Endoscopic port access resection of left atrial myxoma: Clinical outcomes and a single surgeon's learning curve experience.

Objectives: To evaluate the safety and efficacy of the port access approach for left atrial (LA) myxoma resection and to analyze the learning curve for this procedure. Methods: Thirty-six consecutive patients with LA myxoma who underwent port access surgery between April 2018 and March 2023 were enrolled in this retrospective study. The procedure included (1) unilateral or bilateral femoral artery cannulation; (2) the use of three 5-mm trocars and a 20- to 30-mm port; (3) a transseptal, biatrial, or LA approach depending on the location of the tumor base; and (4) complete or subendocardial tumor resection. CUSUM analysis was used to evaluate the aortic cross-clamp (ACC) time and cardiopulmonary bypass (CPB) time learning curves. Variables among the learning curve phases were compared. Results: The average ACC and CPB times were 49 (range, 45-79) minutes and 127 (range, 120-164) minutes, respectively. There was 1 case of conversion to sternotomy due to aortic root bleeding and 1 case of unilateral pulmonary edema. CUSUMACCtime analysis included 3 phases: phase I, the initial learning period (cases 1-11); phase II, the technical competence period (cases 12-23); and phase III, the challenging period (cases 24-36). Conclusions: The port access approach is safe and feasible for LA myxoma resection. According to the learning curve analysis, 11 cases are required to achieve technical competence, and 23 cases are required to address highly challenging cases.

Totally Endoscopic Surgery for Repairing Sinus Venosus Atrial Septal Defect Using Double-Patch Technique on Beating Heart.

OBJECTIVE: Minimally invasive cardiac surgery has not been widely applied in repairing sinus venosus atrial septal defect (SV-ASD). Most were minithoracotomy using the single-patch technique for patients with anomalous pulmonary veins (APVs) connecting to the superior vena cava-right atrium (SVC-RA) junction. It is unclear whether patients with APVs draining high to the SVC can be repaired safely and effectively through port access. METHODS: From May 2019 to October 2022, 11 consecutive SV-ASD patients with APVs connecting high to the SVC were enrolled in this prospective study. One 12 mm port and 2 trocars (5.5 mm and 10 mm) were established. The pleural and pericardial spaces were filled with CO2. The SVC was snared just below the azygos vein. The RA incision was longitudinally extended along the SVC-RA junction to the SVC. The bovine pericardial patches were used to redirect the APV flow to the left atrium through the ASD and to enlarge the SVC and the SVC-RA junction. RESULTS: There were no early or late deaths and no reoperations. The concomitant procedures included 5 patients (45.5%) with patent foramen ovale closure, 2 with ASD extension, and 3 with tricuspid valve repair. No endoscopic failure was recorded. The average cardiopulmonary bypass and operative times were 96 (23) min and 190 (30) min, respectively. No cases of venous stenosis or sinus node dysfunction were noted during follow-up of 16.4 ± 12.2 months. CONCLUSIONS: SV-ASD with the APVs draining high to the SVC could be repaired safely and effectively through port access with a double-patch technique.

Totally Endoscopic Resection of Right Atrial Diverticulum: A Case Report.

Right atrial diverticulum is a rare congenital heart defect with only about 30 cases reported. Surgery is the main method of treatment and is indicated when the patients have signs of right heart compression. In this study, we report the case of a 43-year-old male patient who was diagnosed with massive right atrial diverticulum. This patient was the first case who underwent successful repair by totally endoscopic surgery on the beating heart.

Totally endoscopic atrial septal defect repair in a patient with interrupted inferior vena cava with azygos-hemiazygos continuation.

Atrial septal defect combined with interrupted inferior vena cava (IVC), which is a rare condition, makes it impossible to apply totally endoscopic surgery (TES). The most difficulty is how to drain blood from the posthepatic segment of the IVC. In this study, we report a case of a 44-year-old female patient who was diagnosed with secundum atrial septal defect combined with interrupted IVC with azygos-hemiazygos continuation. This patient underwent successful repair by TES with transthoracic cannulation for the posthepatic segment of the IVC.

Quantitative Analysis of Colistin-Resistant Escherichia coli in Retail Meat from Local Vietnamese Markets.

