Results from 228 Patients with Hemifacial Spasm Undergoing Microvascular Decompression without Intraoperative Neuroelectrophysiology Monitoring.

BACKGROUND: Intraoperative neuroelectrophysiology monitoring (IONM) has been used to decrease complications and to increase the successful rate of microvascular decompression (MVD) MVD for hemifacial spasm (HFS). Still, it is not available at limited resource centers. We report the outcome of patients undergoing MVD for HFS without using IONM. METHODS: The variables concerning the patients' demographics (age and gender), clinical characteristics, offending vessels (vertebral artery type and non-vertebral artery type), postoperative grade of HFS, and postoperative complications of HFS patients undergoing MVD were retrospectively reviewed and collected. The scoring system provided by the Japan Society for MVD was used to evaluate the postoperative outcome of HFS. Postoperative hearing ability was evaluated according to a subjective assessment of the patients. RESULTS: A total of 228 patients were recruited. Their median age was 51.0 (44.0-57.0) years old. The total cure effect was observed in 207 (90.8%) patients within the first week after the surgery and in 200 (96.1%) patients in a 2-year follow-up. Permanent hearing disturbance happened in 2 patients (0.9%). No patient had permanent unilateral deafness (0%). No postoperative permanent facial paralysis was reported. CONCLUSIONS: MVD without IONM may be performed safely and effectively to treat patients with HFS.

Effect of Donors' Biliary Variation on Postoperative Biliary Complications in Living Donor Liver Transplantation: A Single-Center Observational Study in Vietnam.

BACKGROUND: Our study aims to evaluate the biliary anatomy variation according to the Varotti classification and its correlation with surgical outcomes for both donors and recipients undergoing living donor liver transplants (LDLTs). METHODS: A retrospective analysis of 150 LDLT cases performed at a single center in Vietnam with preoperative radiologic evaluations and intraoperative surgical assessments to identify biliary variant anatomy. Postoperative biliary complications were documented and analyzed. Statistical analysis was performed to determine any significant associations between biliary variations and post-transplant outcomes. RESULTS: One hundred fifty cases of LDLT at 108 Military Central Hospital from October 2017 to December 2022 were included in our study. Among the donors, the mean age was 30.89 ± 7.23, with male predominance (77.3%). The prevalence of type 1 biliary anatomy was 84.67%. Type 2, 3a, 3b, 4a, and 4b accounted for 5.33%, 2.67%, 5.33%, 0.67%, and 1.33% of cases, respectively. Donors' complications were witnessed in 7 cases (4.67%), and all needed intervention (Clavien-Dindo grade 3). Biliary complications were found in 36 (24.0%) recipients, with 22 (14.67%) cases of biliary stenosis and 16 (10.67%) cases of biliary leak, including 2 cases encountering both complications. Age, gender, graft type, preoperative liver function, biliary variant anatomy, number of graft orifices, Model for End-Stage Liver Disease score, and blood loss were not significant risk factors for recipients' biliary complications. Cold ischemia time significantly increased the biliary complication rate. CONCLUSIONS: This study shows that biliary variant anatomy is common in living liver donors. Such variations should not be a contraindication to liver donation. However, accurate pre- and intraoperative radiologic and surgical evaluations are fundamental for a careful reconstruction plan.

Laparoscopic-cholangioscopic cooperative modified tunnel technique for hepatolithiasis combined with dilated common bile duct: A case report and literature review.

INTRODUCTION: Intrahepatic and extrahepatic lithiasis, a condition characterized by the presence of stones in the liver and bile ducts, is a common disease in Asia, particularly in East and Southeast Asia. We report a case with laparoscopic exploration of the common bile duct using a flexible cholangioscope and modified trans-common bile duct tunnel for hepatolithiasis combined with the dilated common bile duct. PRESENTATION OF CASE: A 35-year-old male patient has had chronic epigastric and right upper quadrant pain. The common bile duct was 11 mm dilated, and hepatolithiasis was also present, according to an upper abdomen MRI. The largest stone measured between 14 and 21 mm. A modified trans-common bile duct tunnel from the abdominal wall into the common bile duct was used in a laparoscopic procedure to examine the common bile duct. Complications during the procedure or following it were not present. The procedure took 120 min, and the blood loss was about 50 ml. The patient was discharged on the sixth postoperative day, and a follow-up visit one month later revealed that single-session stone clearance had been accomplished. DISCUSSION: Laparoscopic exploration of the common bile duct using a cholangioscope and modified trans-choledochal tube is applicable in selected patients and can be effectively and safely used to treat hepatolithiasis combined with the dilated common bile duct. CONCLUSION: In this case, we present an innovative approach for hepatolithiasis when combined with dilated common bile duct.

