Comparison of waist circumference and waist-to-height ratio as predictors of clustering of cardiovascular risk factors among middle-aged people in rural Khanh Hoa, Vietnam.

OBJECTIVE: Given the population-level variation in stature, a universal cut-off for waist circumference (WC) may not be appropriate for some populations. We compared the performance of WC and waist-to-height ratio (WHtR) to detect the clustering of cardiovascular disease (CVD) risk factors in rural Vietnam. METHODS: We obtained data from a baseline survey of the Khanh Hoa Cardiovascular Study comprising 2942 middle-aged residents (40-60 years). We used areas under the receiver operating characteristics curve (AUROC), net reclassification index (NRI), and integrated discrimination improvement (IDI) to compare the performance of WC and WHtR in predicting CVD risk clustering (≥2 of the following risk factors: hypertension, diabetes, dyslipidemia, and elevated C-reactive protein). RESULTS: The optimal cut-off values for WC were 81.8 and 80.7 cm for men and women, respectively. Regarding the clustering of CVD risk factors, the AUROC (95% CI) of WC and WHtR were 0.707 (0.676 to 0.739) and 0.719 (0.689 to 0.749) in men, and 0.682 (0.654 to 0.709) and 0.690 (0.663 to 0.717) in women, respectively. Compared with WC, WHtR had a better NRI (0.229; 0.102-0.344) and IDI (0.012; 0.004-0.020) in men and a better NRI (0.154; 0.050-0.257) in women. CONCLUSIONS: The optimal WC cut-off for Vietnamese men was approximately 10 cm below the recommended Asian cut-off. WHtR might perform slightly better in predicting the clustering of CVD risk factors among the rural population in Vietnam.

Hemophagocytic lymphohistiocytosis secondary to diffuse large B-cell lymphoma presenting with recurrent multi-territory infarcts: A case report.

Lymphoma-associated hemophagocytic syndrome is a life-threatening disease with poor prognosis and may present as ischemic stroke. We report a case of a 56-year-old female with recurrent multi-territory infarcts caused by diffuse large B-cell lymphoma with secondary hemophagocytic lymphohistiocytosis. She had been diagnosed with ischemic stroke and hemophagocytic syndrome probably secondary to Epstein-Barr virus infection 3 months previously and treated with Dexamethasone and Aspirin. High resolution vessel wall magnetic resonance imaging showed vessel wall thickening at some intracranial vessels suggesting vasculitis. Abdominal computed tomography scan revealed splenomegaly, multiple bilateral small nodules of the lung, multiple liver lesions, multiple bilateral renal masses, gastric wall thickening and multiple nodules in the omentum. Cerebrospinal fluid cytology showed increased cerebrospinal-fluid protein level. Hemophagocytosis was showed on bone marrow aspirate cytology. Gastric tissue biopsy revealed large B cell lymphoma. Chemotherapy was not given because the patient had severe pneumonia and sepsis. The patient died 28 days after the definitive diagnosis was confirmed. Ischemic stroke in our patient with diffuse large B-cell lymphoma may be due to vasculitis or intravascular large B-cell lymphoma.

Role of diffusion-weighted MRI in differentiation between benign and malignant anterior mediastinal masses.

