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Joonki Hong,1,2 Hai Hong Tran,1 Jinhwan Jung,1 Hyeryung Jang,3 Dongheon Lee,1 In-Young Yoon,4,5 Jung Kyung Hong,4,5,* Jeong-Whun Kim5,6,* 1Asleep Inc., Seoul, Korea; 2Korea Advanced Institute of Science and Technology, Daejeon, Korea; 3Dongguk University, Seoul, Korea; 4Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea; 5Seoul National University College of Medicine, Seoul, Korea; 6Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea*These authors contributed equally to this workCorrespondence: Jeong-Whun Kim, Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Korea, Email kimemails7@gmail.com Jung Kyung Hong, Department of Psychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Korea, Email hongjk15@gmail.comPurpose: Nocturnal sounds contain numerous information and are easily obtainable by a non-contact manner. Sleep staging using nocturnal sounds recorded from common mobile devices may allow daily at-home sleep tracking. The objective of this study is to introduce an end-to-end (sound-to-sleep stages) deep learning model for sound-based sleep staging designed to work with audio from microphone chips, which are essential in mobile devices such as modern smartphones.Patients and Methods: Two different audio datasets were used: audio data routinely recorded by a solitary microphone chip during polysomnography (PSG dataset, N=1154) and audio data recorded by a smartphone (smartphone dataset, N=327). The audio was converted into Mel spectrogram to detect latent temporal frequency patterns of breathing and body movement from ambient noise. The proposed neural network model learns to first extract features from each 30-second epoch and then analyze inter-epoch relationships of extracted features to finally classify the epochs into sleep stages.Results: Our model achieved 70% epoch-by-epoch agreement for 4-class (wake, light, deep, REM) sleep stage classification and robust performance across various signal-to-noise conditions. The model performance was not considerably affected by sleep apnea or periodic limb movement. External validation with smartphone dataset also showed 68% epoch-by-epoch agreement.Conclusion: The proposed end-to-end deep learning model shows potential of low-quality sounds recorded from microphone chips to be utilized for sleep staging. Future study using nocturnal sounds recorded from mobile devices at home environment may further confirm the use of mobile device recording as an at-home sleep tracker.Keywords: respiratory sounds, sleep stages, deep learning, smartphone, polysomnography

Jung Kyung Hong,1,2,* Taeyoung Lee,3,* Roben Deocampo Delos Reyes,4 Joonki Hong,3,4 Hai Hong Tran,4 Dongheon Lee,4 Jinhwan Jung,4 In-Young Yoon1,2 1Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea; 2Seoul National University College of Medicine, Seoul, Korea; 3Korea Advanced Institute of Science and Technology, Daejeon, Korea; 4Asleep Inc., Seoul, Korea*These authors contributed equally to this workCorrespondence: In-Young YoonDepartment of Psychiatry, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, KoreaTel +82-31-787-7433Fax +82-31-787-4058Email iyoon@snu.ac.krJinhwan JungR&D Division, Asleep Inc, Asleep, 15, Teheran-ro 82-gil, Gangnam-gu, Seoul, KoreaTel +82-10-6228-7137Email insomnia@asleep.aiStudy Objectives: Automated sleep stage scoring is not yet vigorously used in practice because of the black-box nature and the risk of wrong predictions. The objective of this study was to introduce a confidence-based framework to detect the possibly wrong predictions that would inform clinicians about which epochs would require a manual review and investigate the potential to improve accuracy for automated sleep stage scoring.Methods: We used 702 polysomnography studies from a local clinical dataset (SNUBH dataset) and 2804 from an open dataset (SHHS dataset) for experiments. We adapted the state-of-the-art TinySleepNet architecture to train the classifier and modified the ConfidNet architecture to train an auxiliary confidence model. For the confidence model, we developed a novel method, Dropout Correct Rate (DCR), and the performance of it was compared with other existing methods.Results: Confidence estimates (0.754) reflected accuracy (0.758) well in general. The best performance for differentiating correct and wrong predictions was shown when using the DCR method (AUROC: 0.812) compared to the existing approaches which largely failed to detect wrong predictions. By reviewing only 20% of epochs that received the lowest confidence values, the overall accuracy of sleep stage scoring was improved from 76% to 87%. For patients with reduced accuracy (ie, individuals with obesity or severe sleep apnea), the possible improvement range after applying confidence estimation was even greater.Conclusion: To the best of our knowledge, this is the first study applying confidence estimation on automated sleep stage scoring. Reliable confidence estimates by the DCR method help screen out most of the wrong predictions, which would increase the reliability and interpretability of automated sleep stage scoring.Keywords: confidence estimation, deep learning, electroencephalography, polysomnography, sleep stages, accuracy improvement

Kien Gia To,1,2 Lynn Meuleners,1 Max Bulsara,3 Michelle L Fraser,1 Dat Van Duong,4 Dung Van Do,2 Van-Anh Ngoc Huynh,2 Tien Duy Phi,5 Hoang Huy Tran,5 Nguyen Do Nguyen51Curtin Monash Accident Research Centre (C-MARC), Faculty of Health Sciences, Curtin University, Perth, WA, Australia; 2University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; 3Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia; 4United Nations Population Fund, Hanoi, Vietnam; 5Eye Hospital, Ho Chi Minh City, VietnamAim: Little information exists on the impact of cataract surgery on falls and other injuries in Vietnam. The aim of this study was to determine the impact of first and both eye cataract surgery on the number of falls and other injuries among bilateral cataract patients in Ho Chi Minh City, Vietnam.Materials and methods: A longitudinal cohort study was conducted involving 413 bilateral cataract patients aged 50+ years. Participants were assessed at three time points: 1 week before, 1–3 months after, and 1 year after first-eye cataract surgery. Visual measures (visual acuity, contrast sensitivity and stereopsis) were taken, and self-reported falls and injury data were collected. A multilevel longitudinal Poisson regression model was used to investigate change in the number of falls after surgery.Results: The risk of falls decreased by 78% (incidence-rate ratio [IRR] 0.22, 95% confidence interval [CI] 0.06–0.77; P=0.018) in the year after cataract surgery for participants who had first-eye surgery only and 83% (IRR 0.17, 95% CI 0.04–0.69; P=0.012) for participants who had the second eye operated on compared to before surgery. The risk of falls was three times higher for females than males (IRR 3.13, 95% CI 1.53–6.40; P=0.002). Improved binocular contrast sensitivity was also associated with a decrease in falls (IRR 0.40, 95% CI 0.17–0.97; P=0.042). The prevalence of other injuries also decreased after cataract surgery.Conclusion: Cataract surgery reduced the number of falls and other injuries in Vietnam. Contrast sensitivity may be important for ophthalmologists to consider when prioritizing patients for surgery and assessing their fall risk.Keywords: falls, injuries, cataract surgery, longitudinal, older population, Vietnam

Bacterial infections in irregular and branched confinements pose significant therapeutic challenges. Despite their high antimicrobial efficacy, enzyme-mimicking nanoparticles (nanozymes) face difficulties in achieving localized catalysis at distant infection sites within confined spaces. Incorporating nanozymes into microrobots enables the delivery of catalytic agents to hard-to-reach areas, but poor nanoparticle dispersibility and distribution during fabrication hinder their catalytic performance. To address these challenges, a nanozyme-shelled microrobotic platform is introduced using magnetic microcapsules with collective and adaptive mobility for automated navigation and localized catalysis within complex confinements. Using double emulsions produced from microfluidics as templates, iron oxide and silica nanoparticles are assembled into 100-µm microcapsules, which self-organize into multi-unit, millimeter-size assemblies under rotating magnetic fields. These microcapsules exhibit high peroxidase-like activity, efficiently catalyzing hydrogen peroxide to generate reactive oxygen species (ROS). Notably, microcapsule assemblies display remarkable collective navigation within arched and branched confinements, reaching the targeted apical regions of the tooth canal with high accuracy. Furthermore, these nanozyme-shelled microrobots perform rapid catalysis in situ and effectively kill biofilms on contact via ROS generation, enabling localized antibiofilm action. This study demonstrates a facile method of integrating nanozymes onto a versatile microrobotic platform to address current needs for targeted therapeutic catalysis in complex and confined microenvironments., (© 2024 The Author(s). Advanced Healthcare Materials published by Wiley‐VCH GmbH.)