After action review of the COVID-19 surveillance system in Quang Ninh Province, Vietnam, in 2020.

Surveillance is the backbone of any response to an infectious disease outbreak, and comprehensive evaluation of surveillance systems is crucial. However, structured evaluations of surveillance systems during the COVID-19 pandemic are scarce. We conducted an after action review (AAR) of the performance of the COVID-19 surveillance system in Quang Ninh Province, Vietnam, during 2020 using the COVID-19-specific AAR methodology developed by the World Health Organization in combination with guidance from the US Centers for Disease Control and Prevention (CDC). We conducted a stakeholder survey, document reviews, and key informant interviews with staff from Quang Ninh CDC's COVID-19 surveillance system. The COVID-19 surveillance system was based on the pre-existing surveillance system in the province. The system's strengths were early preparation for emergency response, strong governance and central coordination, and multidisciplinary collaboration. Stakeholders agreed that the system proved useful and adaptive to the fast-evolving COVID-19 situation but was weakened by overly complex systems, redundant administrative processes, unclear communication channels, and lack of resources. Overall, the surveillance systems in Quang Ninh province proved effective in containing COVID-19 and adaptive in a fast-changing epidemiological context. Several recommendations were made based on identified areas of concern that are of relevance for COVID-19 surveillance systems in Vietnam and similar settings.

Ancient Schwannoma of the Radial Nerve: A Case Report.

Ancient schwannoma is a very rare subtype of schwannoma. In this report, a case of ancient schwannoma in the upper extremity is reported. A 40-year-old man presented with a slowly growing tumor in the right forearm. He underwent surgery to remove the tumor. Investigation revealed an ancient schwannoma originated from the right radius. Careful preoperative imaging evaluation is important for correct preoperative diagnosis and surgical strategy.

After action review of the COVID-19 surveillance system in Quang Ninh Province, Vietnam, in 2020.

Surveillance is the backbone of any response to an infectious disease outbreak, and comprehensive evaluation of surveillance systems is crucial. However, structured evaluations of surveillance systems during the COVID-19 pandemic are scarce. We conducted a after action review (AAR) of the performance of the COVID-19 surveillance system in Quang Ninh Province, Vietnam, during 2020 using the COVID-19-specific AAR methodology developed by the World Health Organization in combination with guidance from the US Centers for Disease Control and Prevention (CDC). We conducted a stakeholder survey, document reviews, and key informant interviews with staff from Quang Ninh CDC's COVID-19 surveillance system. The COVID-19 surveillance system was based on the pre-existing surveillance system in the province. The system's strengths were early preparation for emergency response, strong governance and central coordination, and multidisciplinary collaboration. Stakeholders agreed that the system proved useful and adaptive to the fast-evolving COVID-19 situation but was weakened by overly complex systems, redundant administrative processes, unclear communication channels, and lack of resources. Overall, the surveillance systems in Quang Ninh province proved effective in containing COVID-19 and adaptive in a fast-changing epidemiological context. Several recommendations were made based on identified areas of concern that are of relevance for COVID-19 surveillance systems in Vietnam and similar settings.

Preliminary results of laparoscopic cholecystectomy using real-time indocyanine green fluorescence: a cross-sectional study.

Evaluating the results of laparoscopic cholecystectomy (LC) using indocyanine green (ICG) fluorescence. Materials and methods: This is a cross-sectional study of patients with LC using real-time fluorescent ICG to treat gallbladder disease from May 2021 to May 2022 in the 108 Military Central Hospital. Results: There were 68 patients who underwent LC using intraoperative ICG fluorescence for bile duct visualization. The mean age of the patients was 55.4±16.2, and the male/female ratio was 1.52. Chronic cholecystitis caused by stones accounted for the majority (51.47%). The authors detected 7.35% of cases with anatomical changes of the extrahepatic biliary tract using ICG fluorescence and clearly identified the anatomy of the common bile duct and the cystic duct at 100 and 92.65%, respectively. The average surgical time was 42.8±14.6 min. There were no postoperative complications or side effects from ICG; the average hospital stay was 2.8±1.5 days. Conclusions: ICG fluorescence cholangiography allows surgeons to easily identify critical anatomical landmarks in the LC. Thereby helping the surgery to be performed safely, avoiding severe complications due to damage to the biliary tract.

