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Safety and feasibility of one-stage neonatal approach for short-segment Hirschsprung’s disease

by Quynh Anh Tran, Hien Duy Pham, Dung Boi Ly, Minh Quang Ngo, Nhung Thi Nguyen, Liem Thanh Nguyen, Quang Thanh Nguyen

Background

Early definitive surgery for Hirschsprung disease (HD) in neonates is increasingly adopted to reduce preoperative morbidity and preserve long term bowel function. However, comparative data across minimally invasive approaches in neonates with short segment disease remain limited. This study compared outcomes of single incision laparoscopic assisted endorectal pull through (SILEP), conventional laparoscopic assisted endorectal pull through (CLEP), and complete transanal endorectal pull through (TERPT) for rectosigmoid HD.

Methods

We conducted a retrospective cohort study of 55 neonates who underwent one stage definitive surgery before 28 days of age at a high volume center between January 2019 and December 2021. The primary outcome was long term bowel function assessed using the Rintala Bowel Function Score (BFS) after a minimum of 4 years of follow up. Secondary outcomes included operative parameters, postoperative complications (Clavien Dindo classification), and cosmetic outcomes using the Manchester Scar Scale (MSS) in the laparoscopic groups.

Results

All patients successfully underwent surgery at a mean age of 22.4 ± 4.3 days. Operative time differed across approaches and was shorter for SILEP (53.8 ± 11.9 minutes) and TERPT (52.1 ± 18.3 minutes) than for CLEP (70.2 ± 22.5 minutes, p = 0.036). At follow up (mean 54.0 ± 7.7 months), the overall BFS was 17.5 ± 2.5 with no significant differences among groups (p = 0.32). MSS was numerically lower for SILEP than for CLEP (6.2 ± 1.1 vs 6.8 ± 1.9, p = 0.53). Complications were infrequent, with 14 minor and 7 major events, and there was no mortality or Clavien Dindo grade IV or V morbidity.

Conclusion

SILEP, CLEP, and TERPT are feasible one stage options for neonates with rectosigmoid HD, with comparable long term bowel function and low rates of major complications. SILEP and TERPT were associated with shorter operative times, and SILEP showed a trend toward improved cosmetic scores compared with CLEP. These findings support an individualized approach to technique selection based on intraoperative requirements and institutional expertise.

Bioactivity of <i>Cyperus amuricus</i> extracts against hepatocellular carcinoma and molecular docking analysis targeting the PI3K/AKT/mTOR pathway

by Thanh Luan Nguyen, Thanh Khoi Tu, Thien-Vy Phan, Chanh M. Nguyen, Khoa D. Nguyen, Minh Quan Pham, Hai Ha Pham Thi

Cyperus amuricus (Cyperaceae) has exhibited potential anticancer activity against hepatocellular carcinoma (HCC), yet its molecular mechanisms and phytoconstituent interactions with oncogenic pathways remain underexplored. This study integrates in vitro cytotoxicity assays and molecular docking to evaluate the effects of C. amuricus fractionated extracts on HCC, focusing on PI3K/AKT/mTOR signaling axis. The ethyl acetate (EA) fraction selectively inhibited HepG2 cell proliferation (IC50 = 159.76 µg/mL) with minimal toxicity to normal fibroblasts. Apoptotic features—cell shrinkage, membrane blebbing, nuclear condensation, and DNA fragmentation—were confirmed through DAPI staining and gel electrophoresis. Western blot analysis revealed dose-dependent suppression of phosphorylated Akt and p70S6K, indicating pathway inhibition. Molecular docking identified strong binding affinities between Cyperaceae-derived compounds and PI3K/AKT/mTOR targets, with luteolin 7-O-β-D-glucuronopyranoside-6″-methyl ester blocked PI3K activation, vitexin bound AKT’s allosteric site, and digitoxin targeted mTOR’s ATP-binding pocket, showing comparable binding energies to reference ligands. These findings suggest C. amuricus as a promising candidate for natural product-based HCC therapy.