Tailoring the microstructure of magnetic microparticles is of vital importance for their applications. Spiky magnetic particles, such as those made from sunflower pollens, have shown promise in single cell treatment and biofilm removal. Synthetic methods that can replicate or extend the functionality of such spiky particles would be advantageous for their widespread utilization. In this work, a wet-chemical method is introduced for spiky magnetic particles that are templated from microrod-stabilized Pickering emulsions. The spiky morphology is generated by the upright attachment of silica microrods at the oil-water interface of oil droplets. Spiky magnetic microparticles with control over the length of the spikes are obtained by dispersing hydrophobic magnetic nanoparticles in the oil phase and photopolymerizing the monomer. The spiky morphology dramatically enhances colloidal stability of these particles in high ionic strength solutions and physiologic media such as human saliva and saline-based biofilm suspension. To demonstrate their utility, the spiky magnetic particles are applied for magnetically controlled removal of oral biofilms and retrieval of bacteria for diagnostic sampling. This method expands the toolbox for engineering microparticle morphology and could promote the fabrication of functional magnetic microrobots., (© 2024 The Author(s). Small published by Wiley‐VCH GmbH.)

Clostridium difficile infection (CDI) has been increasing due to the effect of recurrent hospitalizations. The use of antibiotics has been shown to alter the gut microbiome and lead to CDIs. The treatment is limited to three major antibiotics; however, the incidence of recurrent CDIs has been increasing and drug resistance is a major concern. This aspect is a growing concern in modern medicine especially in the elderly population, critical care patients, and immunocompromised individuals who are at high risk of developing CDIs. Clostridium difficile can lead to various complications including septic shock and fulminant colitis that could prove to be lethal in these patients. Newer modalities of treatment have been developed including bezlotoxumab, a monoclonal antibody and fecal microbiota transplant. There have been studies showing asymptomatic carriers and drug resistance posing a major threat to the healthcare system. Newer treatment options are being studied to treat and prevent CDIs. This review will provide an insight into the current treatment modalities, prevention and newer modalities of treatment and challenges faced in the treatment of CDIs., Competing Interests: Conflict-of-interest statement: No potential conflict of interest was reported by the authors., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Introduction: Bilothorax is a rare and poorly documented condition in the medical literature, with following hepatobiliary procedures being the most common cause. We present a case of bilothorax following endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis., Case Presentation: A 71-year-old woman with a history of prior percutaneous biliary stone removals presented with Charcot's triad and was diagnosed with cholangitis due to a distal common bile duct stone. She underwent ERCP with successful stone extraction and stent placement. Two days later, she developed a right-sided pleural effusion diagnosed as a post-ERCP bilothorax. She was treated with thoracentesis and antibiotics, and her condition significantly improved. After 15 days, she was discharged, and a one-month follow-up showed no complications or recurrence., Clinical Discussion: Bile is a potent chemo irritant that can cause adhesive pleurodesis. Besides, accompanying cholangitis can lead to pleural infection and empyema. In this patient, early diagnosis leading to timely pleural drainage decisions helped avoid potential consequences., Conclusion: Post-ERCP bilothorax is a rare complication but can lead to severe consequences. Nonoperative management by pleural drainage is a safe and effective strategy if diagnosis is made early, helping patients avoid more invasive interventions., Competing Interests: Declaration of competing interest We have no conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The increasing prevalence of pharmaceutical contaminants in aquatic ecosystems poses profound challenges for both environmental sustainability and public health. Addressing this pressing issue requires the development of innovative, cost-effective, and efficient remediation approaches. Here we report the synthesis of WO 3 /diatomite composites and their photocatalytic degradation in conjunction with potassium peroxymonosulfate (PMS) activation. By leveraging the synergistic effects, we observe a remarkable degradation of tetracycline, a significant pharmaceutical contaminant, under visible light. Analytically, we have elucidated the driving factors for the enhanced performance, emphasizing the optimal amount of WO 3 (10%) in the composite and PMS concentration (3 mM). Specifically, the WO 3 /diatomite catalyst presents a degradation rate of 80.75% tetracycline (40 mg L -1 ) after 180 min of visible light irradiation. Also, we elucidate the primary roles of ˙SO 4 - radicals in driving the photocatalytic reaction using free radical trapping studies. Our approach not only offers a direct solution to controlling pharmaceutical contamination but also opens new possibilities for advancing the design of composite-based photocatalysts by taking advantage of nature-derived materials., Competing Interests: There is no interest to declare., (This journal is © The Royal Society of Chemistry.)

Aortic aneurysm (AA) refers to the persistent dilatation of the aorta, exceeding three centimeters. Investigating the pathophysiology of this condition is important for its prevention and management, given its responsibility for more than 25000 deaths in the United States. AAs are classified based on their location or morphology. various pathophysiologic pathways including inflammation, the immune system and atherosclerosis have been implicated in its development. Inflammatory markers such as transforming growth factor β, interleukin-1β, tumor necrosis factor-α, matrix metalloproteinase-2 and many more may contribute to this phenomenon. Several genetic disorders such as Marfan syndrome, Ehler-Danlos syndrome and Loeys-Dietz syndrome have also been associated with this disease. Recent years has seen the investigation of novel management of AA, exploring the implication of different immune suppressors, the role of radiation in shrinkage and prevention, as well as minimally invasive and newly hypothesized surgical methods. In this narrative review, we aim to present the new contributing factors involved in pathophysiology of AA. We also highlighted the novel management methods that have demonstrated promising benefits in clinical outcomes of the AA., Competing Interests: Conflict-of-interest statement: No potential conflict of interest was reported by the authors., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

The prevalence of atrial fibrillation among older adults is increasing. Research has indicated that atrial fibrillation is linked to cognitive impairment disorders such as Alzheimer and vascular dementia, as well as Parkinson disease. Various mechanisms are believed to be shared between atrial fibrillation and cognitive impairment disorders. The specific pathologies and mechanisms of different cognitive disorders are still being studied. Potential mechanisms include cerebral hypoperfusion, ischemic or hemorrhagic infarction, and cerebrovascular reactivity to carbon dioxide. Additionally, circulatory biomarkers and certain infectious organisms appear to be involved. This review offers an examination of the overlapping epidemiology between atrial fibrillation and cognitive disorders, explores different cognitive disorders and their connections with this arrhythmia, and discusses trials and guidelines for preventing and treating atrial fibrillation in patients with cognitive disorders. It synthesizes existing knowledge on the management of atrial fibrillation and identifies areas that require further investigation to bridge the gap in understanding the complex relationship between dementia and atrial fibrillation., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Appendiceal neuroendocrine tumors (NETs) rank as the third most frequent neoplasm affecting the appendix, originating from enterochromaffin cells. This study aims to evaluate the influence of various prognostic factors on the mortality rates of patients diagnosed with NETs of the appendix., Methods: Conducted retrospectively, the study involved 3346 patients, utilizing data sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Our analysis centered on investigating demographic characteristics, clinical features, overall mortality (OM), and cancer-specific mortality (CSM) among the cohort. Variables showing a p -value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox regression analysis. A Hazard Ratio (HR) > 1 indicated an unfavorable prognosis., Results: In the multivariate analysis, higher OM and CSM were observed in males, older age groups, tumors with distant metastasis, poorly differentiated tumors, and those who underwent chemotherapy. Non-Hispanic Black individuals showed elevated mortality rates., Conclusion: Delayed diagnosis may contribute to the increased mortality in this community. Improved access to healthcare and treatment is crucial for addressing these disparities. Larger prospective studies are needed to pinpoint the underlying causes of elevated mortality in non-Hispanic Black populations, and randomized controlled trials (RCTs) are warranted to evaluate therapies for advanced-stage appendix NETs.