Understanding the COVID-19 Infodemic: Analyzing User-Generated Online Information During a COVID-19 Outbreak in Vietnam.

OBJECTIVES: Online misinformation has reached unprecedented levels during the coronavirus disease 2019 (COVID-19) pandemic. This study analyzed the magnitude and sentiment dynamics of misinformation and unverified information about public health interventions during a COVID-19 outbreak in Da Nang, Vietnam, between July and September 2020. METHODS: We analyzed user-generated online information about five public health interventions during the Da Nang outbreak. We compared the volume, source, sentiment polarity, and engagements of online posts before, during, and after the outbreak using negative binomial and logistic regression, and assessed the content validity of the 500 most influential posts. RESULTS: Most of the 54,528 online posts included were generated during the outbreak (n = 46,035; 84.42%) and by online newspapers (n = 32,034; 58.75%). Among the 500 most influential posts, 316 (63.20%) contained genuine information, 10 (2.00%) contained misinformation, 152 (30.40%) were non-factual opinions, and 22 (4.40%) contained unverifiable information. All misinformation posts were made during the outbreak, mostly on social media, and were predominantly negative. Higher levels of engagement were observed for information that was unverifiable (incidence relative risk [IRR] = 2.83; 95% confidence interval [CI], 1.33-0.62), posted during the outbreak (before: IRR = 0.15; 95% CI, 0.07-0.35; after: IRR = 0.46; 95% CI, 0.34-0.63), and with negative sentiment (IRR = 1.84; 95% CI, 1.23-2.75). Negatively toned posts were more likely to be misinformation (odds ratio [OR] = 9.59; 95% CI, 1.20-76.70) or unverified (OR = 5.03; 95% CI, 1.66-15.24). CONCLUSIONS: Misinformation and unverified information during the outbreak showed clustering, with social media being particularly affected. This indepth assessment demonstrates the value of analyzing online "infodemics" to inform public health responses.

Investigating COVID-19 transmission in a tertiary hospital in Hanoi, Vietnam using social network analysis.

OBJECTIVES: In March 2020, a COVID-19 outbreak in a major referral hospital in Hanoi, Vietnam led to 7664 patients and staff being sent into lockdown for 2 weeks, and more than 52,200 persons across 49 provinces being quarantined. We assessed SARS-CoV-2 transmission patterns during this to-date largest hospital outbreak in Vietnam using social network analysis (SNA). METHODS: We constructed a directed relational network and calculated network metrics for 'degree', 'betweenness', 'closeness' and 'eigenvector' centrality to understand individual-level transmission patterns. We analysed network components and modularity to identify sub-network structures with disproportionately big effects. RESULTS: We detected 68 connections between 46 confirmed cases, of whom 27 (58.7%) were ancillary support staff, 7 (15.2%) caregivers, 6 (13%) patients and 2 (4.4%) nurses. Among the 10 most important cases selected by each SNA network metric, transmission dynamics clustered in 17 cases, of whom 12 (70.6%) cases were ancillary support staff. Ancillary support staff also constituted 71.1% of cases in the dominant sub-network and 68.8% of cases in the three largest sub-communities. CONCLUSIONS: We identified non-clinical ancillary support staff, who are responsible for room service and food distribution in hospital wards in Vietnam, as a group with disproportionally big impacts on transmission dynamics during this outbreak. Our findings call for a holistic approach to nosocomial outbreak prevention and response that includes both clinical and non-clinical hospital staff. Our work also shows the potential of SNA as a complementary outbreak investigation method to better understand infection patterns in hospitals and similar settings.

Assessing the mental effects of COVID-19-related work on depression among community health workers in Vietnam.

