Factors influencing surgical outcomes of fixation with locking plate for three- and four-part proximal humerus fractures in patients aged 50 ​Years and older.

Background: Treating complex three- and four-part proximal humerus fractures, especially in the elderly, remains contentious, with internal fixation using locking plates and shoulder arthroplasty being primary options. Although proximal humerus locking plates are more commonly used than shoulder replacements, they have a high complication rate. Factors like low bone density, advanced age, multiple fragment fractures, and medial cortical support loss negatively impact treatment outcomes. This study evaluates the functional and radiographic outcomes of using locking plates for treating these fractures in patients aged 50 and older, and the factors influencing outcomes and complication rates at the Ho Chi Minh City Hospital for Trauma and Orthopedics. Method: A descriptive case series study was conducted on 58 patients aged 50 and older (15 males, 43 females) with three- and four-part proximal humerus fractures. These patients underwent open reduction and internal fixation with Locking - compression plate (LCP) periarticular proximal humerus plates at the Ho Chi Minh City Hospital for Traumatology and Orthopedics (HTO) from April 2020 to April 2022. The minimum postoperative follow-up period was 12 months. Results: The average age of the patients was 62.78 â€‹± â€‹7.73 years, with a mean follow-up of 26.24 â€‹± â€‹5.93 months. Among them, 41 had three-part fractures (70.68 â€‹%) and 17 had four-part fractures (29.32 â€‹%). At the final follow-up (≥12 months), the mean Constant-Murley score was 70.81 â€‹± â€‹9.15, and the mean QDASH score was 8.33 â€‹± â€‹2.77. Complications occurred in 6 cases (10.34 â€‹%). Complex fractures, such as four-part fractures with displacement greater than 2 â€‹mm, had lower Constant-Murley scores and higher QDASH scores (p â€‹< â€‹0.05). Age, gender, bone density by deltoid tuberosity index (DTI), bone grafting, and rotator cuff sutures showed similar trends, but the differences were not statistically significant. Conclusion: Open reduction and internal fixation (ORIF) provides good bone healing and functional outcomes for three- and four-part proximal humerus fractures. Factors such as age, gender, bone density, bone grafting, and rotator cuff sutures do not significantly affect outcomes. Therefore, osteoporosis should not be a contraindication for ORIF with locking plates in these cases. Complex fractures, however, often lead to poorer outcomes and higher complication rates post-surgery.

Evaluation of the Use of Phenobarbital and Benzodiazepines in the Management of Alcohol Withdrawal Syndrome in Patients Requiring Neurological/Neurosurgical Critical Care: A Propensity-Matched Analysis.

Objective There is growing interest in the use of phenobarbital for alcohol withdrawal syndrome in critically ill patients, though experience in neurologically injured patients is limited. The purpose of this study was to compare the safety and effectiveness of phenobarbital-containing alcohol withdrawal regimens versus benzodiazepine monotherapy in the neurocritical care unit. Methods We conducted a retrospective cohort study of adult patients admitted to the neurocritical care unit from January 2014 through November 2021 who received pharmacologic treatment for alcohol withdrawal. Treatment groups were defined as benzodiazepine monotherapy versus phenobarbital alone or in combination with benzodiazepines. The primary outcome was the percentage of patients requiring intubation after receiving alcohol withdrawal treatment. Secondary outcomes included all-cause, in-hospital mortality, intensive care unit length of stay, discharge disposition, change in Glasgow Coma Scale (GCS) score, and the use of adjunctive agents. Results We analyzed data from 156 patients, with 77 (49%) in the benzodiazepine group and 79 (51%) in the phenobarbital combination group. The groups were well-balanced for baseline characteristics, though more males (67, 85%) were in the phenobarbital group. Only three (1.9%) patients received phenobarbital monotherapy, and the rest (153, 98.1%) received combination therapy. The percentage of patients requiring mechanical ventilation was significantly higher in the phenobarbital combination group compared to benzodiazepine monotherapy (39% (n=31) versus 13% (n=10); OR: 4.33, 95% CI: 1.94-9.66; p<0.001). The use of adjunctive propofol and dexmedetomidine was higher in the phenobarbital group (propofol 35% (n= 28) versus 9% (n=7) and dexmedetomidine 30% (n=24) versus 5% (n=4), respectively). Patients in the phenobarbital group also had lower GCS scores and higher Clinical Institute Withdrawal Assessment of Alcohol (CIWA-Ar) scores during their intensive care unit admission, possibly suggesting more severe alcohol withdrawal. There was no difference in intensive care unit length of stay, all-cause, in-hospital mortality, discharge disposition, or therapeutic adjuncts. Conclusions Combination therapy of phenobarbital plus benzodiazepines was associated with higher odds of requiring mechanical ventilation. Few patients received phenobarbital monotherapy. Additional studies are needed to better compare the effects of phenobarbital monotherapy versus benzodiazepines in neurocritical patients.