The eradication of drug-resistant microbial biofilms remains an unresolved global health challenge. Small-scale robotics are providing innovative therapeutic and diagnostic approaches with high precision and efficacy. These approaches are rapidly moving from proof-of-concept studies to translational biomedical applications using ex vivo, animal, and clinical models. Here, we discuss the fundamental and translational aspects of how microrobots target the infection sites to disrupt the structural and functional traits of biofilms and their antimicrobial resistance mechanisms. We emphasize current approaches of mechanochemical disruption and on-site drug delivery that are supported by in vivo models and preclinical testing, while also highlighting diagnostics potential. We also discuss clinical translation challenges and provide perspectives for development of microrobotics approaches to combat biofilm infections and biofouling in humans., Competing Interests: Declaration of interests HK and ES have an interest in patent application Small-scale Robots for Biofilm Eradication 17/291,326. HK, ES and AB have an interest in patent application Automated and Precise Device for Dental Plaque Detection, Monitoring and Removal 17/764,587. HK, ES, AB and MJK have an interest in patent application Wireless Retrieval of Biological Samples for Diagnostics 63/339,132., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Profound dengue shock syndrome (DSS) complicated by severe respiratory failure necessitating mechanical ventilation (MV) accounts for high case fatality rates among PICU-admitted patients. A major challenge to management is the assessment of intravascular volume, which can be hampered by severe plasma leakage and the use of MV., Design: Retrospective cohort, from 2013 to 2021., Patients: Sixty-seven children with profound DSS supported by MV, some of whom underwent bedside point-of-care ultrasound (POCUS) for assessment and monitoring of hemodynamics and fluid administration., Setting: PICU of the tertiary Children's Hospital No. 2 in Vietnam., Interventions: None., Measurements and Main Results: We analyzed data clinical and laboratory data during PICU stay. In particular, during use of MV (i.e., at times 0-, 6-, and 24-hr after commencement) and fluid resuscitation. The primary study outcome was 28-day in-hospital mortality, and the secondary outcomes were associations with changes in hemodynamics, blood lactate, and vasoactive-inotrope score (VIS). Patients had a median age of 7 years (interquartile range, 4-9). Use of POCUS during fluid management (39/67), as opposed to not using (28/67), was associated with lower mortality (6/39 [15%] vs. 18/28 [64%]; difference 49 % [95% CI, 28-70%], p < 0.001). Use of POCUS was associated with lower odds of death (adjusted odds ratio 0.17 [95% CI, 0.04-0.76], p = 0.02). The utilization of POCUS, versus not, was associated with greater use of resuscitation fluid, and reductions in VIS and pediatric logistic organ dysfunction (PELOD-2) score at 24 hours after MV and PICU discharge., Conclusions: In our experience of pediatric patients with profound DSS and undergoing MV (2013-2021), POCUS use was associated with lower odds of death, a higher volume of resuscitation fluid, and improvements in the blood lactate levels, VIS, and PELOD-2 score., Competing Interests: Drs. T.T. Nguyen, T.L. Vo, Nguyen , D.T. Tran, Đoan, Pham, Mai, Q.X.T. Nguyen, T.K. Nguyen, and T.T.K. Nguyen disclosed the study was funded by Kim Oanh Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

Photoplethysmography (PPG) is the wearable devices' most widely used technology for monitoring heart rate. The systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and guidelines. This systematic review seeks to establish the effects of wearable health devices on cardiac arrhythmias concerning their impact on the personalization of cardiac management, their refining effect on stroke prevention strategies, and their influence on research and preventive care of cardiac arrhythmias and their re-evaluation of the patient-physician relationship. The population, exposure, control, outcomes, and studies (PECOS) criteria were used in the systematic review. This review considered studies that covered the tests conducted on individuals who presented with cardiovascular diseases (CVD) and also healthy people. The intervention for studies included wearable health devices that could detect and diagnose cardiac arrhythmias.  The study considered articles that reported on the personalization of cardiac management, stroke prevention strategies, influence in research and preventive care of cardiac arrhythmias, and the re-evaluation of the patient-physician relationship. Two independent researchers were used in the extraction of the data. In case of dispute, the issue was resolved using a third party. The study's quality analysis was conducted using AXIS. The management of atrial fibrillation (AF) lies heavily in the prevention of stroke. The accuracy being reported in the prediction of arrhythmias and the monitoring of heart rates makes wearable devices an efficient means to personalize health care. Personalization of health and treatment in preventing and managing arrhythmias becomes possible due to the portability of smart wearable devices. However, limitations may be observed due to the high costs incurred in their purchase and use. Using smart wearable devices for the detection of cardiac arrhythmias was very significant., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Tran et al.)

Cardiovascular diseases (CVDs) represent a major global health concern, responsible for significant morbidity, mortality, and disability. To mitigate the impact of CVDs, individuals often seek preventive measures, and one such approach is the consumption of green tea. This study aims to provide a comprehensive and up-to-date assessment of the effects of green tea consumption on the prevalence of cardiovascular outcomes. Following PRISMA guidelines, we conducted a systematic review using PubMed and Google Scholar databases to identify relevant studies. Our analysis revealed that the risk factors associated with CVDs can vary across different diseases, with hypertension being a common risk factor for CVD mortality and CVD. Notably, the consumption of green tea exhibited a positive effect on reducing the prevalence of cardiometabolic risks and hypercholesterolemia. Furthermore, green tea consumption was observed to have a beneficial impact on lowering both diastolic and systolic blood pressure. In conclusion, the studies reviewed in this research suggest that the consumption of green tea has a significant and positive influence on cardiovascular health. These findings highlight the potential of green tea as a valuable component of a healthy lifestyle, offering a promising avenue for its use as a dietary supplement to reduce the risk of CVDs., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Tran et al.)

Implantable cardioverter defibrillators (ICD) have been recommended as an effective therapy in treating sudden cardiac deaths. This study evaluates the safety and efficacies of ICDs in detecting arrhythmias. Different ICDs, such as the transvenous cardioverter defibrillator (TV-ICD) and the subcutaneous implantable cardioverter defibrillator (S-ICD), are used. This systematic review identified Embase, PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Web of Science as the primary electronic databases for research. Supplementation of the available articles for the review was done using Google Scholar. The population, exposure, control, outcome, and studies (PECOS) criteria were used in this study. The quality of the included studies was assessed using the Critical Appraisal Skills Program (CASP) standard checklist. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used in this systematic review. Two researchers conducted the extraction of data. A pre-designed Excel worksheet (Microsoft, Redmond, Washington) was used in the recording of extracted data. Eight studies were identified for use in this systematic review. Safety of the ICDs was observed with the minimum number of reported inappropriate shocks. Studies conducted identified that women had a lower number of incidences when a long detection setting by sex was conducted. Strategic programming of ICDs was noted as effective in lowering the levels of mortality. Studies claimed that the reduction of inappropriate shocks were important in the reduction of myocardial damage, which resulted in the mortality rate among the patients decreasing. Having high cutoff rates and long intervals for detection in ICD programming was noted to help in reducing ICD therapy intervention among patients. Differences among the male and female populations were inconsequential in the efficacy and safety of ICDs. Their effectiveness in sensitivity, pacing success, and defibrillation success were high and very significant. ICDs were safe in their use in the detection of arrhythmias., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Tran et al.)

This paper shows an effective method to significantly enhance the isolation of a closely spaced two-port patch antenna, which can be deployed for full-duplex transceivers as well as multiple-input-multiple-output (MIMO) systems. Two rectangular microstrip patches are arranged in the E-plane configuration. To achieve high isolation, a grounded stub is positioned between the radiating patches. For validation of the proposed concept, an antenna prototype is fabricated for measurements. The measured data demonstrates that the port-to-port mutual coupling can be suppressed to -50 dB, which is useful in self-interference cancellation for full-duplex communication systems. Compared with the coupled design, the isolation is significantly enhanced by 43 dB with an inter-element spacing of 0.034λc, where λc is a free-space wavelength at the center operating frequency. Regarding MIMO metrics, the antenna also shows good MIMO diversity performance based on an envelope correlation coefficient and a diversity gain., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Tran et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Study Design: A single-center prospective observational study., Objective: To clarify the usefulness of a novel scoliosis screening method using a 3-dimensional (3D) human fitting application and a specific bodysuit., Summary of Background Data: Several scoliosis screening methods, such as scoliometer and Moiré topography, are available for detecting scoliosis. In the present study, a novel screening method for scoliosis using a 3D human fitting application and a specific bodysuit was developed., Patients and Methods: Patients with scoliosis or suspected scoliosis, patients with non-scoliosis, and healthy volunteers were enrolled. They were divided into "non-scoliosis" and "scoliosis" groups. The scoliosis group was further subdivided into "mild," "moderate," and "severe-scoliosis" groups. Patients' characteristics and Z values, which were calculated by a 3D virtual human body model created by a 3D human fitting application and a specific bodysuit to evaluate trunk asymmetry caused by scoliosis, were compared between the non-scoliosis and scoliosis groups or among the non, mild, moderate and severe-scoliosis groups. Finally, the optimal cutoff of the Z value was determined to detect moderate to severe scoliosis using receiver operating characteristic curve analysis., Results: A total of 101 patients were included. The non-scoliosis group consisted of 47 patients, and the scoliosis group included 54 patients, with 11, 31, and 12 patients in the mild, moderate, and severe-scoliosis groups, respectively. The scoliosis group showed a significantly higher Z value than the non-scoliosis group. The moderate or severe-scoliosis group had a significantly higher Z value than the non or mild-scoliosis group. The receiver operating characteristic curve analysis revealed that the optimal cutoff of the Z value was 19.9 mm (sensitivity, 95.3% and specificity, 58.6%)., Conclusion: A novel scoliosis screening method consisting of a 3D human fitting application and a specific bodysuit may be useful for detecting moderate to severe scoliosis., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Recent reverse genetics technologies have enabled genetic manipulation of plant negative-strand RNA virus (NSR) genomes. Here, we report construction of an infectious clone for the maize-infecting Alphanucleorhabdovirus maydis, the first efficient NSR vector for maize. The full-length infectious clone was established using agrobacterium-mediated delivery of full-length maize mosaic virus (MMV) antigenomic RNA and the viral core proteins (nucleoprotein N, phosphoprotein P, and RNA-directed RNA polymerase L) required for viral transcription and replication into Nicotiana benthamiana. Insertion of intron 2 ST-LS1 into the viral L gene increased stability of the infectious clone in Escherichia coli and Agrobacterium tumefaciens. To monitor virus infection in vivo, a green fluorescent protein (GFP) gene was inserted in between the N and P gene junctions to generate recombinant MMV-GFP. Complementary DNA (cDNA) clones of MMV-wild type (WT) and MMV-GFP replicated in single cells of agroinfiltrated N. benthamiana. Uniform systemic infection and high GFP expression were observed in maize inoculated with extracts of the infiltrated N. benthamiana leaves. Insect vectors supported virus infection when inoculated via feeding on infected maize or microinjection. Both MMV-WT and MMV-GFP were efficiently transmitted to maize by planthopper vectors. The GFP reporter gene was stable in the virus genome and expression remained high over three cycles of transmission in plants and insects. The MMV infectious clone will be a versatile tool for expression of proteins of interest in maize and cross-kingdom studies of virus replication in plant and insect hosts., (© 2022 The Authors. Molecular Plant Pathology published by British Society for Plant Pathology and John Wiley & Sons Ltd.)