FKG-MM: A multi-modal fuzzy knowledge graph with data integration in healthcare

by Nguyen Hong Tan, Tran Manh Tuan, Pham Minh Chuan, Nguyen Duc Hoang, Le Quang Thanh, Le Hoang Son

Artificial Intelligence (AI) has been dramatically applied to healthcare in various tasks to support clinicians in disease diagnosis and prognosis. It has been known that accurate diagnosis must be drawn from multiple evidence, namely clinical records, X-Ray images, IoT data, etc called the multi-modal data. Despite the existence of various approaches for multi-modal medical data fusion, the development of comprehensive systems capable of integrating data from multiple sources and modalities remains a considerable challenge. Besides, many machine learning models face difficulties in representation and computation due to the uncertainty and diversity of medical data. This study proposes a novel multi-modal fuzzy knowledge graph framework, called FKG-MM, which integrates multi-modal medical data from multiple sources, offering enhanced computational performance compared to unimodal data. In addition, the FKG-MM framework is based on the fuzzy knowledge graph model, one of the models that represent and compute effectively with medical data in tabular form. Through some experiment scenarios utilizing the well-known BRSET dataset on multi-modal diabetic retinopathy, it has been experimentally validated that the feature selection method, when combining image features with tabular medical data features, gives the highest reliability results among 5 methods including Feature Selection Method, Tensor Product, Hadamard Product, Filter Selection, and Wrapper Selection. In addition, the experiment also confirms that the accuracy of FKG-MM increases by 12–14% when combining image data with tabular medical data than the related methods diagnosing only on tabular data.

Pilot randomised controlled trial of the self-help plus stress management intervention among patients with breast and gynaecological cancer in Viet Nam: a study protocol

Por: Le · P. D. · Nguyen · N. B. · Dang · A. T. T. · Tran · L. T. K. · Pham · H. N. · Le · T. A. · Vo · K. V. · Nguyen · H. T. · Hoang · D.-T. T. · Phan · D. C. · Nguyen · C. B. T. · Nguyen · M. H. T. · Nguyen · Q. H. · Phan · H. N. T. · Dang · T. Q. · Nguyen · H. T. · Le · D. D. · Phan · T. H
Introduction

Implementation of low-intensity, evidence-based psychological interventions can help meet the mental health and psychosocial needs of people with cancer, especially in low-resource settings where there is a dearth of mental health specialists. In this study, we will conduct a feasibility randomised controlled trial (RCT) of the stress management intervention Self-Help Plus, which has been translated and adapted to Vietnamese, vSH+, among people newly diagnosed with breast or gynaecological cancer in Viet Nam.

Methods and analysis

At six participating hospitals, individuals diagnosed with breast or gynaecologic cancer within the past year will be recruited, consented and randomised into either enhanced usual care (EUC) or EUC plus the vSH+ intervention, which consists of four sessions each lasting approximately 75 min. Quantitative surveys will be administered at three time points: enrolment/baseline (T0), after 6 weeks (T1) and after 4 months (T2). A qualitative evaluation component, which will include in-depth interviews with patients, implementers and healthcare staff and managers, as well as focus group discussions with caregivers, will assess the acceptability and feasibility of the vSH+ intervention.

Ethics and dissemination

Ethical reviews for the study were obtained from Boston University, Hanoi University of Public Health (HUPH) and all the participating hospital sites. On completion of data collection and analyses, the research team will prepare and submit abstracts to scientific conferences as well as manuscripts to peer-reviewed journals. We will also conduct dissemination events to report the trial results to relevant stakeholders.

Trial registration number

NCT06398067.

Prognostic value of the PaO2/FiO2 ratio for mortality in acute respiratory distress syndrome: a retrospective observational study in a lower-middle-income country

Por: Luong · C. Q. · Dao · C. X. · Nguyen · M. H. · Pham · D. T. · Pham · Q. T. · Vu · T. T. · Truong · H. T. · Nguyen · H. H. · Nguyen · T. T. P. · Luong · H. T. T. · Nguyen · C. B. · Khuong · D. Q. · Dang · H. D. · Tran · C. H. · Nguyen · T. T. · Nguyen · T. A. · Pham · T. T. · Bui · G. T. H
Objectives

To evaluate the accuracy of the arterial oxygen partial pressure/inspired oxygen fraction (PaO2/FiO2) ratio in predicting mortality among acute respiratory distress syndrome (ARDS) patients in Vietnam.

Design

A retrospective observational study.

Setting

A central hospital in Vietnam.

Participants

Adult patients diagnosed with ARDS based on the Berlin definition and admitted to Bach Mai Hospital between August 2015 and August 2023. ARDS severity was converted from descriptive categories to the Berlin score, ranging from 1 (PaO2/FiO2>300 mm Hg) to 4 (PaO2/FiO2≤100 mm Hg).

Primary outcome

All-cause hospital mortality.