Dataset on intergenic spacer regions of chloroplast genome and potential DNA barcode of Hoya varticillata var varticillata in Vietnam.

Hoya verticillata var verticillata, an epiphytic plant, is both an ornamental and a valuable medicinal plant. However, H. verticillata has a similar morphology to other species belonging to the Hoya genus, so it is challenging to distinguish the H. verticillata var verticillata, plant accurately. Alternatively, if H. verticillata var verticillata, is deformed or powdered, it is more challenging to identify. This dataset includes information on H. verticillata var verticillata, samples collected from the natural environment and four chloroplast DNA markers to support H. verticillata var verticillata, species identification. Phylogenetic analysis based on sequences of intergenic spacer regions (trnK-rps16, rps16-trnQ, psbI-atpA, and ndhC-trnV) shows that H. verticilata var verticillata, is very closely related and distributed in the same group as Hoya carnosa with a Bootstrap coefficient of 99-100 %. Four intergenic spacer region sequences, trnK-rps16, rps16-trnQ, psbI-atpA, and ndhC-trnV from the chloroplast genome are potential DNA barcoding candidates to distinguish H. verticilata var verticillata, from different species in the Hoya genus.

The first two case reports of confirmed Mpox in patients with syphilis in a dense urban setting, Can Tho, Vietnam: From clinical presentation, treatment, and epidemiological surveillance to prevention.

This report elucidated the first two noteworthy cases of Mpox that manifested as an emerging concern in a densely populated city in Vietnam. Two male patients (22 and 27 years old) were admitted to the hospital due to the presence of small pustules on their faces, accompanied by symptoms of fatigue, drowsiness, and muscle pain. Reverse transcription-polymerase chain reaction confirmed the presence of Mpox. The patients possessed a medical history involving four previous treatments for syphilis, a continuous antiretroviral regimen for over 3 years, no previous history of chickenpox, a lack of vaccination against chickenpox, and engagement in intimate contact with other men. Following a 14-day isolation period coupled with appropriate medical interventions, both patients exhibited stable health conditions, marked by the absence of fever and the desiccation of skin blisters. Subsequently, they were discharged with instructions for ongoing health monitoring. Comprehensive surveillance and monitoring approaches have been implemented for all individuals in close contact with the affected patients, adhering to established guidelines. Notably, no suspected cases have been identified during the current surveillance efforts. The collective findings underscore the significance of robust surveillance, continuous monitoring, and strategic vaccination initiatives, particularly in densely populated urban centers, to effectively manage and mitigate the impact of Mpox outbreaks.

Fungal Cell Wall-Associated Effectors: Sensing, Integration, Suppression, and Protection.

The cell wall (CW) of plant-interacting fungi, as the direct interface with host plants, plays a crucial role in fungal development. A number of secreted proteins are directly associated with the fungal CW, either through covalent or non-covalent interactions, and serve a range of important functions. In the context of plant-fungal interactions many are important for fungal development in the host environment and may therefore be considered fungal CW-associated effectors (CWAEs). Key CWAE functions include integrating chemical/physical signals to direct hyphal growth, interfering with plant immunity, and providing protection against plant defenses. In recent years, a diverse range of mechanisms have been reported that underpin their roles, with some CWAEs harboring conserved motifs or functional domains, while others are reported to have novel features. As such, the current understanding regarding fungal CWAEs is systematically presented here from the perspective of their biological functions in plant-fungal interactions. An overview of the fungal CW architecture and the mechanisms by which proteins are secreted, modified, and incorporated into the CW is first presented to provide context for their biological roles. Some CWAE functions are reported across a broad range of pathosystems or symbiotic/mutualistic associations. Prominent are the chitin interacting-effectors that facilitate fungal CW modification, protection, or suppression of host immune responses. However, several alternative functions are now reported and are presented and discussed. CWAEs can play diverse roles, some possibly unique to fungal lineages and others conserved across a broad range of plant-interacting fungi. [Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY 4.0 International license.