The spread of drug-resistant bacteria via food has contributed to the dissemination of resistant bacteria among humans. However, the status of food contamination with resistant bacteria, particularly the quantitative level of resistant bacteria in food, has not yet been well elucidated. In this study, the abundance of colistin-resistant Escherichia coli in meat samples was quantified to understand the origin of the contamination of meat available in local Vietnamese markets. Fifteen samples each of chicken and pork meat purchased from local Vietnamese markets were assessed for the presence of colistin-resistant E. coli with the mobile colistin resistance gene, mcr. The results showed that 40% (6/15) and 66% (10/15) of the pork and chicken meat samples, respectively, were contaminated with colistin-resistant E. coli. The median quantitative levels of colistin-resistant E. coli in the contaminated pork and chicken samples were 1.8 × 104 and 4.2 × 103 CFU/g, respectively. The results of phylogenetic analysis of isolates from a chicken meat sample showed that the contaminated colistin-resistant E. coli was a mix of multiple phylogenetical clones of bacteria that may have multiplied during sale. This is the first study to quantify the abundance of colistin-resistant E. coli in meat samples.

Rural-urban differences in preferences for influenza vaccination among women of childbearing age: implications for local vaccination service implementation in Vietnam.

OBJECTIVES: Pregnant women and new mothers are among the most vulnerable to seasonal influenza; however, little is known about their preferences for flu vaccination. We examined the rural-urban differences in uptake, demand and willingness to pay (WTP) for influenza vaccination among women of childbearing age, to assess the feasibility of implementing locally produced vaccines in Vietnam. METHODS: A cross-sectional study was performed in both urban and rural areas of Hanoi in 2018. Socio-demographic characteristics, history of vaccination, demand and WTP for influenza vaccines were obtained. A multivariate logistic regression model was employed to identify the associated factors. RESULTS: Of 750 participants, 29.9% had had flu shots in the current or previous flu season and 64.3% indicated demand for this vaccine. The median of the maximum amount of WTP for influenza vaccination services was US$ 8.5 (IQR: 8.5-17.0). Women living in rural areas had a significantly lower uptake and higher demand, and were willing to pay less than women in urban locations (21.1% vs. 36.6%; 69% vs. 60.2%; and US $8.5 vs. US $11.7, respectively). For urban participants, factors associated with higher demand and WTP for flu shots included having ANC in health facilities and having been vaccinated against influenza in the past; for rural women, these factors were having suffered from influenza and hearing about it. CONCLUSIONS: This study informs the feasibility of implementing locally produced influenza vaccines in Vietnam. Educational programs, along with counselling services and government subsidies, should be implemented to improve the coverage, demand and WTP for the vaccine.

OBJECTIFS: Les femmes enceintes et les nouvelles mères sont parmi les plus vulnérables à la grippe saisonnière; cependant, on en sait peu sur leurs préférences pour la vaccination contre la grippe. Nous avons examiné les différences entre les zones rurales et urbaines dans l'adoption, la demande et la volonté de payer pour la vaccination antigrippale chez les femmes en âge de procréer, afin d'évaluer la faisabilité de la mise en œuvre de vaccins produits localement au Vietnam. MÉTHODES: Une étude transversale a été réalisée dans les zones urbaines et rurales de Hanoi en 2018. Les caractéristiques sociodémographiques, les antécédents de vaccination, la demande et la volonté de payer pour les vaccins antigrippaux ont été obtenus. Un modèle de régression logistique multivariée a été utilisé pour identifier les facteurs associés. RÉSULTATS: Sur 750 participantes, 29,9% s'étaient fait vacciner contre la grippe au cours de la saison grippale actuelle ou précédente, 64,3% ont indiqué une demande pour ce vaccin. La médiane du montant maximal de la volonté de payer pour les services de vaccination contre la grippe était de 8,5 USD (IQR: 8,5 à 17,0). Les femmes vivant dans les zones rurales avaient une adoption nettement plus faible, une demande plus élevée et étaient prêtes à payer moins que les femmes des zones urbaines (21,1% contre 36,6%; 69% contre 60,2%; et 8,5 USD contre 11,7 USD, respectivement). Pour les participantes urbaines, les facteurs associés à une demande plus élevée et à la volonté de payer pour les vaccins contre la grippe comprenaient le fait d'avoir des soins prénatals dans les établissements de santé et d'avoir été vaccinés contre la grippe dans le passé; pour les femmes rurales, ces facteurs comprenaient, avoir souffert de la grippe et en avoir entendu parler. CONCLUSIONS: Cette étude informe sur la faisabilité de la mise en œuvre de vaccins antigrippaux produits localement au Vietnam. Des programmes éducatifs, ainsi que des services de conseil et des subventions gouvernementales devraient être mis en œuvre pour améliorer la couverture, la demande et la volonté de payer pour le vaccin.