BACKGROUND: Community health workers (CHWs) involved in the COVID-19 response might be at increased risk of developing depression, though evidence is scarce. We investigated effects of COVID-19-related work on changes in depression levels among CHWs in Vietnam and identified sub-groups among CHWs who are at particular risk of developing severe depression. METHODS: We conducted a cross-sectional online survey among 979 CHWs who were involved in the COVID-19 response in Vietnam, in particular during the 2021 Tet holiday outbreak between January and March 2021. Respondents were asked to report depression symptoms at two-time points, before the start of the COVID-19 pandemic (average June to December 2019) and during the 2021 Tet holiday outbreak using the PHQ-9 mental health questionnaire. We estimated depression levels at both time points and developed univariate and multivariable logistic regression models to estimate odds ratios and 95% confidence intervals (95% CIs) to explore the association between deterioration to high depression levels and selected risk factors. RESULTS: Median depression levels among CHWs in Vietnam doubled from 3 (IQR = 2-7) before COVID-19 to 6 (IQR = 3-9) on the PHQ-9 scale during the Tet holiday outbreak. The proportion with normal/minimal levels decreased from 77.1% (95% CI = 74.4-79.7) to 50.9% (95% CI = 47.7-54) (p-value < 0.001), while the proportion of CHWs with moderate, moderately severe, and severe depression levels increased 4.3, 4.5, and five-fold, respectively. Less sleep and poor sleep quality, working in unfavorable work environments, and being involved in contact tracing and the organization of quarantine for suspected cases were associated with an increased risk of deterioration to high depression levels. CONCLUSIONS: We found a substantial increase in overall depression levels among CHWs in Vietnam due to their COVID-19 related work and a particularly worrisome rise in CHWs suffering from severe depression. CHWs are an indispensable yet often overlooked cadre of work in many low- and middle-income countries and shoulder a heavy psychological burden during the COVID-19 pandemic. Targeted psychological support for CHWs is needed to improve their mental health and to ensure the sustainability of community-based health interventions during COVID-19 and future epidemics.

Using 'infodemics' to understand public awareness and perception of SARS-CoV-2: A longitudinal analysis of online information about COVID-19 incidence and mortality during a major outbreak in Vietnam, July-September 2020.

BACKGROUND: Trends in the public perception and awareness of COVID-19 over time are poorly understood. We conducted a longitudinal study to analyze characteristics and trends of online information during a major COVID-19 outbreak in Da Nang province, Vietnam in July-August 2020 to understand public awareness and perceptions during an epidemic. METHODS: We collected online information on COVID-19 incidence and mortality from online platforms in Vietnam between 1 July and 15 September, 2020, and assessed their trends over time against the epidemic curve. We explored the associations between engagement, sentiment polarity, and other characteristics of online information with different outbreak phases using Poisson regression and multinomial logistic regression analysis. We assessed the frequency of keywords over time, and conducted a semantic analysis of keywords using word segmentation. RESULTS: We found a close association between collected online information and the evolution of the COVID-19 situation in Vietnam. Online information generated higher engagements during compared to before the outbreak. There was a close relationship between sentiment polarity and posts' topics: the emotional tendencies about COVID-19 mortality were significantly more negative, and more neutral or positive about COVID-19 incidence. Online newspaper reported significantly more information in negative or positive sentiment than online forums or social media. Most topics of public concern followed closely the progression of the COVID-19 situation during the outbreak: development of the global pandemic and vaccination; the unfolding outbreak in Vietnam; and the subsiding of the outbreak after two months. CONCLUSION: This study shows how online information can reflect a public health threat in real time, and provides important insights about public awareness and perception during different outbreak phases. Our findings can help public health decision makers in Vietnam and other low and middle income countries with high internet penetration rates to design more effective communication strategies during critical phases of an epidemic.

Taxonomical insights and ecology of sandfly (Diptera, Psychodidae) species in six provinces of Northern Vietnam.