Ustilago maydis PR-1-like protein has evolved two distinct domains for dual virulence activities.

The diversification of effector function, driven by a co-evolutionary arms race, enables pathogens to establish compatible interactions with hosts. Structurally conserved plant pathogenesis-related PR-1 and PR-1-like (PR-1L) proteins are involved in plant defense and fungal virulence, respectively. It is unclear how fungal PR-1L counters plant defense. Here, we show that Ustilago maydis UmPR-1La and yeast ScPRY1, with conserved phenolic resistance functions, are Ser/Thr-rich region mediated cell-surface localization proteins. However, UmPR-1La has gained specialized activity in sensing phenolics and eliciting hyphal-like formation to guide fungal growth in plants. Additionally, U. maydis hijacks maize cathepsin B-like 3 (CatB3) to release functional CAPE-like peptides by cleaving UmPR-1La's conserved CNYD motif, subverting plant CAPE-primed immunity and promoting fungal virulence. Surprisingly, CatB3 avoids cleavage of plant PR-1s, despite the presence of the same conserved CNYD motif. Our work highlights that UmPR-1La has acquired additional dual roles to suppress plant defense and sustain the infection process of fungal pathogens.

Targeting Skeletal Muscle Dysfunction With L-Carnitine for the Treatment of Patients With Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is a major medical problem and the world's third leading cause of death. COPD is a chronic disease with heterogeneous clinical symptoms, disease progression, and treatment responses. Besides pulmonary symptomatology, the common systemic clinical manifestations are cachexia, muscle weakness, and widespread comorbidities such as cardiovascular diseases, diabetes, osteoporosis, and infections. The adverse effects of pharmaceutical therapies contribute to the difficulty of health risk assessment and management of COPD patients. This review shows how skeletal muscle dysfunction and metabolic abnormalities contribute significantly to COPD patients' symptoms, functional activities, quality of life, and overall disease outcomes. Based on the clinical evidence of L-carnitine and derivatives as metabolic and muscle bioenergetic enhancers, we propose broader research and implementation of this nutraceutical agent as an effective, inexpensive, and safe adjuvant therapeutic for the long-term management of COPD patients. Moreover, we believe the management of COPD as a chronic disease should be shifted from symptomatic reactive pharmaceutical intervention to more constructive and non-toxic approaches using a single or combination of natural and nutritional agents with potential muscle metabolic enhancing and immunomodulating activities to achieve a better overall outcome for the patients in terms of morbidity, mortality, and medical cost-reduction.

The Rationality of Implementation of Dimethyl Sulfoxide as Differentiation-inducing Agent in Cancer Therapy.

One of the major hallmarks of many cancer cells is dedifferentiated cells (immature cells) with little or no resemblance to normal cells. Besides the poor differentiation, malignant cells also have important features such as aggressiveness and resistance to different therapeutics. Differentiation potentiators hold great promise for cancer treatment. Dimethyl sulfoxide (DMSO) is a well-characterized pharmaceutical solvent. It is used as a component of numerous cancer therapeutic approaches, including cancer treatment and several approved cancer immune therapeutics such as Car-T cell therapy and the FDA-approved drug Mekinist (trametinib DMSO) for melanoma treatment. It is also biologically recognized as a pharmaceutical solvent and cryoprotectant. In the current literature, there are no mentions of DMSO's possible ability to potentiate therapeutic activity as a component of these cancer treatments. This review aimed to summarize scientific evidence and substantiate the concept that DMSO can contribute positively to the overall efficacy of cancer treatment as an adjuvant that is safe, inexpensive, and an effective differentiation-inducing therapeutic agent.

Acidolysis of Poly(ethylene terephthalate) Waste Using Succinic Acid under Microwave Irradiation as a New Chemical Upcycling Method.