Background: The growing public interest and awareness regarding the significance of sleep is driving the demand for sleep monitoring at home. In addition to various commercially available wearable and nearable devices, sound-based sleep staging via deep learning is emerging as a decent alternative for their convenience and potential accuracy. However, sound-based sleep staging has only been studied using in-laboratory sound data. In real-world sleep environments (homes), there is abundant background noise, in contrast to quiet, controlled environments such as laboratories. The use of sound-based sleep staging at homes has not been investigated while it is essential for practical use on a daily basis. Challenges are the lack of and the expected huge expense of acquiring a sufficient size of home data annotated with sleep stages to train a large-scale neural network., Objective: This study aims to develop and validate a deep learning method to perform sound-based sleep staging using audio recordings achieved from various uncontrolled home environments., Methods: To overcome the limitation of lacking home data with known sleep stages, we adopted advanced training techniques and combined home data with hospital data. The training of the model consisted of 3 components: (1) the original supervised learning using 812 pairs of hospital polysomnography (PSG) and audio recordings, and the 2 newly adopted components; (2) transfer learning from hospital to home sounds by adding 829 smartphone audio recordings at home; and (3) consistency training using augmented hospital sound data. Augmented data were created by adding 8255 home noise data to hospital audio recordings. Besides, an independent test set was built by collecting 45 pairs of overnight PSG and smartphone audio recording at homes to examine the performance of the trained model., Results: The accuracy of the model was 76.2% (63.4% for wake, 64.9% for rapid-eye movement [REM], and 83.6% for non-REM) for our test set. The macro F1-score and mean per-class sensitivity were 0.714 and 0.706, respectively. The performance was robust across demographic groups such as age, gender, BMI, or sleep apnea severity (accuracy 73.4%-79.4%). In the ablation study, we evaluated the contribution of each component. While the supervised learning alone achieved accuracy of 69.2% on home sound data, adding consistency training to the supervised learning helped increase the accuracy to a larger degree (+4.3%) than adding transfer learning (+0.1%). The best performance was shown when both transfer learning and consistency training were adopted (+7.0%)., Conclusions: This study shows that sound-based sleep staging is feasible for home use. By adopting 2 advanced techniques (transfer learning and consistency training) the deep learning model robustly predicts sleep stages using sounds recorded at various uncontrolled home environments, without using any special equipment but smartphones only., (©Hai Hong Tran, Jung Kyung Hong, Hyeryung Jang, Jinhwan Jung, Jongmok Kim, Joonki Hong, Minji Lee, Jeong-Whun Kim, Clete A Kushida, Dongheon Lee, Daewoo Kim, In-Young Yoon. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 01.06.2023.)

Helicobacter pylori (H. pylori)  is a gram-negative aerobic pathogen that primarily colonizes the gastric mucosa. Peptic ulcer disease, atrophic gastritis, gastric cancer, and mucosal-associated lymphoid tissue lymphoma have all been linked to chronic H. pylori  infection. Hence, it is critical to diagnose and treat it as early as possible. There are both invasive and noninvasive tests available to detect it. In this review, the diagnostic abilities of two invasive tests - histology and the rapid urease test (RUT) - are compared in a variety of clinical situations. This systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 checklist. We performed a literature search using the PubMed and Google Scholar databases in accordance with the eligibility criteria and ultimately selected eight articles for final analysis. The Newcastle-Ottawa scale adapted for cross-sectional studies, the Scale for the Assessment of Narrative Review Articles (SANRA), and the PRISMA 2020 checklist were used to assess the quality of selected articles for cross-sectional studies, traditional literature reviews, and systematic reviews, respectively. According to the findings of the review, both histology and the RUT have high sensitivity and specificity in diagnosing H. pylori though this varies depending on the clinical situation, making one test superior to the other. Neither of these tests can be considered the gold standard method on its own. Hence, using at least two diagnostic tests at the same time is critical for ensuring high sensitivity and specificity while accurately diagnosing the pathogen., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Urgessa et al.)

Slippery liquid-infused porous surfaces (SLIPS) show remarkable liquid repellency, making them useful for many coating applications. The outstanding repellency of SLIPS comes from a lubricant layer stabilized within and at the surface of a porous template. The stability of this lubricant layer is key for SLIPS to exhibit their unique functionality. The lubricant layer, however, is depleted over time, causing degradation of liquid repellency. The formation of wetting ridges surrounding liquid droplets on the surface of SLIPS is one of the primary sources of lubricant depletion. Here, we present the fundamental understanding and characteristics of wetting ridges and highlight the latest developments that enable the detailed investigation and suppression of wetting ridge formation on SLIPS. In addition, we offer our perspectives on new and exciting directions for SLIPS., (© 2023 IOP Publishing Ltd.)

Waterpipe smoking is an emerging epidemic and a severe public health problem worldwide. Observational studies on the hazards of a specific new waterpipe tobacco product are timely needed. The objectives were to analyze how dangerous waterpipe tobacco smoking is on the causes of all mortality, including cancer, and how effective smoking cessation is for improving health. We analyzed the hazards of exclusive waterpipe smoking through a prospective cohort study in Northern Vietnam. We obtained exposure data on the smoking status of specific cigarette and waterpipe and smoking cessation histories from each study participant. The outcome includes deaths due to all causes. The cause of death for each case is determined based on medical records. HR (95%CI) was estimated using a Cox proportional-hazards-regression analysis for overall mortality and all cancers. The ever-cigarette smoking group as the reference group, the exclusive waterpipe smoking group had a statistical increase in the risk for overall mortality HR (95% CI): 1.63 (1.32, 2.00), and all cancers HR (95%CI): 1.67 (1.18, 2.38). The risk of death increased statistically in the group of waterpipe smoking over 20 years for overall mortality HR (95%CI): 1.82 (1.45, 2.29), and all cancers HR (95%CI): 1.91 (1.27, 2.88). After stopping smoking, the risk of death decreased steadily. The risk of death was reduced by 41% for overall mortality HR (95%CI): 0.59 (0.39, 0.89), and 74% for death from cancers HR (95%CI): 0.26 (0.08, 0.83) after ten years or longer of cessation. Life expectancy was shortened by more than six years for the group of exclusive waterpipe smokers compared to non-smokers. This study found new novel hazards of exclusive waterpipe tobacco smoking. The findings are scientific evidence for developing strategies, policies, and budget allocations to control this novel tobacco product and promote cessation to improve life expectancy., (© 2023. The Author(s).)