Diffusion-weighted imaging (DWI) is considered to be a useful biomarker to characterize the cellularity of lesions, yet its application in the thorax to evaluate anterior mediastinal lesions has not been well investigated. The aims of our study were to describe the magnetic resonance (MR) characteristics of anterior mediastinal masses and to assess the role of apparent diffusion coefficient (ADC) value in distinguishing benign from malignant lesions of the anterior mediastinum. We conducted a retrospective cross-sectional study including 55 patients with anterior mediastinal masses who underwent preinterventional MR scanning with the following sequences: T1 VIBE DIXON pre and post-contrast, T2 HASTE, T2 TIRM, DWI-ADC map (b values of 0 and 2000 sec/mm2). The ADC measurements were obtained by two approaches: hot-spot ROI and whole-tumor histogram analysis. The lesions were grouped by three distinct ways: benign versus malignant, group A (benign lesions and type A, AB, B1 thymoma) versus group B (type B2, B3 thymoma and other malignant lesions), lymphoma versus other malignancies. The study was composed of 55 patients, with 5 benign lesions and 50 malignant lesions. The ADCmean, ADCmedian, ADC10, ADC90 in the histogram-based approach and the hot-spot-ROI-based mean ADC of the malignant lesions were significantly lower than those of benign lesions (P values< 0.05). The hot-spot-ROI-based mean ADC had the highest value in differentiation between benign and malignant mediastinal lesions, as well as between group A and group B; the ADC cutoffs (with sensitivity, specificity) to differentiate malignant from benign lesions and group A from group B were 1.17 x 10-3 mm2/sec (80%, 80%) and 0.99 x 10-3 mm2/sec (78.4%, 88.9%), respectively. The ADC values obtained by using the hot-spot-ROI-based and the histogram-based approaches are helpful in differentiating benign and malignant anterior mediastinal masses.

Intermittent and Unilateral Chorioretinal Folds due to Combined Chiari 1 Malformation and Basilar Invagination.

We report the case of a 35-year-old female with combined Chiari 1 malformation and basilar invagination, who presented with intermittent conjunctival chemosis and unilateral chorioretinal folds that were temporally correlated. She denied any flashes, floaters, eye redness, or pain. She also denied nausea or vomiting. Clinical exam and optical coherence tomography imaging revealed conjunctival chemosis and chorioretinal folds in the left eye. Subsequent magnetic resonance imaging of the brain and the orbits were consistent with combined Chiari 1 malformation and basilar invagination. The unilateral and intermittent chorioretinal folds and conjunctival chemosis presentation of combined Chiari 1 malformation and basilar invagination is unusual. To the best of our knowledge, this is the first case to be reported with this unique clinical presentation. It is most important to be aware that unilateral and intermittent chorioretinal folds associated with conjunctival chemosis may be signs of intracranial disease.

Correlation of Chest X-Ray Scores in SARS-CoV-2 Patients With the Clinical Severity Classification and the Quick COVID-19 Severity Index.

Objectives This study aimed to assess the role of chest X-ray (CXR) scoring methods and their correlations with the clinical severity categories and the Quick COVID-19 Severity Index (qCSI). Methods We conducted a retrospective study of 159 COVID-19 patients who were diagnosed and treated at the University Medical Center between July and September 2021. Chest X-ray findings were evaluated, and severity scores were calculated using the modified CXR (mCXR), Radiographic Assessment of Lung Edema (RALE), and Brixia scoring systems. The three scores were then compared to the clinical severity categories and the qCSI using Spearman's correlation coefficient. Results Overall, 159 patients (63 males and 96 females) (mean age: 58.3 ± 15.7 years) were included. The correlation coefficients between the mCXR score and the Brixia and RALE scores were 0.9438 and 0.9450, respectively. The correlation coefficient between the RALE and Brixia scores was marginally higher, at 0.9625. The correlation coefficients between the qCSI and the Brixia, RALE, and mCXR scores were 0.7298, 0.7408, and 0.7156, respectively. The significant difference in the mean values of the three CXR scores between asymptomatic, mild, moderate, severe, and critical groups was also noted. Conclusions There were strong correlations between the three CXR scores and the clinical severity classification and the qCSI.

Deep Learning Model With Convolutional Neural Network for Detecting and Segmenting Hepatocellular Carcinoma in CT: A Preliminary Study.

Introduction Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world. Early detection and accurate diagnosis of HCC play an important role in patient management. This study aimed to develop a convolutional neural network-based model to identify and segment HCC lesions utilizing dynamic contrast agent-enhanced computed tomography (CT). Methods This retrospective study used CT image sets of histopathology-confirmed hepatocellular carcinoma over three phases (arterial, venous, and delayed). The proposed convolutional neural network (CNN) segmentation method was based on the U-Net architecture and trained using the domain adaptation technique. The proposed method was evaluated using 115 liver masses of 110 patients (87 men and 23 women; mean age, 56.9 years ± 11.9 (SD); mean mass size, 6.0 cm ± 3.6). The sensitivity for identifying HCC of the model and Dice score for segmentation of liver masses between radiologists and the CNN model were calculated for the test set. Results The sensitivity for HCC identification of the model was 100%. The median Dice score for HCC segmenting between radiologists and the CNN model was 0.81 for the test set. Conclusion Deep learning with CNN had high performance in the identification and segmentation of HCC on dynamic CT.