A novel method of chemical upcycling of used poly(ethylene terephthalate) (PET) bottles by acidolysis with succinic acid (SA) was performed under microwave irradiation. The long polyester chain of PET was efficiently fragmented into small molecules and oligomers, such as terephthalic acid and α,ω-dicarboxylic acid oligo(ethylene succinate-co-terephthalate) (OEST). Various input molar ratios of SA/PET from 1.0 to 2.5 were used, and the product mixtures were separated successfully. The recovered terephthalic acid can be reused as a basic chemical. The α,ω-dicarboxylic acid OEST was used as a curing agent for epoxy resin. The recovered SA can be reused for further PET acidolysis. Structures of OEST were identified by Fourier transform infrared (FTIR) spectroscopy, 1H NMR spectroscopy, and electrospray ionization-mass spectrometry (ESI-MS). The presence of succinic anhydride as a side product was confirmed by FTIR and ESI-MS analyses. The evaporation of SA and the formation of volatile succinic anhydride compete with the acidolysis of PET. The minimum SA/PET ratio of 1.0 was selected so that the acidolysis was effective and without the SA recovery step by MEK treatment. OEST-1.0 was used for curing diglycidyl ether of bisphenol A. The structures and thermal properties of cured adducts were confirmed by FTIR and differential scanning calorimetry (DSC). This chemical upcycling method of PET is eco-friendly without the use of a solvent and a catalyst for the reaction, and all materials were recovered and they could be reused for novel polymer preparation.

Successful phytotherapy for a patient with severe immune thrombocytopenia and failed with corticosteroids, azathioprine, eltrombopag, and platelet transfusion - A case report.

The purpose of this study was to investigate and evaluate the effectiveness of phytotherapy on a severe and complicated Immune Thrombocytopenia (ITP) patient who had failed with conventional treatments. A male patient presented with clinical symptoms of ITP and had been treated with Corticosteroids, Azathioprine, Eltrombopag, and platelet transfusions for over three years. The patient had an initial response but later developed severe complications, including hydrothorax, gastric pain, hematuria, and digestive hemorrhage, and no further response to treatment. The patient then received Phytotherapy for 17 months which significantly improved the clinical symptoms, platelet counts, and laboratory tests. Despite his active lifestyle, the patient was symptom-free with platelet counts ranging from 109 to 132×109/L.

Establishment of an in-house real-time RT-PCR assay for the detection of severe acute respiratory syndrome coronavirus 2 using the first World Health Organization international standard in a resource-limited country.

BACKGROUND: The COVID-19 pandemic caused by SARS-CoV-2 remains public health burdens and many unresolved issues worldwide. Molecular assays based on real-time RT-PCR are critical for the detection of SARS-CoV-2 in clinical specimens from patients suspected of COVID-19. OBJECTIVE: We aimed to establish and validate an in-house real-time RT-PCR for the detection of SARS-CoV-2. METHODOLOGY: Primers and probes sets in our in-house real-time RT-PCR assay were designed in conserved regions of the N and E target genes. Optimized multiplex real-time RT-PCR assay was validated using the first WHO International Standard (NIBSC code: 20/146) and evaluated clinical performance. RESULTS: The limit of detection validated using the first WHO International Standard was 159 IU/ml for both E and N target genes. The evaluation of clinical performance on 170 clinical samples showed a positive percent agreement of 100% and the negative percent agreement of 99.08% for both target genes. The Kappa value of 0.99 was an excellent agreement, the strong correlation of Ct values observed between two tests with r2  = 0.84 for the E gene and 0.87 for the N gene. Notably, we assessed on 60 paired saliva and nasopharyngeal samples. The overall agreement was 91.66%, and Kappa value of 0.74 showed a high agreement between two types of samples. When using nasopharyngeal swabs as the reference standard, positive percent agreement, and negative percent agreement were 91.83% and 90.90%, respectively. CONCLUSION: In the present study, we established and validated an in-house real-time RT-PCR for molecular detection of SARS-CoV-2 in a resource-limited country.

Intestinal perforation caused by fishbone in a child with the misdiagnosis of acute appendicitis: A case report.

If a child has abdominal pain, it is important to evaluate the possibility of intestinal perforation caused by foreign objects such as fishbone. If a foreign agent is present, laparoscopic surgery is an effective method to remove the foreign objects.

A Novel Core Effector Vp1 Promotes Fungal Colonization and Virulence of Ustilago maydis.