Right anterolateral mini-thoracotomy without inferior vena cava cannulation for atrial septal defect repair in small children: A feasible technique.

OBJECTIVE: To evaluate the effectiveness and safety of right anterolateral mini-thoracotomy without inferior vena cava (IVC) cannulation for closing atrial septal defect (ASD) in small children. METHODS: From February 2016 to August 2017, 10 patients (the mean age was 18.5 ±â€¯10.1 months and the mean weight was 8.3 ±â€¯2.1 kg) underwent ASD closure via right anterolateral mini-thoracotomy. The superior vena cava cannula was placed through the right internal jugular vein. A 3-4 cm incision was made on the right chest. The pleural and pericardial cavities were filled with CO2 and the heart was beating during the surgery. Blood returned from IVC was drained by a right heart sucker. All ASDs were closed using artificial patch, continuous suture. Mean follow-up was 18 months (range, 15-22 months). RESULTS: No post-operative complications or deaths occurred. Mean operation time and mean cardiopulmonary bypass time were 140.5 ±â€¯27.8 min and 50.3 ±â€¯16.5 min, respectively. These patients were extubated within the first 6 h. The intensive care unit stay time and the post-operative hospital stay time were 19.6 ±â€¯2.6 h and 7.1 ±â€¯1.2 days, respectively. Follow-up transthoracic echocardiography showed no residual shunts or lung atelectasis. CONCLUSIONS: The right anterolateral mini-thoracotomy without IVC cannulation is feasible for repairing ASD in small children. This technique is effective and safe and can be used as a therapeutic option for ASD.

A Vietnamese human genetic variation database.

Large scale human genome projects have created tremendous human genome databases for some well-studied populations. Vietnam has about 95 million people (the 14th largest country by population in the world) of which more than 86% are Kinh people. To date, genetic studies for Vietnamese people mostly rely on genetic information from other populations. Building a Vietnamese human genetic variation database is a must for properly interpreting Vietnamese genetic variants. To this end, we sequenced 105 whole genomes and 200 whole exomes of 305 unrelated Kinh Vietnamese (KHV) people. We also included 101 other previously published KHV genomes to build a Vietnamese human genetic variation database of 406 KHV people. The KHV database contains 24.81 million variants (22.47 million single nucleotide polymorphisms (SNPs) and 2.34 million indels) of which 0.71 million variants are novel. It includes more than 99.3% of variants with a frequency of >1% in the KHV population. Noticeably, the KHV database revealed 107 variants reported in the human genome mutation database as pathological mutations with a frequency above 1% in the KHV population. The KHV database (available at https://genomes.vn) would be beneficial for genetic studies and medical applications not only for the Vietnamese population but also for other closely related populations.

Totally endoscopic ventricular septal defect repair using bilateral femoral arterial cannulation in an 8-year-old girl.

INTRODUCTION: There are few reports on applying totally endoscopic surgery (TES) for repairing ventricular septal defect (VSD), especially in children. CASE PRESENTATION: We described an 8-year-old girl, weighing 17 kg, who was diagnosed with peri-membranous VSD and patent ductus arteriosus (PDA). The patient had undergone trans-catheter PDA closure first, and 3 weeks later, TES was performed for VSD repair through 4 small trocars (one 12 mm trocar and three 5 mm trocars) without robotic assistance. Arterial line was set up indirectly to the right femoral artery (FA) through a graft with an additional line to the left side for reducing arterial pressure. DISCUSSION: FA cannulation in small children induce some risks, such as: FA trauma, critical lower limb ischaemia, and iliac or femoral arterial stenosis. Our new method of FA cannulation was safe with 13 months of follow-up. The major concerns in this case were repairing VSD through small trocars in a small child. CONCLUSION: Bilateral FA cannulation and the way to set up small trocars may facilitate totally endoscopic VSD repair in small children. However, the safety and efficacy of these approaches needs to be validated by larger studies preferably randomised controlled trials.