We studied sandfly (Diptera: Psychodidae) populations in six provinces of Vietnam. This work explores the diversity of sandfly species according to the province, as well as environment, and updated information on public health since leishmaniasis cases were reported in two provinces. Sandflies were collected using 428 CDC light traps from May 30 to October 13, 2016 and identified based on the morphology of the cibarium, pharynx and/or male genitalia or female spermathecae. A total of 2585 sandflies belonging to five genera and 13 identified species were collected. The main species were: the Sergentomyia barraudi group (12.53%), Se. sylvatica (9.63%) and Phlebotomus stantoni (3.95%). In all, 294 Sergentomyia specimens classified as Se. sp2 and Se. sp3 and a heterogeneous group, herein called Se. und_sp., showed unknown morphological characteristics requiring further studies. We provide detailed comments about morphological description and taxonomical identification in order to help standardization of sandfly classification in Southeast Asia. We observed differentiation according to the provinces in terms of density and species richness, with Lang Son having the highest density and Ninh Binh having the highest species richness. The majority of specimens were collected in rock caves and outdoors, suggesting mainly cavernicolous and exophilic characters of sandfly species in Northern Vietnam. However, specimens were also collected in intra- and peri-domiciliary sites. It is worth noting that Ph. stantoni was the main species found in dog sheds and indoors, and in particular in a leishmaniasis patient's house.

TITLE: Aperçu taxonomique et écologie des espèces de phlébotomes (Diptera, Psychodidae) dans six provinces du nord du Vietnam. ABSTRACT: Nous avons étudié les populations de phlébotomes (Diptera : Psychodidae) dans six provinces du Vietnam. Ce travail explore la diversité des espèces de phlébotomes selon les provinces, les environnements et les informations mises à jour sur la santé publique depuis que des cas de leishmanioses ont été signalés dans deux provinces. Des phlébotomes ont été collectés à l'aide de 428 pièges lumineux CDC du 30 mai au 13 octobre 2016 et identifiés sur la base de la morphologie du cibarium, du pharynx et/ou des organes génitaux des mâles ou des spermathèques des femelles. Au total, 2585 phlébotomes, appartenant à cinq genres et 13 espèces identifiées, ont été collectés. Les principales espèces étaient : le groupe Sergentomyia barraudi (12,53 %), Se. sylvatica (9,63 %) et Phlebotomus stantoni (3,95 %). 294 spécimens de Sergentomyia classés comme Se. sp2 et Se. sp3 et un groupe hétérogène ici appelé Se. und_sp. ont montré des caractéristiques morphologiques inconnues nécessitant des études complémentaires. Nous fournissons des commentaires détaillés sur la description morphologique et l'identification taxonomique afin d'aider à la normalisation de la classification des phlébotomes en Asie du Sud-Est. Nous avons observé une différenciation selon les provinces en termes de densité et de richesse en espèces, avec Lang Son ayant la plus forte densité et Ninh Binh ayant la plus grande richesse en espèces. La majorité des spécimens ont été collectés dans des grottes rocheuses et à l'extérieur, suggérant principalement des caractères cavernicoles et exophiles des espèces de phlébotomes du nord du Vietnam. Cependant, des spécimens ont également été collectés dans des sites intra et péri-domiciliaires. Il convient de noter que Ph. stantoni était la principale espèce trouvée dans les abris pour chiens et à l'intérieur, notamment dans la maison d'un patient atteint de leishmaniose.

The first newborn patient with SARS-CoV-2 variant B.1.1.7 identified in Viet Nam: treatment and care practices.

SARS-CoV-2 variant B.1.1.7, first detected in September 2020 in the United Kingdom of Great Britain and Northern Ireland, has spread quickly to many countries around the world. While some publications have described the clinical features of adult patients with the B.1.1.7 variant, little information is available on newborn patients. We report the clinical characteristics, treatment and care practices for a 21-day-old newborn patient who was confirmed to be infected with SARS-CoV-2 variant B.1.1.7 in Viet Nam during contact tracing after her father was confirmed to be infected with SARS-CoV-2. The patient displayed no symptoms of COVID-19 on admission but 3 days later developed diarrhoea, vomiting, a runny nose and a productive cough. These symptoms lasted for 3 days before becoming milder for 1 day and then stopping until discharge. During treatment, the patient received Vietnamese traditional herbal peppermint extracts for cough and digestive probiotics for diarrhoeal symptoms. A saltwater solution (Sterimar 0.9%) was used to clean the patient's sinuses. The patient was cared for and fed breastmilk by her mother, who was provided with personal protective equipment, including sterilized infant equipment, medical masks and hand sanitizer, during hospitalization. The patient's mother tested negative for SARS-CoV-2 throughout hospitalization. In conclusion, we found no severely abnormal clinical symptoms in a newborn infected with SARS-CoV-2 variant B.1.1.7 during treatment. Our case suggests that newborn patients with the B.1.1.7 variant can receive exclusive breastmilk feeding if sufficient preventive measures are provided for both mother and child.