The biotrophic fungus Ustilago maydis secretes a plethora of uncharacterized effector proteins and causes smut disease in maize. Among the effector genes that are up-regulated during the biotrophic growth in maize, we identified vp1 (virulence promoting 1), which has an expression that was up-regulated and maintained at a high level throughout the life cycle of the fungus. We characterized Vp1 by applying in silico analysis, reverse genetics, phenotypic assessment, microscopy, and protein localization and provided a fundamental understanding of the Vp1 protein in U. maydis. The reduction in fungal virulence and colonization in the vp1 mutant suggests the virulence-promoting function of Vp1. The deletion studies on the NLS (nuclear localization signal) sequence and the protein localization study revealed that the C-terminus of Vp1 is processed after secretion in plant apoplast and could localize to the plant nucleus. The Ustilago hordei ortholog UhVp1 lacks NLS localized in the plant cytoplasm, suggesting that the orthologs might have a distinct subcellular localization. Further complementation studies of the Vp1 orthologs in related smut fungi revealed that none of them could complement the virulence function of U. maydis Vp1, suggesting that UmVp1 could acquire a specialized function via sequence divergence.

Application of Dimethyl Sulfoxide as a Therapeutic Agent and Drug Vehicle for Eye Diseases.

Dimethyl sulfoxide (DMSO) is an amphipathic molecule widely used as a solvent for water-insoluble substances, cryopreserving, and cell-biological therapies. It has known properties as an inducer of cellular differentiation, a free radical scavenger, and a radioprotectant. In addition, DMSO is used for its various therapeutic and pharmaceutical properties, such as anti-inflammatory, local and systemic analgesic, antibacterial, antifungal, antiviral, and membrane penetration enhancement agents. DMSO treatment can be given orally, intravenously, or topically for a wide range of indications. The administration of DMSO exhibits favorable outcomes in human eye diseases with low to none observed ocular or systemic ocular toxicity. Nevertheless, DMSO is an essential and nonpatentable potential therapeutic agent that remains underexplored and ignored by pharmaceutical developers and ophthalmologists. This current review takes data from experimental and clinical studies that have been published to substantiate the potential therapeutic efficacy of DMSO and stimulate the research of its application in clinical ophthalmology. Given that DMSO is inexpensive, safe, and easily formulated into therapeutic medicinal products and conventional ophthalmological drugs, this compound should be further explored and studied in the treatment of a variety of acute and chronic ocular disorders.

Effect of bodyweight on VerifyNow Aspirin platelet function test: a retrospective review.

BACKGROUND: Antiplatelet therapy is used to prevent stent thrombosis in intracranial stents, but the optimal dose of aspirin is unknown. This study sought to determine whether the degree of platelet inhibition with aspirin is affected by bodyweight as observed through a platelet reactivity assay. METHODS: This is a retrospective review of patients who underwent neurovascular stent placement and had a VerifyNow Aspirin assay result. The primary outcome was the correlation between the VerifyNow Aspirin result, bodyweight, and the initial dose of aspirin. Secondary outcomes included the impact of the VerifyNow P2Y12 result and of weight on the incidence of bleeding or a thrombotic event. RESULTS: Of the 142 included patients, 62.7% weighed ≥70 kg and 88.7% were initiated on aspirin 300-325 mg daily. 83.8% achieved a therapeutic VerifyNow Aspirin result. There was minimal correlation between the VerifyNow Aspirin result, bodyweight, and aspirin dose (R2=0.02). Between patients who weighed <70 kg versus ≥70 kg, there was no difference in the mean aspirin reaction units (ARU) (449 vs 435, p=0.32) or in the incidence of bleeding (28% vs 17.1%, p=0.14) or a thrombotic event (4% vs 5.3%, p=0.59). No patient experienced stent thrombosis and eight patients experienced in-stent stenosis. In a multivariate analysis, only the VerifyNow P2Y12 result predicted the development of either bleeding or a thrombotic event (p<0.01). CONCLUSIONS: Bodyweight did not influence the likelihood of obtaining a therapeutic VerifyNow Aspirin result. The clinical utility of obtaining VerifyNow Aspirin assays for this patient population is unknown.

Determinants of Risk Factors for Renal Impairment among HIV-Infected Patients Treated with Tenofovir Disoproxil Fumarate-Based Antiretroviral Regimen in Southern Vietnam.