Mass deworming for improving health and cognition of children in endemic helminth areas: A systematic review and individual participant data network meta-analysis.

Background: Soil transmitted (or intestinal) helminths and schistosomes affect millions of children worldwide. Objectives: To use individual participant data network meta-analysis (NMA) to explore the effects of different types and frequency of deworming drugs on anaemia, cognition and growth across potential effect modifiers. Search Methods: We developed a search strategy with an information scientist to search MEDLINE, CINAHL, LILACS, Embase, the Cochrane Library, Econlit, Internet Documents in Economics Access Service (IDEAS), Public Affairs Information Service (PAIS), Social Services Abstracts, Global Health CABI and CAB Abstracts up to March 27, 2018. We also searched grey literature, websites, contacted authors and screened references of relevant systematic reviews. Selection Criteria: We included randomised and quasirandomised deworming trials in children for deworming compared to placebo or other interventions with data on baseline infection. Data Collection and Analysis: We conducted NMA with individual participant data (IPD), using a frequentist approach for random-effects NMA. The covariates were: age, sex, weight, height, haemoglobin and infection intensity. The effect estimate chosen was the mean difference for the continuous outcome of interest. Results: We received data from 19 randomized controlled trials with 31,945 participants. Overall risk of bias was low. There were no statistically significant subgroup effects across any of the potential effect modifiers. However, analyses showed that there may be greater effects on weight for moderate to heavily infected children (very low certainty evidence). Authors' Conclusions: This analysis reinforces the case against mass deworming at a population-level, finding little effect on nutritional status or cognition. However, children with heavier intensity infections may benefit more. We urge the global community to adopt calls to make data available in open repositories to facilitate IPD analyses such as this, which aim to assess effects for the most vulnerable individuals.

Totally endoscopic atrial septal defect repair using transthoracic aortic cannulation in a 10.5-kg-boy.

INTRODUCTION: Although totally endoscopic surgery (TES) has been widely applied for the treatment of atrial septal defect (ASD), small children receive few benefits from this technique due to risks of the femoral cannulation. CASE PRESENTATION: A 23-month-old boy, weighing 10.5 kg, with the diagnosis of sinus venosus ASD underwent successful repair by TES. We performed this surgery through 4 small trocars (one 12 mm trocar and three 5 mm trocars), without robotic assistance. In this case, we inserted the arterial cannula directly into the ascending aorta instead of the femoral artery (FA). The defects were repaired on the beating heart with CO2 insufflation. DISCUSSION: Femoral cannulation in small children pose some risks, such as increased arterial line pressure, critical lower limb ischaemia, and post-operative iliac or femoral arterial stenosis. Putting the arterial cannula directly into the ascending aorta is a good solution but is difficult to be performed through TES, especially in small children. The major concern of operating on the beating heart is the air embolism, which requires special preventative methods. CONCLUSION: Transthoracic aortic cannulation may facilitate TES in small children. However, the safety and efficacy of this approach needs to be validated by larger studies preferably randomised controlled trials.

Vicinal land use change strongly drives stream bacterial community in a tropical montane catchment.

Impact of land use (LU) change on stream environmental conditions and the inhabiting bacterial community remains rarely investigated, especially in tropical montane catchments. We examined the effects of LU change and its legacy along a tropical stream by comparing seasonal patterns of dissolved organic carbon (DOC) / colored dissolved organic matter (CDOM) in relation to variations in structure, diversity and metabolic capacities of particle-attached (PA) and free-living (FL) bacterial communities. We hypothesized that despite seasonal differences, hydrological flows that accumulate allochthonous carbon along the catchment are a major controlling factor of the bacterial community. Surprisingly, local environmental conditions that were largely related to nearby LU and the legacy of LU change were more important for stream bacterial diversity than hydrological connectivity. DOC was strongly correlated with PA richness and diversity. The legacy of LU change between teak plantation and annual crops induced high DOC and high diversity and richness of PA in the adjacent waters, while banana plantations were associated with high diversity of FL. The community structures of both PA and FL differed significantly between seasons. Our results highlight the importance of vicinal LU change and its legacy on aquatic bacterial communities in mixed used tropical watersheds.