Human tissue cultures of lung cancer predict patient susceptibility to immune-checkpoint inhibition.

Despite novel immunotherapies being approved and established for the treatment of non-small cell lung cancer (NSCLC), ex vivo models predicting individual patients' responses to immunotherapies are missing. Especially immune modulating therapies with moderate response rates urge for biomarkers and/or assays to determine individual prediction of treatment response and investigate resistance mechanisms. Here, we describe a standardized ex vivo tissue culture model to investigate individual tumor responses. NSCLC tissue cultures preserve morphological characteristics of the baseline tumor specimen for up to 12 days ex vivo and also maintain T-cell function for up to 10 days ex vivo. A semi-automated analysis of proliferating and apoptotic tumor cells was used to evaluate tissue responses to the PD-1 inhibitor nivolumab (n = 12), from which two cases could be successfully correlated to the clinical outcome. T-cell responses upon nivolumab treatment were investigated by flow cytometry and multispectral imaging. Alterations in the frequency of the Treg population and reorganization of tumor tissues could be correlated to nivolumab responsiveness ex vivo. Thus, our findings not only demonstrate the functionality of T cells in NSCLC slice cultures up to 10 days ex vivo, but also suggests this model for stratifying patients for treatment selection and to investigate in depth the tumor-associated T-cell regulation.

PD-1 inhibition in patient derived tissue cultures of human gastric and gastroesophageal adenocarcinoma.

Emerging immunotherapies quest for better patient stratification in cancer treatment decisions. Moderate response rates of PD-1 inhibition in gastric and esophagogastric junction cancers urge for meaningful human model systems that allow for investigating immune responses ex vivo. Here, the standardized patient-derived tissue culture (PDTC) model was applied to investigate tumor response to the PD-1 inhibitor Nivolumab and the CD3/CD28 t-lymphocyte activator ImmunoCultTM. Resident t-lymphocytes, tumor proliferation and apoptosis, as well as bulk gene expression data were analyzed after 72 h of PD-1 inhibition either as monotherapy or combined with Oxaliplatin or ImmunoCultTM. Individual responses to PD-1 inhibition were found ex vivo and combination with chemotherapy or t-lymphocyte activation led to enhanced antitumoral effects in PDTCs. T-lymphocyte activation as well as the addition of pre-cultured peripheral blood mononuclear cells improved PDTC for studying t-lymphocyte and tumor cell communication. These data support the potential of PDTC to investigate immunotherapy ex vivo in gastric and esophagogastric junction cancer.

Association of public health interventions and COVID-19 incidence in Vietnam, January to December 2020.

BACKGROUND: Vietnam implemented various public health interventions such as contact tracing and testing, mandatory quarantine, and lockdowns in response to coronavirus disease 2019 (COVID-19). However, the effects of these measures on the epidemic remain unclear. METHODS: This article describes the public health interventions in relation to COVID-19 incidence. Maximum likelihood estimations were used to assess containment delays (time between symptom onset and start of isolation) and multivariable regression was employed to identify associated factors between interventions and COVID-19 incidence. The effective reproductive numbers (Rt) were calculated based on transmission pairs. RESULTS: Interventions were introduced periodically in response to the epidemic. Overall, 817 (55.4%) among 1474 COVID-19 cases were imported. Based on a serial interval of 8.72 ± 5.65 days, it was estimated that Rt decreased to below 1 (lowest at 0.02, 95% CI 0-0.12) during periods of strict border control and contact tracing, and increased ahead of new clusters. The main method to detect cases shifted over time from passive notification to active case-finding at immigration or in lockdown areas, with containment delays showing significant differences between modes of case detection. CONCLUSIONS: A combination of early, strict, and consistently implemented interventions is crucial to control COVID-19. Low-middle income countries with limited capacity can contain COVID-19 successfully using non-pharmaceutical interventions.

Successful containment of a flight-imported COVID-19 outbreak through extensive contact tracing, systematic testing and mandatory quarantine: Lessons from Vietnam.