Vietnam has high rates of antibiotic use and resistance. Measuring resistance in commensal bacteria could provide an objective indicator for evaluating the impact of interventions to reduce antibiotic use and resistance. This study aimed to evaluate the feasibility, acceptability, and bacterial recovery for different sampling strategies. We conducted a cross-sectional mixed methods study in a rural community in Ha Nam Province, northern Vietnam, and collected structured interviews, samples, and in-depth interviews from households. Out of 389 households invited, 324 participated (83%), representing 1502 individuals. Samples were collected from these individuals (1498 stool, 1002 self-administered nasal swabs, and 496 HW-administered nasopharyngeal swabs). Pneumococci were recovered from 11.1% (128/1149) of the total population and 26.2% (48/183) of those under 5-years. Recovery was higher for health-worker (HW)-administered swabs (13.7%, 48/350) than self-administered swabs (10.0%, 80/799) (OR 2.06, 95% CI 1.07-3.96). Cost per swab was cheaper for self-administered ($7.26) than HW-administered ($8.63) swabs, but the overall cost for 100 positive samples was higher ($7260 and $6300 respectively). Qualitative interviews revealed that HW-administered nasopharyngeal swabs took longer to collect, caused more discomfort, and were more difficult to take from children. Factors affecting participation included sense of contribution, perceived trade-offs between benefits and effort, and peer influence. Reluctance was related to stool sampling and negative perceptions of research. This study provides important evidence for planning community-based carriage studies, including cost, logistics, and acceptability. Self-administered swabs had lower recovery, and though cheaper and quicker, this would translate to higher costs for large population-based studies. Recovery might be improved by swab-type, transport medium, and better cold-chain to lab., (© 2022. The Author(s).)

Medical marijuana treatment for migraine is becoming more common, although the legality and societal acceptance of marijuana for medical purposes in the United States have been challenged by the stigma attached to it as a recreational drug. These substances function to reduce nociception and decrease the frequency of migraine by having an impact on the endocannabinoid system. Our study reviewed the clinical response, dosing, and side effects of marijuana in migraine management. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a literature search in PubMed, Google Scholar, and Science Direct, and nine studies were included in the systematic review. The studies demonstrated that medical marijuana has a significant clinical response by reducing the length and frequency of migraines. No severe adverse effects were noted. Due to its effectiveness and convenience, medical marijuana therapy may be helpful for patients suffering from migraines. However, additional clinical trials and observational studies with longer follow-ups are required to study the efficacy and safety of the drug., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Sherpa et al.)

The treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents can be challenging and involve a combination of pharmacologic and non-pharmacological approaches. Using recent literature, we aim to identify the effectiveness of cognitive behavioral therapy (CBT) and methylphenidate (MPH) in reducing the symptoms and improving the quality of life. The investigators conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Investigators independently conducted a routine search on PubMed and Google Scholar for articles published within the last five years through July 30, 2022. Fourteen studies were identified as generally good quality but with some limitations. The final analysis included 2098 patients with an age range of three to eighteen. Nine studies reporting the efficacy of MPH in children, adolescents, or both had different formulations and doses. Six studies documenting the effectiveness of CBT had varying sessions, duration per therapy, modality of administration, and participants. The diagnostic assessment measures showed that the parent symptom rating was the highest and appeared in 11 studies, reflecting the burden on the family. In addition, a structured-self-rated questionnaire rating appeared in eight studies, and two diagnostic assessment measures, teacher symptom rating and investigators, appeared in six. The studies demonstrated significant reductions in the primary symptoms of ADHD at assessment, which led to improved behavioral and functional status with a reduced impact on family and society. Further trials are needed to understand the benefits of CBT and MPH when combined to reduce psychiatry co-morbidities and improve learning and overall quality of life in the long term., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ojinna et al.)

Despite decreasing the prevalence of chronic hepatitis B (CHB), it is still a major health care challenge. Current antiviral regimens aim to suppress hepatitis B virus (HBV) deoxyribonucleic acid (DNA) activity to prevent the risk of hepatic decompensation, liver cirrhosis, and hepatocellular carcinoma (HCC). Currently, pegylated interferon (Peg-IFN) and nucleos(t)ide analogs (NA) are the first-line choices of drugs. Peg-IFN is now discontinued due to its mode of application and side effects. NA is used once daily to suppress HBV DNA activity but has little effect on covalently closed circular DNA (cccDNA), so continuous long-term therapy is required to suppress HBV DNA. Due to this effect, disease remission, relapse, and even clinical flare are common phenomena after the end of treatment (EOT). This review aimed to analyze the current regimens for treating chronic hepatitis B. Their mode of action, duration of treatment, and events after stopping therapy. The review was performed using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) 2020 guidelines. A search was undertaken in PubMed, PubMed Central, Google Scholar, and ScienceDirect. Screening of articles was carried out to find relevant and appropriate articles. Articles were then quality-checked before inclusion. Our analysis showed that long-term finite therapy with nucleoside analogs could improve clinical outcomes and suppress viral DNA activity. However, a functional cure, loss of hepatitis B surface antigen (HBsAg), is rarely achieved. The decision to end treatment depends on quantitative HBsAg level (qHBsAg), alanine aminotransferase (ALT), HBV DNA (deoxyribonucleic acid), hepatitis B e antigen (HBeAg), and fibrosis assessment. It is concluded that patients with HBeAg negative without cirrhosis can be easily withdrawn from treatment if they have long-term viral remission and a high HBsAg loss rate. However, patients with positive HBeAg should continue treatment because there is a high chance of disease relapse and even acute flare. To predict whether patients will benefit from EOT, some immunomodulatory markers are studied, including interleukin (IL-20, IL-8), fas ligand (FASGL), and IFN gamma. Although these factors are reliable, none pose an independent effect on disease remission. Combination therapy (IFN alpha + oral nucleoside analogs) is promising but has clinical shortcomings., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Butt et al.)

Low awareness of antibiotics and antibiotic resistance may lead to inappropriate antibiotic use and contribute to the problem of antibiotic resistance. This study explored levels and determinants of antibiotic awareness in a rural community in northern Vietnam, through a cross-sectional survey of 324 households in one commune of Ha Nam Province. Awareness and knowledge of antibiotics and antibiotic resistance and determinants were evaluated using structured questionnaires. Most respondents (232/323 (71.8%)) had heard of antibiotics, but fewer could name any antibiotic (68/323 (21.1%)) or had heard of antibiotic resistance (57/322 (17.7%)). In adjusted regression models, antibiotic awareness was lower among those who lived further from health facilities (Odds Ratio (OR): 0.08; 95% Confidence Interval (CI): 0.04-0.19) but higher among those who used interpersonal sources for health information (OR: 4.06; 95% CI: 1.32-12.46). Antibiotic resistance awareness was lower among those who used private providers or pharmacies as their usual health facility (OR: 0.14; 95% CI: 0.05-0.44) but higher among those with medical insurance (OR: 3.70; 95% CI: 1.06-12.96) and those with high media use frequency (OR: 9.54; 95% CI: 2.39-38.07). Awareness of Antimicrobial Resistance (AMR) was also higher among those who sought health information from official sources (OR: 3.88; 95% CI: 1.01-14.86) or had overall high levels of health information seeking (OR: 12.85; 95% CI: 1.63-101.1). In conclusion, communication interventions need to target frequently used media platforms, such as television, as well as key health information providers, such as health workers, as channels for increasing knowledge and changing community antibiotic use behaviour., Competing Interests: The authors declare no conflict of interest.

In recent years, many documented cases of systemic lupus erythematosus (SLE) have been on the rise. The complicated pathophysiology of the disease makes it challenging to manage. Two databases, PubMed and Google Scholar, have a detailed screening using keywords and Medical Subject Heading (MeSH) combinations. The words are "Systemic Lupus Erythematosus OR SLE OR Lupus," "Glutathione," and "Curcumin." Articles had a detailed process of screening and quality appraisal. Using the English language as a primary filtering parameter, papers over the last 20 years, dating from 2002 to 2022, are the basis of this review. We reviewed all possible human studies documenting the use of curcumin and glutathione for treating SLE. A total of 15 articles are part of this systematic review. Curcumin and glutathione can act as potent drugs for treating lupus. Curcumin can be a more promising alternative since it operates on various pathways and is a more easily accessible source., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ravi et al.)

This paper presents a circularly polarized (CP) multiple-input multiple-output (MIMO) antenna using a microstrip patch and parasitic elements. The proposed design exhibits wideband characteristics for both impedance and axial ratio bandwidths. Especially, the mutual coupling between the MIMO elements is significantly depressed without using any decoupling network. To achieve these features, parasitic elements are positioned nearby and in different layers to the radiating elements. The measured results demonstrate that the proposed MIMO CP antenna has a wideband operation of 11.3% (5.0-5.6 GHz), which is defined by an overlap between -10-dB impedance and 3-dB axial ratio bandwidths. Across this band, the realized gain is better than 6.0 dBi, and the isolation is greater than 32 dB with the highest value of 45 dB. The MIMO parameters such as the envelope correlation coefficient, diversity gain, and channel capacity loss are also investigated thoroughly, which are found to be good on the scale of diversity standards.