Dried Blood Spots, an Affordable Tool to Collect, Ship, and Sequence gDNA from Patients with an X-Linked Agammaglobulinemia Phenotype Residing in a Developing Country.

Background: New sequencing techniques have revolutionized the identification of the molecular basis of primary immunodeficiency disorders (PID) not only by establishing a gene-based diagnosis but also by facilitating defect-specific treatment strategies, improving quality of life and survival, and allowing factual genetic counseling. Because these techniques are generally not available for physicians and their patients residing in developing countries, collaboration with overseas laboratories has been explored as a possible, albeit cumbersome, strategy. To reduce the cost of time and temperature-sensitive shipping, we selected Guthrie cards, developed for newborn screening, to collect dried blood spots (DBS), as a source of DNA that can be shipped by regular mail at minimal cost. Method: Blood was collected and blotted onto the filter paper of Guthrie cards by completely filling three circles. We enrolled 20 male patients with presumptive X-linked agammaglobulinemia (XLA) cared for at the Vietnam National Children's Hospital, their mothers, and several sisters for carrier analysis. DBS were stored at room temperature until ready to be shipped together, using an appropriately sized envelope, to a CLIA-certified laboratory in the US for sequencing. The protocol for Sanger sequencing was modified to account for the reduced quantity of gDNA extracted from DBS. Result: High-quality gDNA could be extracted from every specimen. Bruton tyrosine kinase (BTK) mutations were identified in 17 of 20 patients studied, confirming the diagnosis of XLA in 85% of the study cohort. Type and location of the mutations were similar to those reported in previous reviews. The mean age when XLA was suspected clinically was 4.6 years, similar to that reported by Western countries. Two of 15 mothers, each with an affected boy, had a normal BTK sequence, suggesting gonadal mosaicism. Conclusion: DBS collected on Guthrie cards can be shipped inexpensively by airmail across continents, providing sufficient high-quality gDNA for Sanger sequencing overseas. By using this method of collecting gDNA, we were able to confirm the diagnosis of XLA in 17 of 20 Vietnamese patients with the clinical diagnosis of agammaglobulinemia.

Synthesis and antibacterial properties of a novel magnetic nanocomposite prepared from spent pickling liquors and polyguanidine.

Magnetic nanoparticles have received much interest for their application in wastewater treatment because of their easy retrieval and reuse. However, the methods used to synthesise high saturation magnetization magnetic nanoparticles require expensive and pure precursors. In the current study, we explore the potential for using spent pickling liquor, a wastewater solution from steel factories, as the iron precursor for preparing iron oxide nanoparticles. Here, magnetic Fe3O4 nanoparticles were synthesized via the oxidation-precipitation of spent pickling liquors using a saturated solution of calcium hydroxide at room temperature. The Fe3O4 nanoparticles were then modified with antibacterial polyguanidine to form a nanocomposite. It was found that monodisperse magnetic Fe3O4 nanoparticles with a size in the range 20-30 nm and a high saturation magnetization value of 73.9 emu g-1 were synthesised. The Fe3O4 nanoparticles were successfully encapsulated with polyguanidine to form an Fe3O4/polyguanidine nanocomposite. FT-IR and TGA analysis results indicated the presence of the polymer on the Fe3O4 surface and the polymer content in the nanocomposite was about 15% (w/w). The Fe3O4/polyguanidine nanocomposite exhibited strong antibacterial activity against Escherichia coli (E. coli), demonstrating its potential for use in disinfecting wastewater.

Defining the Performance Parameters of a Rapid Screening Tool for FMR1 CGG-Repeat Expansions Based on Direct Triplet-Primed PCR and Melt Curve Analysis.