BACKGROUND: The importation of SARS-CoV-2 through air travel poses substantial risks to generate new COVID-19 outbreaks. Timely contact tracing is particularly crucial to limit onwards transmission in settings without established community transmission. METHODS: We conducted an in-depth analysis of the response to a big flight-associated COVID-19 outbreak in Vietnam in March 2020 that involved contact tracing, systematic testing and strict quarantine up to third generation contacts. RESULTS: 183 primary contacts from the flight as well as 1000 secondary and 311 third generation contacts were traced, tested, and quarantined across 15 provinces across Vietnam. The protracted confirmation of the index case at 3 days and 19 h after arrival resulted in isolation/quarantine delays of 6.8 days (IQR 6.3-6.8) and 5.8 days (IQR 5.8-7.0) for primary and secondary cases, respectively, which generated 84.0 and 26.4 person-days of community exposure from primary and secondary cases, respectively. Nevertheless, only 5 secondary cases occurred. CONCLUSIONS: A large flight-related COVID-19 cluster was successfully contained through timely, systematic and comprehensive public health responses despite delayed index case identification. Multiagency collaboration and pre-established mechanisms are crucial for low and middle income countries like Vietnam to limit community transmission after COVID-19 importation through air travel.

Timeliness of contact tracing among flight passengers during the COVID-19 epidemic in Vietnam.

BACKGROUND: International air travel plays an important role in the global spread of SARS-CoV-2, and tracing of close contacts is an integral part of the public health response to COVID-19. We aimed to assess the timeliness of contact tracing among airline passengers arriving in Vietnam on flights containing COVID-19 cases and investigated factors associated with timeliness of contact tracing. METHODS: We included data from 2228 passengers on 22 incoming flights between 2 and 19 March 2020. Contact tracing duration was assessed separately for the time between the date of index case confirmation and date of contact tracing initiation (interval I), and the date of contact tracing initiation and completion (interval II). We used log-rank tests and multivariable Poisson regression models to identify factors associated with timeliness. RESULTS: The median duration of interval I and interval II was one (IQR: 1-2) and 3 days (IQR: 2-5), respectively. The contact tracing duration was shorter for passengers from flights where the index case was identified through mandatory testing directly upon arrival (median = 4; IQR: 3-5) compared to flights with index case detection through self-presentation at health facilities after arrival (median = 7; IQR: 5-8) (p-value = 0.018). Cumulative hazards for successful tracing were higher for Vietnamese nationals compared to non-Vietnamese nationals (p < 0.001). CONCLUSIONS: Contact tracing among flight passengers in the early stage of the COVID-19 epidemic in Vietnam was timely though delays occurred on high workload days. Mandatory SARS-CoV-2 testing at arrival may reduce contact tracing duration and should be considered as an integrated screening tool for flight passengers from high-risk areas when entering low-transmission settings with limited contact tracing capacity. We recommend a standardized risk-based contact tracing approach for flight passengers during the ongoing COVID-19 epidemic.

FOXM1 Inhibition in Ovarian Cancer Tissue Cultures Affects Individual Treatment Susceptibility Ex Vivo.

Diagnosis in an advanced state is a major hallmark of ovarian cancer and recurrence after first line treatment is common. With upcoming novel therapies, tumor markers that support patient stratification are urgently needed to prevent ineffective therapy. Therefore, the transcription factor FOXM1 is a promising target in ovarian cancer as it is frequently overexpressed and associated with poor prognosis. In this study, fresh tissue specimens of 10 ovarian cancers were collected to investigate tissue cultures in their ability to predict individual treatment susceptibility and to identify the benefit of FOXM1 inhibition. FOXM1 inhibition was induced by thiostrepton (3 µM). Carboplatin (0.2, 2 and 20 µM) and olaparib (10 µM) were applied and tumor susceptibility was analyzed by tumor cell proliferation and apoptosis in immunofluorescence microscopy. Resistance mechanisms were investigated by determining the gene expression of FOXM1 and its targets BRCA1/2 and RAD51. Ovarian cancer tissue was successfully maintained for up to 14 days ex vivo, preserving morphological characteristics of the native specimen. Thiostrepton downregulated FOXM1 expression in tissue culture. Individual responses were observed after combined treatment with carboplatin or olaparib. Thus, we successfully implemented a complex tissue culture model to ovarian cancer and showed potential benefit of combined FOXM1 inhibition.