Otitis media with effusion (OME) affects approximately 80% of children due to the middle ear being flooded with fluids, though with no microbial infection manifestations. Multiple issues can drive recurring pediatric OME, such as environment-based issues, previous medical issues, inherited vulnerability from family, contact time at childcare institutes, passive smoking, and more than three siblings together with atopy or allergic rhinitis. If OME is not promptly addressed, this could eventually result in hearing impairment or loss, with consequent negative repercussions on the child's communicative and behavioral patterns. OME diagnosis within the clinic is possible, with hearing capacity being assessed pre- and post-therapy. Adenoid hypertrophy (AH) represents a typical causative factor for middle-ear conditions, stemming from mechanical or anatomical issues. Consequently, adenoid size is paramount when determining tympanometry types and ear fluids. This systematic review investigated PubMed, Medline, Cochrane Library, and Science Direct databases in order to retrieve knowledge related to this issue, adopting inclusion and exclusion criteria and maintaining review quality through the employment of the Assessment of Multiple Systematic Reviews (AMSTAR), the Newcastle-Ottawa tool, and the Axis scale. This systematic review analyzed a previous review article, six observation-based investigations, and three cross-sectional investigations. Previous randomized controlled trials (RCTs) were not found within previous literature, suggesting such scarcity in this research niche and thus warranting future RCT investigations based on this compelling research niche., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Mashat et al.)

An anal fissure is a common condition that affects patients of all ages. Its clinical presentation is a sharp pain on defecation with or without blood. It is treated by conservative or surgical means. This study aims to assess the efficacy of a sitz bath as compared to lateral internal sphincterotomy in the treatment of anal fissures. The search strategy used keywords related to the topic of study. Three databases were used: PubMed, Google Scholar, and Science Direct. A total of 551 articles were screened. A quality assessment check was done on the articles leaving 11 articles. Four aspects of sitz bath outcomes were evaluated in the articles. In terms of analgesia, articles showed conflicting evidence. However, the overall evidence supports the use of sitz baths for their analgesic properties. In terms of healing, most articles had similar recovery rates of around 80%. Much of the research supported the use of sitz baths as the primary treatment to heal acute fissures. When compared to lateral internal sphincterotomy, the recovery rates of lateral internal sphincterotomy are superior to those of conservative treatment, including sitz baths. However, studies showed incontinence as a side effect of lateral internal sphincterotomy, and no studies reported side effects from the sitz baths. To conclude, the results of the articles support the use of sitz baths to treat anal fissures. Sitz baths have been found to have analgesic properties, as well as a good healing time. But, compared to lateral internal sphincterotomy, there is a significant difference in the healing rate at the end stage of treatment, lateral internal sphincterotomy is found to be superior. With regards to the side effects, none have been reported from using a sitz bath., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alnasser et al.)

Livestock has been implicated as a reservoir for antimicrobial resistance (AMR) genes that can spread to humans when antimicrobials are used in animals for food production to treat clinical diseases and prevent and control common disease events. In Vietnam, mcr-1 -harboring Escherichia coli (MCRPEC) strains have been isolated from humans, animals (chickens, pigs, and dogs) feces, flies, foods, and the environment (rainwater, well water, and irrigation water) in communities and from clinical specimens in hospitals. The relationship between levels of AMR in livestock and its occurrence in humans is complex and is driven by many factors. We conducted whole genome sequencing of MCRPEC to analyze the molecular epidemiological characteristics, history, and relatedness of 50 isolates obtained in 2019 from different reservoirs in farms and markets in Ha Nam province, Vietnam. 34 sequence types (STs) with 3 new STs were identified in multilocus sequence typing analysis: ST12945 and ST12946 from chicken feces, and ST12947 from flies. The AMR phenotypes of 50 MCRPEC isolates were as follows: ampicillin (100%, 50/50), cefotaxime (10%, 5/50), gentamicin (60%, 30/50), amikacin (8%, 4/50), meropenem (6%, 3/50), ceftazidime (18%, 9/50), colistin (24%, 12/50) and ciprofloxacin (80%, 40/50). All 50 MCRPEC isolates were identified as MDR. 100% (50/50) isolates carried AMR genes, ranging from 5 to 22 genes. The most prevalent plasmid replicon types carrying mcr-1 were IncP-1 (17/37, 45.9%), IncX4 (7/37, 18.9%), and IncHI2/IncHI2A (6/37, 16.2%). These data suggest that the epidemiology of the mcr-1 gene is mostly determined by plasmid spreading instead of clonal dissemination of MCRPE strains. The co-occurrence of several STs such as ST10, ST48, ST155, ST206, ST2705 in various sample types, joined to the higher prevalence of a few types of Inc plasmids, confirms the dissemination of the mcr-1 carrying plasmids in E. coli clones established in livestock. 5 over 8 STs identified in flies (ST206, ST2705, ST155, ST10, and ST48) suggested the fly contribution in the transmission of AMR bacteria in environments. These popular STs also occur in human samples and 100% of the human samples were positive for the mcr-1 gene., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Nguyen, Ngo, Tran, Vu, Le, Tran, Pham, Nguyen, Tran, Nguyen, Nguyen, Tran, Dang, Bañuls, Choisy, van Doorn, Suzuki and Tran.)

Impella (Abiomed, Danvers, MA) devices nowadays have been linked to cardiogenic shock (CS) due to the importance of their use as therapeutic instruments. This study aims to review pathophysiologic mechanisms of cardiogenic shock and the implementation of Impella to overcome this condition. To investigate several different types of studies and analyze the use of Impella device in cardiogenic shock and the outcomes of heart malfunctioning and determine its positive and negative impacts as a therapeutic tool in cardiac ischemia and use as a resource in critical patients, we conducted a systematic review through different databases (PubMed, ScienceDirect, and Google Scholar) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and used the Medical Subjects Heading (MeSH) search strategy to obtain significant articles. We found 883 papers in total, and after removing duplicates, applying inclusion/exclusion criteria, and finding the most significant information, we ended up with 30 articles that were reviewed containing information about the impact of Impella device in cardiogenic shock in different locations. The study strongly concludes that Impella device in the setting of cardiogenic shock has more advantages than disadvantages in terms of outcomes and complications as a non-pharmacologic tool. Improvements in left ventricular ejection fraction and signs and symptoms of cardiogenic shock criteria were determinants. Nevertheless, complications during the implementation and use of the device were established; in this manner, the evaluation and treatment of each patient separately are imperative. Consequently, more studies on this relevant topic are needed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Munoz Tello et al.)

Ultrasonography and elastography are the most widely used imaging modalities for diagnosing non-alcoholic fatty liver disease. This study aimed to assess and compare the diagnostic accuracy in patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis. This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was done for the past seven years using Pubmed, Pubmed Central, Cochrane, and Google Scholar databases on Jun 29, 2022. Studies were included based on the following predefined criteria: observational studies, randomized controlled trial (RCT), comparative studies, studies using liver biopsy or MRI proton density fat fraction (MRI PDFF) as a reference standard, ultrasonography, and elastography with measures of their diagnostic accuracy like sensitivity (SN), specificity (SP), area under the receiver operating characteristic (AUROC) curve, and English language. The data were extracted on a predefined template. The final twelve eligible studies were assessed using the quality assessment of diagnostic accuracy tool (QUADS-2). Most studies focused on elastography techniques, and the remaining focused on quantitative ultrasonography methods like the controlled attenuation parameter (CAP) and attenuation coefficient (AC). Only one study was available for the evaluation of qualitative ultrasonography. MRI was generally found superior to other diagnostic tests for determining liver stiffness through magnetic resonance elastography (MRE) and steatosis through MRI PDFF. Data assessing the comparative diagnostic accuracy of the two tests were inconclusive., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Geethakumari et al.)