BACKGROUND: The situation of renal impairment among HIV-infected patients treated with TDF-based antiretroviral (ARV) regimen greater than 3 years is little known when TDF use has been promptly increasing in Vietnam. METHODS: We analyse demographic and clinical data from a cross-sectional survey of 400 HIV-infected patients aged ≥18 years, who were treatment-naive or switched TDF regimen within over 3 years between November 2018 and March 2019. Serological tests for serum creatinine, ALT, and AST were performed. Renal impairment was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Multivariate regression analyses were used to explore the risk factors associated with renal impairment. RESULTS: At the baseline, 7.8% of respondents had estimated glomerular filtration rate (eGFR) of 30-59 mL/min/1.73 m2 and 0.8% had eGFR of 15-29 mL/min/1.73 m2, out of 34 (8.5%) of participants who had renal impairment. Multivariate analysis showed that participants who had preexposure to isoniazid (adjusted PR [aPR] = 0.35 Cl: 0.14-0.91) compared with nonexposure to isoniazid who had a BMI from 18.5 up to 25 kg/m2 (aPR = 0.31 Cl: 0.15-0.62) compared with BMI below 18.5 kg/m2 were less likely to suffer from renal impairment. Patients aged greater than 60 years (aPR = 26.75, 95% Cl: 3.38-211.62) compared with those aged 20-29 years were more likely to have increased risk of renal impairment. CONCLUSION: Our findings underscore the need for longitudinal studies to assess the influence of TDF on maintaining the low prevalence of renal impairment among HIV-infected patients in Vietnam.

Synthesis of Novel Thermostable Polyamideimides from Bis(2-aminoethyl)terephthalamide and Dianhydrides.

Bis(2-aminoethyl)terephthalamide, an amide-containing diamine, was obtained from the aminolysis of waste poly(ethylene terephthalate) bottles. This diamine reacts with various aromatic dianhydrides to form novel polyamideimides (PAIs). The formation of amic acid or ammonium carboxylate salt intermediates depends strongly on the substituents of the dianhydrides. The electron-withdrawing substituents promote the creation of an ammonium carboxylate salt, whereas the electron donors assist with the amic acid intermediate formation. These salts and amic acids were further converted into polyimides by thermal treatment. The structures of the intermediates and PAIs were characterized by Fourier transform infrared, 1H nuclear magnetic resonance (NMR), and 13C NMR spectroscopies, and their thermal properties were determined by differential scanning calorimetry and thermogravimetry. X-ray diffraction patterns and inherent viscosity values of these PAIs were also reported. By using these chemical transformations, waste poly(ethylene terephthalate) bottles were converted into high-performance PAIs. These PAIs can be used as membrane-modifying agents for industrial separation applications.

Transmission and serotype features of hand foot mouth disease in household contacts in Dong Thap, Vietnam.

BACKGROUND: Hand, foot and mouth disease (HFMD) has emerged as a major public health issue in Vietnam since 2003. We aimed to investigate the household transmission of HFMD and its causative viruses from 150 households in a high incidence province in Vietnam. METHODS: A longitudinal study was conducted in patients presenting to the provincial hospital with a HFMD-like syndrome, along with their household members between April and August 2014 in Dong Thap Province. Each participant was followed up for 2 weeks. We enrolled 150 patients aged under 15 who were clinically diagnosed with HFMD in Dong Thap Hospital, 600 household members, and 581/600 household members completed the study. All participants were interviewed using a standard questionnaire. Throat swabs and blood samples were taken for molecular detection of viruses and assessment of neutralizing antibodies, respectively. Index cases were defined using a clinical case definition, household contact cases were defined using a similar definition applied to the 2 weeks before admission and 2 weeks after discharge of the index case. Characteristics of index cases, household contacts, the attack rate, serotype features and related factors of HFMD were reported. RESULT: Among 150 index cases, 113 were laboratory confirmed: 90/150 were RT-PCR-positive, 101/142 had a ≥ 4-fold increase of neutralizing antibody against Enterovirus A71 (EV-A71), Coxsackievirus (CV) A6 or CV-A16 across the two samples collected. 80/150 (53%) were males, and 45/150 (30%) were under the age of 1. The predominant serotype was CV-A6, identified in 57/87 (65.5%) of the specimens. No deaths were reported. Among 581 household contacts, 148 were laboratory confirmed: 12/581 were RT-PCR-positive, 142/545 had a ≥ 4-fold increase of neutralizing antibodies against EV-A71, CV-A6 or CV-A16; 4 cases experienced HFMD in the past 4 weeks. Attack rate among household contacts was 148/581 (25.5%). In 7/12 (58%) instances, the index and secondary cases were infected with the same serotype. Having a relationship to index case was significantly associated with EV infection. CONCLUSION: The attack rate among household contacts was relatively high (25.5%) in this study and it seems justified to also consider the household setting as an additional target for intervention programs.

