestinal aganglionosis in Hirschsprung disease (HSCR). ENSC therapy has been proposed as a possible treatment for HSCR, but whether the survival and development of postnatal-derived ENSCs similarly rely on signals from the mesenchymal environment is unknown and has important implications for developing protocols to expand ENSCs for cell transplantation therapy. Enteric neural crest-derived cells (ENCDCs) and EMCs were cultured from the small intestine of Wnt1-Rosa26-tdTomato mice. EMCs promoted the expansion of ENCDCs 9.5-fold by inducing ENSC properties, including expression of Nes, Sox10, Sox2, and Ngfr. EMCs enhanced the neurosphere-forming ability of ENCDCs, and this persisted after withdrawal of the EMCs. These effects were mediated by paracrine factors and several ligands known to support neural stem cells were identified in EMCs. Using the optimized expansion procedures, neurospheres were generated from small intestine of the Ednrb-/- mouse model of HSCR. These ENSCs had similar proliferative and migratory capacity to Ednrb+/+ ENSCs, albeit neurospheres contained fewer neurons. ENSCs derived from Ednrb-/- mice generated functional neurons with similar calcium responses to Ednrb+/+ ENSCs and survived after transplantation into the aganglionic colon of Ednrb-/- recipients. EMCs act as supporting cells to ENSCs postnatally via an array of synergistically acting paracrine signaling factors. These properties can be leveraged to expand autologous ENSCs from patients with HSCR mutations for therapeutic application.