Introduction: Contemporary data on the epidemiology of acute myocardial infarction (AMI) in Vietnam are extremely limited., Methods: We established population-based registries of residents from 2 provinces in a northern urban (Hai Phong), and a central rural (Thanh Hoa), province of Vietnam hospitalized with a validated first AMI in 2018. We described patient characteristics, in-hospital management and clinical complications, and estimated incidence rates of AMI in these two registries., Results: A total of 785 patients (mean age = 71.2 years, 64.7% men) were admitted to the two hospitals with a validated first AMI. Approximately 64% of the AMI cases were ST-segment-elevation AMI. Patients from Thanh Hoa compared with Hai Phong were more likely to delay seeking acute hospital care. The incidence rates (per 100,000 population) of initial AMI in Thanh Hoa and Hai Phong were 16 and 30, respectively. Most patients were treated with aspirin (Thanh Hoa: 96%; Hai Phong: 90%) and statins (both provinces: 91%) during their hospitalization. A greater proportion of patients in Hai Phong (69%) underwent percutaneous revascularization than those in Thanh Hoa (58%). The most common in-hospital complications were heart failure (both provinces:12%), cardiogenic shock (Thanh Hoa: 10%; Hai phong: 7%); and cardiac arrest (both provinces: 9%). The in-hospital case-fatality rates for patients from Thanh Hoa and Hai Phong were 6.8% and 3.8%, respectively., Conclusions: The incidence and hospital case-fatality rates of AMI were low in two Vietnamese provinces. Extent of pre-hospital delay and in-hospital use of evidence-based therapies were suboptimal, being more prominent in the rural province., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Bloodstream infections (BSIs) are a leading cause of sepsis, which is a life-threatening condition that significantly contributes to the mortality of bacterial infections. Aminoglycoside antibiotics such as gentamicin or amikacin are essential medicines in the treatment of BSIs, but their clinical efficacy is increasingly being compromised by antimicrobial resistance. The aminoglycoside apramycin has demonstrated preclinical efficacy against aminoglycoside-resistant and multidrug-resistant (MDR) Gram-negative bacilli (GNB) and is currently in clinical development for the treatment of critical systemic infections., Methods: This study collected a panel of 470 MDR GNB isolates from healthcare facilities in Cambodia, Laos, Singapore, Thailand and Vietnam for a multicentre assessment of their antimicrobial susceptibility to apramycin in comparison with other aminoglycosides and colistin by broth microdilution assays., Results: Apramycin and amikacin MICs ≤ 16 µg/mL were found for 462 (98.3%) and 408 (86.8%) GNB isolates, respectively. Susceptibility to gentamicin and tobramycin (MIC ≤ 4 µg/mL) was significantly lower at 122 (26.0%) and 101 (21.5%) susceptible isolates, respectively. Of note, all carbapenem and third-generation cephalosporin-resistant Enterobacterales, all Acinetobacter baumannii and all Pseudomonas aeruginosa isolates tested in this study appeared to be susceptible to apramycin. Of the 65 colistin-resistant isolates tested, four (6.2%) had an apramycin MIC > 16 µg/mL., Conclusion: Apramycin demonstrated best-in-class activity against a panel of GNB isolates with resistances to other aminoglycosides, carbapenems, third-generation cephalosporins and colistin, warranting continued consideration of apramycin as a drug candidate for the treatment of MDR BSIs., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Type 2 diabetes mellitus (T2DM) is a significant cause of cardiovascular deaths worldwide. There are many oral antihyperglycemic drugs available to treat diabetic patients. Among them, sodium-glucose cotransporter 2 (SGLT2) inhibitors provide effective treatment in all stages of T2DM regardless of blood glucose levels and benefit the cardiovascular system. SGLT2 inhibitors have an additional diuretic effect that reduces blood pressure and hospitalizations and improves heart failure outcomes. This study will assess the efficacy of SGLT2 inhibitors in cardiovascular outcomes in patients with T2DM and cardiovascular disease. Our systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and involved a literature search utilizing PubMed and Google Scholar databases. In addition, we thoroughly searched for studies conducted in the last 10 years that corresponded with our outlined inclusion and exclusion criteria. Our search yielded 779 articles. The articles were then quality-checked before inclusion. We ultimately selected six randomized controlled trials and two meta-analyses of research articles after applying the inclusion and exclusion criteria. Our research study included 91,796 T2DM and cardiovascular disease patients. We examined cardiovascular outcomes among these T2DM patients, such as major adverse cardiac events (MACE), blood pressure, heart failure, and hospitalizations. Our study showed that SGLT2 inhibitors significantly reduce weight and blood pressure due to their natriuretic effects. In addition, they also improve heart failure symptoms and reduce hospitalizations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Sarker et al.)

Clostridioides difficile (C. difficile) is a gram-positive, anaerobic, spore-forming bacterium that produces toxins A and B, disrupting the intestinal brush border and resulting in severe diarrhea. The most common causes of infection include prolonged antibiotic use, proton pump inhibitors (PPIs), and long-term hospitalization resulting in complications such as pseudomembranous colitis and toxic megacolon. This systematic review aims to consider fecal microbiota transplantation (FMT) as an early treatment modality in C. difficile infection to prevent complications and reduce related morbidity and mortality. We systematically screened three databases using regular keywords such as "fecal microbiota transplantation," " C. difficile ," "pseudomembranous colitis," and "toxic megacolon" and Medical Subject Headings (MeSH) terms. We applied the inclusion and exclusion criteria and performed a thorough quality appraisal using standardized checklists. We were finally left with 10 articles, including seven case reports, one case series, and two observational studies. Questions remain as to the route of administration of FMT, timing, safety, availability, and the number of sittings required. More randomized controlled trials are needed to address all these questions and to assess the safety of FMT. We believe the role of FMT is very important as it can prevent C. difficile related complications and would be an ideal treatment option in a population group that is often unfit for surgical management., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ramesh et al.)

Heyde's syndrome encompasses the triad of aortic stenosis (AS), angiodysplasia, and acquired Von Willebrand's disease (aVWD). The disease itself is a rare association that affects a small subset of patients who suffer from aortic stenosis. Nonetheless, it represents a vital area of clinical interest and is woefully underreported in the literature. Patients with Heyde's syndrome develop gastrointestinal bleeding (GI) as a result of angiodysplasia and due to lack of adequate hemostasis, they tend to be positively predisposed toward developing gastrointestinal hemorrhage. Due to the glaring lack of comprehensive literature on Heyde's syndrome, this systematic review aims to bridge the gap by elucidating the various diagnostic and treatment options available to clinicians for Heyde's syndrome patients as well as to give a detailed account of the pathophysiology of the disease. This systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Google Scholar, Gulf Medical University (GMU) e-library, and PubMed were thoroughly searched for studies done in the last 10 years, which corresponds with our outlined inclusion and exclusion criteria. Relevant studies were then selected on the basis of their abstracts and titles. These studies then underwent a comprehensive quality assessment in which any papers which did not meet this study's eligibility criteria were omitted. Overall, 18 studies fulfilled the criteria of this systematic review., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Jamil et al.)

Loss of the von Hippel-Lindau (VHL) tumor suppressor gene function accounts for 70% to 80% of all clear-cell renal cell carcinoma (ccRCC) cases, the most prevalent form of RCC. Accumulating evidence has indicated that ccRCC arises from sites of chronic inflammation, yet how ccRCC tumor cells interact with immune components of the microenvironment has not been fully elucidated. In this study, we used unbiased proteomic and genomic analyses on components of the tumor microenvironment under different conditions, identifying the molecular and cellular mechanisms that underlie the cross-talk between VHL-deficient kidney tubule cells and macrophages. In vitro and in a Vhlh conditional knockout mouse model, VHL-deficient noncancerous kidney epithelial cells, representing the early stage of ccRCC initiation, secreted IL6 that induced macrophage infiltration and polarization toward the protumorigenic M2 phenotype. Activated human macrophages secreted CCL18 and TGFβ1 to stimulate epithelial-to-mesenchymal transition (EMT) of the kidney tubule cells. Treatment with IL6-neutralizing antibody rescued inflammatory, proliferative, and EMT phenotypes of kidney epithelial cells in Vhlh conditional knockout mice. Furthermore, in a human ccRCC xenograft model, exogenous human primary or cultured macrophages significantly promoted primary tumor growth and metastasis in a CCL18-dependent manner. These findings identify specific factors involved in reciprocal cross-talk between tumor cells and immune components in the microenvironment, thus providing an avenue for early intervention in ccRCC., Significance: The identification of VHL-deficient kidney tubule cell cross-talk with macrophages regulated by IL6 and CCL18 reveals potential targets for the prevention and treatment of ccRCC., (©2022 The Authors; Published by the American Association for Cancer Research.)