Excellent Fireproof Characteristics and High Thermal Stability of Rice Husk-Filled Polyurethane with Halogen-Free Flame Retardant.

The thermal stabilities, flame retardancies, and physico-mechanical properties of rice husk-reinforced polyurethane (PU-RH) foams with and without flame retardants (FRs) were evaluated. Their flammability performances were studied by UL94, LOI, and cone calorimetry tests. The obtained results combined with FTIR, TGA, SEM, and XPS characterizations were used to evaluate the fire behaviors of the PU-RH samples. The PU-RH samples with a quite low loading (7 wt%) of aluminum diethylphosphinate (OP) and 32 wt% loading of aluminum hydroxide (ATH) had high thermal stabilities, excellent flame retardancies, UL94 V-0 ratings, and LOIs of 22%-23%. PU-RH did not pass the UL94 HB standard test and completely burned to the holder clamp with a low LOI (19%). The cone calorimetry results indicated that the fireproof characteristics of the PU foam composites were considerably improved by the addition of the FRs. The proposed flame retardancy mechanism and cone calorimetry results are consistent. The comprehensive FTIR spectroscopy, TG, SEM, and XPS analyses revealed that the addition of ATH generated white solid particles, which dispersed and covered the residue surface. The pyrolysis products of OP would self-condense or react with other volatiles generated by the decomposition of PU-RH to form stable, continuous, and thick phosphorus/aluminum-rich residual chars inhibiting the transfer of heat and oxygen. The PU-RH samples with and without the FRs exhibited the normal isothermal sorption hysteresis effect at relative humidities higher than 20%. At lower values, during the desorption, this effect was not observed, probably because of the biodegradation of organic components in the RH. The findings of this study not only contribute to the improvement in combustibility of PU-RH composites and reduce the smoke or toxic fume generation, but also solve the problem of RHs, which are abundant waste resources of agriculture materials leading to the waste disposal management problems.

Emergence of New Delhi Metallo-Beta-Lactamase (NDM) and Klebsiella pneumoniae Carbapenemase (KPC) Production by Escherichia coli and Klebsiella pneumoniae in Southern Vietnam and Appropriate Methods of Detection: A Cross-Sectional Study.

Carbapenemase-producing Enterobacteriaceae (CPE) are well known to cause many serious infections resulting in increasing mortality rate, treatment cost, and prolonged hospitalization. Among the widely recognized types of carbapenemases, New Delhi ß-lactamase (NDM) and Klebsiella pneumoniae carbapenemase (KPC) are the most important enzymes. However, in Vietnam, there are only scattered reports of CPE due to the lack of simple and affordable methods that are suitable to laboratory conditions. This study aims to survey the characteristics of carbapenem-resistant E. coli and K. pneumoniae (CR-E/K) at two hospitals in Southern Vietnam and perform some simple methods to detect the two enzymes. A total of 100 CR-E/K strains were collected from clinical isolates of Gia Dinh People's Hospital and Dong Nai General Hospital, Vietnam, from November 2017 to May 2018. The patient-related information was also included in the analysis. We conducted real-time polymerase chain reaction (PCR), Modified Hodge Test (MHT), and combined disk test (CDT) on all isolates. Carbapenemase-encoding genes were detected in 47 isolates (36 NDM, 10 KPC, and one isolate harboring both genes). The E. coli strain carrying simultaneously these two genes was the first case reported here. Most of isolates were collected from patients in ICU, Infectious Disease Department, and Department of Urologic Surgery. Urine and sputum were two common specimens. The true positive rate (sensitivity, TPR) and specificity (SPC) of the imipenem-EDTA (ethylen diamine tetra acetic acid) for NDM detection and the imipenem-PBA (phenylboronic acid) for KPC detection on E. coli were 93.8%, 97.1% and 66.7%, 95.7%, respectively. Meanwhile, the imipenem-EDTA for NDM detection and the imipenem-PBA for KPC detection among K. pneumonia achieved 90.5%, 100% and 100%, 92.9% TPR and SPC, respectively. However, MHT showed low sensitivity and specificity. Our findings showed that CP-E/K were detected with high prevalence in the two hospitals. We suggest that CDT can be used as a low-priced and accurate method of detection.