Results

Of 345 patients, 67.5% were male, and the median age was 55.0 years (IQR: 39.0–66.0). Hospital mortality was 61.2% (211/345). On the first day of admission, the PaO2/FiO2 ratio (areas under the receiver operating characteristic curves (AUROC): 0.585 (95% CI 0.522 to 0.649)) showed limited predictive ability for hospital mortality. Incorporating the PaO2/FiO2 ratio into the Berlin score did not substantially improve accuracy (AUROC: 0.578 (95% CI 0.516 to 0.641)). Both measures were less accurate than Sequential Organ Failure Assessment (SOFA) (AUROC: 0.650 (95% CI 0.590 to 0.711)), Acute Physiology and Chronic Health Evaluation II (APACHE II) (AUROC: 0.685 (95% CI 0.628 to 0.742)) and Confusion, Urea >7 mmol/L (20 mg/dL), Respiratory rate ≥30 breaths/min, Blood pressure (systolic 2/FiO2 values (adjusted OR, AOR: 0.988 (95% CI 0.979 to 0.996)) were independently associated with lower mortality risk, while higher Berlin (AOR: 2.477 (95% CI 1.190 to 5.156)), SOFA (AOR: 1.278 (95% CI 1.102 to 1.482)), APACHE II (AOR: 1.236 (95% CI 1.108 to 1.379)) and CURB-65 (AOR: 7.142 (95% CI 2.581 to 19.763)) scores were associated with increased mortality risk.

Conclusions

In this study of ARDS patients in Vietnam, the PaO2/FiO2 ratio demonstrated limited discriminatory ability for hospital mortality, and incorporating it into the Berlin score did not meaningfully improve performance. While less accurate than SOFA, APACHE II and CURB-65 scores, the PaO2/FiO2 ratio and Berlin score remained independently associated with mortality risk. These findings should be interpreted cautiously, given the retrospective design, single-centre setting and potential selection bias; further validation in larger, multicentre studies is warranted.

Effects of manufacturing modality, primer, and adhesive polymerization on the shear bond strength of customized lingual brackets to glazed zirconia: An <i>in vitro</i> study

by Viet Anh Nguyen, Ngo The Minh Pham, Minh Ngoc Tran, Thi Bich Ngoc Ha, Thi Quynh Trang Vuong

Introduction

Bonding fixed appliances to zirconia restorations is challenging, yet adult orthodontics increasingly involves ceramic crowns and patient-driven esthetic choices such as lingual appliances. Customized lingual brackets may improve fit and reduce adhesive thickness, but evidence on their bonding to zirconia is limited.

Materials and methods

This in vitro study evaluated the shear bond strength of customized lingual brackets bonded to glazed zirconia after airborne-particle abrasion. Bracket manufacturing was either three-dimensionally (3D) printed cobalt-chromium or cast nickel-chromium. Primers were a universal adhesive (Single Bond Universal, 3M) or a primer containing 10-methacryloyloxydecyl dihydrogen phosphate Z-Prime Plus (Bisco), and adhesives were a light-cure orthodontic composite or a dual-cure resin cement. One hundred twenty-eight specimens (n = 16 per group) were tested. Shear bond strength was analyzed with three-way ANOVA, followed by post-hoc Tukey tests. Adhesive Remnant Index (ARI) scores were evaluated with ordinal regression. Significance was set at α = 0.05.

Results

Manufacturing modality significantly affected bond strength, with additively manufactured cobalt-chromium exceeding cast nickel-chromium (P = 0.049). The primer category and polymerization mode showed no significant main effects (P > 0.20) and no significant interactions. Group means clustered 9–10 MPa, and all combinations met the clinically accepted threshold. Additively manufactured brackets exhibited lower ARI scores than cast brackets (P  Conclusions

On glazed, sandblasted zirconia, shear bond strength of customized lingual brackets showed a borderline main effect of fabrication method, whereas primer type and adhesive polymerization mode were not statistically significant. Failures were predominantly located at or near the zirconia–adhesive interface. Within this in vitro model, base manufacturing may warrant attention, whereas primer and curing mode may be selected for handling and workflow considerations, with clinical relevance yet to be established.