Background: Dyslipidemia is highly prevalent in patients with chronic kidney disease (CKD), and the relationship between dyslipidemia and renal function in these patients remains controversial. Our objectives were to determine the triglycerides/HDL-cholesterol ratio (TG/HDL-C), evaluate the correlation between TG/HDL-C and the urine albumin/creatinine ratio (ACR), and estimate the glomerular filtration rate (eGFR) according to MDRD in CKD patients. Methods: A descriptive cross-sectional study was conducted on 152 patients with CKD at the Endocrine Clinic, the University of Medicine and Pharmacy Hospital, Ho Chi Minh City, Vietnam. Study subjects were medically examined and recorded information on the data collection form. Subjects were tested for total cholesterol, triglycerides, HDL-C, LDL-C, urea, creatinine and albumin, urine creatinine, and eGFR according to the MDRD formula. Data were analyzed using SPSS Statistics version 20.0. Results: The average age was 58.08 ± 15.69 years, and the overweight and obesity rate was 54%. Most patients had comorbidities, among which the most common diseases were hypertension and diabetes mellitus. Among the subjects, 57.3% were CKD stage 3 patients, and ACR was in the range of 30−300 mg/g. According to the classification of CKD using GFR and ACR categories, 40.8% of patients were at very high risk. The average TG/HDL-C ratio was 5.09 ± 4.26. There was a medium negative correlation between TG/HDL-C and eGFR (R = 0.44, p < 0.01) and a weak positive correlation between TG/HDL-C and ACR (R = 0.34, p < 0.01). Conclusions: The TG/HDL-C ratio was a risk factor associated with CKD and was noticeable in monitoring and assessing the risk of progression of CKD.

Introduction: Globally, diabetic retinopathy (DR) is the leading cause of blindness in working-aged adults. Early detection and treatment of DR is essential for preventing sight loss. Services must be available, accessible and acceptable to patients if we are to ensure they seek such care., Objectives: To understand patients' knowledge and attitudes towards laser versus antivascular endothelial growth factor (VEGF) injections to treat DR in Vietnam, and to identify factors Vietnamese ophthalmologists consider when making treatment decisions., Methods: This is a descriptive qualitative study based on semi-structured interviews with 18 patients (12 from Ho Chi Minh City and 6 from Hanoi) plus individual interviews with 24 ophthalmologists working in eye clinics in these cities. Thematic analysis was used to analyse the data., Results: In total, 10/24 (41.7%) ophthalmologists were female, and their median age was 41 years (range 29-69 years). The median age of patients was 56.5 years (range 28-72 years), and 7/18 (38.9%) were female. Briefly, factors that influence DR treatment decisions for ophthalmologists are medical considerations (ie, severity of disease, benefits and risks), availability (ie, treatment and resources) and patient-related factors (ie, costs and adherence). Patient's perceived barriers and facilitators to treatments were based on patient and family related factors (ie, treatment and transportation costs) and previous treatment experiences (ie, positive and negative). Recommendations by all participants included ensuring that both laser and anti-VEGF injections are widely available across the country and controlling costs for patients and the healthcare system., Conclusions: Reducing DR treatment costs, optimising treatments options, and expanding the network of clinics offering treatment outside metropolitan areas were the main issues raised by participants. These findings can help inform policy changes in Vietnam and may be generalisable to other low-resource settings., Competing Interests: Competing interests: NC is employed as a Research Director by Orbis International., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Plasmid-Mediated Colistin Resistance 1 (mcr-1) was first reported in 2015 and is a great concern to human health. In this study, we investigated the prevalence of mcr-1 and mcr-1-positive Escherichia coli (MCRPEC) and the association in infection status among various reservoirs connected to livestock. The study was conducted in 70 poultry and swine farms in a commune in Ha Nam province, northern Vietnam. Samples were collected from farmers, food animals, domestic animals, and farm environments (flies and wastewater) for polymerase chain reaction (PCR) screening for mcr-1 gene and species identification of PCR positive isolates. Among 379 obtained mcr-1 positives isolates, Escherichia coli was the major identified, varying from 50% (2/4) in dog feces to 100% (31/31) in humans feces isolates. The prevalence of MCRPEC was 14.4% (20/139), 49.7% (96/193), 31.3% (25/80), 36.7% (40/109), 26.9% (18/67), and 3.9% (2/51) in humans, chickens, pigs, flies, wastewater, and dogs, respectively. The study identified association between MCRPEC infection status in humans and flies (OR = 3.4), between flies and chickens (OR = 5.3), and between flies and pigs (OR = 9.0). Farmers' age and farm livestock unit were also associated factors of MCRPEC infection status in humans (OR = 5.1 and 1.05, respectively). These findings bring new knowledge on antibiotic resistance in livestock setting and important suggestions on potential role of flies in the transmission of mcr-1 resistance gene.

Marafiviruses, including maize rayado fino virus (MRFV) and oat blue dwarf virus (OBDV), encode two carboxy co-terminal coat proteins, CP1 and CP2, which encapsidate the genome to form icosahedral virions. While CP2 expression is expected to be solely driven from a second start codon of a subgenomic RNA under a marafibox promoter sequence, the larger CP1 with an in-frame N-terminal extension relative to CP2 could potentially be expressed either by proteolytic release from the MRFV polyprotein or from subgenomic RNA translation. We examined MRFV CP expression strategy with a series of mutations in the CP coding region and identified mutants viable and nonviable for systemic plant infection. Polyprotein expression of MRFV CP1 was minimal. Mutants blocking CP2 expression failed to establish systemic infection, while mutants depleted in CP1 exhibited systemic infection and formation of virus-like particles but lost leafhopper transmissibility, indicating that CP1 is required for leafhopper transmission., (Copyright © 2022. Published by Elsevier Inc.)

Background: Diabetic eye screening programmes have been developed worldwide based on evidence that early detection and treatment of diabetic retinopathy are crucial to preventing sight loss. However, little is known about the decision-making processes and training needs of diabetic retinal graders, particularly in low- and middle-income countries., Objectives: To provide data for improving evidence-based diabetic retinopathy training to help novice graders process fundus images more like experts., Subjects/methods: This is a mixed-methods qualitative study conducted in southern Vietnam and Northern Ireland. Novice diabetic retinal graders in Vietnam (n = 18) and expert graders in Northern Ireland (n = 5) were selected through a purposive sampling technique. Data were collected from 21st February to 3rd September 2019. The interviewer used neutral prompts during think-aloud sessions to encourage participants to verbalise their thought processes while grading fundus images from anonymised patients, followed by semi-structured interviews. Thematic framework analysis was used to identify themes, supported by illustrative quotes from interviews. Mann-Whitney U tests were used to compare graders' performance., Results: Expert graders used a more systematic approach when grading images, considered all four images per patient and used available software tools such as red-free filters prior to making a decision on management. The most challenging features for novice graders were intra-retinal microvascular abnormalities and new vessels, which were more accurately identified by experts., Conclusion: Taking more time to grade fundus images and adopting a protocol-driven "checklist" approach may help novice graders to function more like experts., (© 2021. The Author(s).)

Background: This study aimed to evaluate the appropriateness of antibiotic dispensing of private pharmacies in Vietnam., Methods: Standardised patient surveys were conducted in randomly selected community pharmacies across 40 districts in Vietnam. Four clinical scenarios were represented by patient actors: (a) an adult requesting treatment for a sibling with a viral upper respiratory tract infection (URTI), (b) a parent requesting treatment for a child with acute diarrhoea, (c) an adult making a direct antibiotic request, and (d) an adult presenting with an antibiotic prescription. We calculated the proportion of interactions that resulted in inappropriate supply of antibiotics and patient advice. Predictors of inappropriate antibiotic supply were assessed., Findings: Patient actors attended 949 pharmacies, resulting in 1266 clinical interactions. Antibiotics were inappropriately supplied to 92% (291/316) of adults requesting treatment for URTI symptoms, 43% (135/316) for children with acute diarrhoea symptoms and to 84% (267/317) of direct request for antibiotics. Only 49% of pharmacies advised patients regarding their antibiotic use. Female actors were more likely to be given antibiotics than male actors for URTI (aOR 2·71, 1·12-6·60) but not for diarrhoeal disease. Pharmacies in northern Vietnam were more likely than those in southern Vietnam to supply antibiotics without a prescription: for adult URTI (aOR=5·8, 95% CI: 2·2-14·9) and childhood diarrhoea (aOR=3·5, 95% CI: 2·0-6·0) symptoms, but less likely to dispense for direct antibiotics request., Interpretation: Inappropriate antibiotic supply was common in Vietnamese private pharmacies. Multifaceted measures are urgently needed to achieve WHO's global action plan for the optimal use of antimicrobials., Funding: This study was funded by a grant from the Australian Department of Foreign Affairs and Trade., Competing Interests: The authors declare that they have no conflict interests., (Crown Copyright © 2022 Published by Elsevier Ltd.)