Population-based screening for CGG-repeat expansions in the fragile X mental retardation 1 (FMR1) gene that cause fragile X syndrome can now be performed more cost-effectively and simply by combining direct triplet-primed PCR (dTP-PCR) with melting curve analysis (MCA). We have now performed a detailed technical validation to define the operational parameters for achieving robust and reliable performance of the FMR1 dTP-PCR MCA assay. We compared the assay's performance on 2 real-time PCR platforms and determined its analytic sensitivity and specificity. We also assessed the assay's performance on DNA isolated from different sources, the effect of differences in CGG-repeat length and AGG-interruption pattern on melt peak temperature (Tm), and the effect of common substances found in DNA solutions on Tms. The assay performed well in distinguishing normal from expansion-carrying samples. The assay had detection sensitivity down to 1 ng and an analytical specificity beyond 150 ng. In addition to peripheral blood DNA, analysis could also be performed on DNA from saliva, buccal swabs, and dried blood spots. Salt increased Tms, glycogen contamination had minimal effect, whereas AGG interruptions lowered Tms. The FMR1 dTP-PCR MCA screening assay is highly sensitive and specific, performs well using DNA from different sources, and is robust and reproducible when reagent concentrations are maintained across all tested samples.

Responses of Aquatic Bacteria to Terrestrial Runoff: Effects on Community Structure and Key Taxonomic Groups.

Organic fertilizer application is often touted as an economical and effective method to increase soil fertility. However, this amendment may increase dissolved organic carbon (DOC) runoff into downstream aquatic ecosystems and may consequently alter aquatic microbial community. We focused on understanding the effects of DOC runoff from soils amended with compost, vermicompost, or biochar on the aquatic microbial community of a tropical reservoir. Runoff collected from a series of rainfall simulations on soils amended with different organic fertilizers was incubated for 16 days in a series of 200 L mesocosms filled with water from a downstream reservoir. We applied 454 high throughput pyrosequencing for bacterial 16S rRNA genes to analyze microbial communities. After 16 days of incubation, the richness and evenness of the microbial communities present decreased in the mesocosms amended with any organic fertilizers, except for the evenness in the mesocosms amended with compost runoff. In contrast, they increased in the reservoir water control and soil-only amended mesocosms. Community structure was mainly affected by pH and DOC concentration. Compared to the autochthonous organic carbon produced during primary production, the addition of allochthonous DOC from these organic amendments seemed to exert a stronger effect on the communities over the period of incubation. While the Proteobacteria and Actinobacteria classes were positively associated with higher DOC concentration, the number of sequences representing key bacterial groups differed between mesocosms particularly between the biochar runoff addition and the compost or vermi-compost runoff additions. The genera of Propionibacterium spp. and Methylobacterium spp. were highly abundant in the compost runoff additions suggesting that they may represent sentinel species of complex organic carbon inputs. Overall, this work further underlines the importance of studying the off-site impacts of organic fertilizers as their impact on downstream aquatic systems is not negligible.

Imaging Artifacts in Echocardiography.

Artifacts are frequently encountered during echocardiographic examinations. An understanding of the physics and underlying assumptions of ultrasound processing involved with image generation is important for accurate interpretation of 2D grayscale, spectral Doppler, color flow Doppler, and 3D artifacts and their clinical implications.

Several steps forward: a new meter for multiple patient use.

Point-of-care (POC) blood glucose testing is becoming ubiquitous in the hospitals because of ease of use, timely results, and cost effectiveness. Historically, these POC devices were designed and regulated for home use by patients with diabetes. Their transition into the hospital multipatient setting has introduced the real risk of cross-contamination and has exposed inadequate accuracy standards. This article highlights some of the current recommendations for these devices and focuses on a new meter that addresses these issues. Although not currently approved for use in the United States, the OneTouch® Verio®Pro blood glucose meter (LifeScan, Inc.), which is the topic of an article by MacRury and coauthors in this issue of the Journal of Diabetes Science and Technology, is a step forward with minimal interferences and good accuracy, and perhaps most importantly, is robust enough to withstand rigorous disinfection.

Blood glucose measurement in the intensive care unit: what is the best method?

Abnormal glucose measurements are common among intensive care unit (ICU) patients for numerous reasons and hypoglycemia is especially dangerous because these patients are often sedated and unable to relate the associated symptoms. Additionally, wide swings in blood glucose have been closely tied to increased mortality. Therefore, accurate and timely glucose measurement in this population is critical. Clinicians have several choices available to assess blood glucose values in the ICU, including central laboratory devices, blood gas analyzers, and point-of-care meters. In this review, the method of glucose measurement will be reviewed for each device, and the important characteristics, including accuracy, cost, speed of result, and sample volume, will be reviewed, specifically as these are used in the ICU environment. Following evaluation of the individual measurement devices and after considering the many features of each, recommendations are made for optimal ICU glucose determination.