Assessing the impact of the COVID-19 pandemic among internally displaced persons in Burkina Faso, Mali and Niger: a cross-sectional study using respondent-driven sampling

Por: Pham · P. N. · Keegan · K. · Johnston · L. G. · Diallo · D. Y. · OMealia · T. · Goh · M. · Vinck · P.
Objectives

Documenting evidence on global health strategies and programmes that provide safeguards for vulnerable populations and strengthen overall pandemic preparedness is essential. This study aimed to identify factors associated with adherence to COVID-19 mitigation measures, COVID-19-related symptoms and testing, as well as pandemic-related income loss among internally displaced persons (IDPs) in urban and remote areas of Burkina Faso, Niger and Mali.

Design

This cross-sectional study used fixed-site respondent-driven sampling (RDS).

Setting

Primary care settings across six urban and remote locations in Burkina Faso, Mali and Niger.

Participants

4144 internally displaced adults, who had been forced from their homes within 5 years of the survey, participated in the study. The survey was conducted between August and October 2021 in two selected locations in three countries: Kaya (n=700) and Ouahigouya (n=715) in Burkina Faso; Bamako (n=707) and Ménaka (n=700) in Mali; and Niamey (n=733), and Diffa (n=589) in Niger. Participants were included if they were born in the study countries, displaced due to conflict, violence or disaster, aged 18 years or older, and living or working in the study site for at least 1 month.

Primary and secondary outcome measures

The primary outcomes measured were adherence to COVID-19 mitigation measures, presence of COVID-19 symptoms, COVID-19 testing and vaccination rates and pandemic-related income loss.

Results

Among 4144 IDPs surveyed across 6 sites in Burkina Faso, Mali and Niger, over half (52%) reported experiencing at least one COVID-19 symptom in the preceding 2 weeks. However, 8% had ever been tested for COVID-19, and fewer than 5% had received a vaccine in all sites except Diffa, where 54% reported vaccination. While willingness to be vaccinated was high (ranging from 56.6% in Bamako to 89.5% in Niamey), access remained limited. Compliance with public health measures varied; for example, 41.7% of IDPs were able to maintain physical distance from non-household members, and just 60.2% reported wearing a mask. Chronic health conditions were consistently associated with higher odds of COVID-19 symptoms (Ménaka OR: 14.65; 95% CI: 7.36 to 29.17). Economic vulnerability was widespread, with more than half of IDPs in Bamako (58.1%) and Niamey (66.4%) reporting income loss due to the pandemic, and average monthly income declining by over 50% in most sites. IDPs in urban areas generally reported greater exposure to COVID-19 risk factors, while those in remote settings reported lower adherence and poorer access to basic preventive measures.

Conclusions

This is the first known RDS study to explore the impact of the COVID-19 pandemic on IDPs. Findings suggest that IDPs in urban areas may face heightened risks of exposure and infection, underscoring the need to prioritise them in public health efforts. Low testing and vaccination rates and significant income loss call for advocacy and economic relief to address these vulnerabilities. Future pandemic responses should integrate health interventions with targeted support, especially mitigating income loss to bolster IDPs’ resilience.

Putting the patient at the centre: a call for research involvement of nurses, midwives and allied health professionals working in genomics

Por: Cowley · L. · Henriques · S. · Roberts · J. · Monje-Garcia · L. · Nolan · J. · Lubasch · K. · Theobald · R. · Greer · R. · Fennell · N. · Clarkson · A. · Clapham · M. · Chilton · S. · Allon · R. · Stopford · C. · Pierce · H. H. · Holliday · D.
Introduction

We report the collaborative views of a group of nurses, midwives and allied health professionals (NMAHPs) in the UK who have a genomics research remit or interest. Our group includes genetic counsellors under this diverse category of healthcare workers.

This group came together as part of the National Institute for Health and Social Care Research (NIHR) Genomics Research National Specialty Group. After responding to a survey to elicit the views of NMAHPs working in genomics, some of the original 45 respondents, along with others who learnt of the project by word of mouth, have worked together to produce this article.

Objective

The paper aims to set out in clear terms the value of NMAHPs to research that supports the patient-centred implementation of genomics in the National Health Service (NHS).

Key argument

We discuss four potential areas where NMAHPs, in particular, can contribute to the research. These are patient perspectives and epistemic justice, psychosocial impacts, the familial nature of genomics and equity. We argue that this group (NMAHPs) represents a potentially underused resource for the NHS as it seeks to ensure that advances in genomics are translated into patient benefit.

Conclusions

We propose that NMAHPs, with our research expertise, are well placed to shape and deliver a research agenda that explores models of patient-centred care in the genomics era. We call for increased funding for NMAHP research roles and funding opportunities to deliver this fundamental work.

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