Clinical Features and Treatment Outcome of a Concurrent Central Retinal Vein Occlusion and Cilioretinal Artery Occlusion.

We describe the clinical features and treatment outcome of a patient with combined central retinal vein occlusion and cilioretinal artery occlusion. A 52-year-old female presented to our clinic with decreased vision in the right eye for 4 days. Visual acuity and intraocular pressure were count fingers at 2&1/2M and 14 mm Hg in the right and 20/20 and 16 mm Hg in the left eye, respectively. Funduscopic exam and optical coherence tomography (OCT) of the right eye confirmed the diagnosis of concurrent cilioretinal artery occlusion and central retinal vein occlusion with segmental macular pallor in the territory of the cilioretinal artery, corresponding marked inner retina thickening on OCT and signs of vein occlusion. The patient received an intravitreal injection of bevacizumab and at 1-month follow-up, vision improved to 20/30 with corresponding anatomical improvement. It is very important to recognize combined central retinal vein occlusion and cilioretinal artery occlusion as they could be treated with intravitreal injections of anti-vascular endothelial growth factors with favorable treatment outcomes.

Central Hyperthyroidism due to Thyroid-Stimulating Hormone-Secreting Pituitary Microadenoma in an Adolescent Boy: Case Report and Review of the Literature.

Thyroid-stimulating hormone- (TSH-) secreting pituitary adenoma (TSH-oma) is a rare cause of secondary hyperthyroidism and can be misdiagnosed as primary hyperthyroidism. We report a case of a 15-year-old male patient who was one of two monozygotic twins and exhibited hyperthyroidism syndrome. The laboratory results showed secondary hyperthyroidism, with increased levels of free T3 (FT3) and free T4 (FT4) and no TSH inhibition. Magnetic resonance imaging (MRI) and histopathological examination of the pituitary gland confirmed pituitary microadenoma. The patient was treated with methimazole, propranolol, and somatostatin analogs to restore euthyroidism before undergoing an endoscopic transsphenoidal resection of the pituitary tumor. After surgery, the hyperthyroidism symptoms improved, thyroid hormones normalized, and MRI of the pituitary gland showed the complete removal of the tumor with no recurrence after 2 years of follow-up.

Kinematic instability in the joints of flatfoot subjects during walking: A biplanar fluoroscopic study.

Abnormal foot kinematics is observed in flatfoot subjects with postural foot deformity. We aimed to investigate joint instability in flatfoot subjects by analyzing the abnormal rotational position and speed of their joints while walking. Five flatfoot subjects participated in our study. Three-dimensional motions of the tibia, talus, calcaneus, navicular, and cuboid were obtained during walking using the biplanar fluoroscopic motion analyses. An anatomical coordinate system was established for each bone. The rotations and ranges of motion (ROMs) of the joints from heel-strike to toe-off were quantified. The relative movements on the articular surfaces were quantified by surface relative velocity vector analysis. The data from flat foot subjects were compared with the data from normal foot subjects in previous studies. The average relative speed on the articular surface of the tibiotalar, subtalar, and calcaneocuboid joints for the flatfoot subjects was significantly higher (p < 0.05) than that for the normal foot subjects. The flatfoot subjects exhibited increased movements toward plantar flexion in the tibiotalar joint, and eversion and external rotations in the talonavicular joint during the stance phase, compared to the normal subjects (p < 0.01). Furthermore, the flatfoot subjects had a significantly larger ROM along with the inversion/eversion rotations (5.6 ± 1.8° vs. 10.7 ± 4.0°) and internal/external rotations (7.1 ± 1.5° vs. 10.5 ± 3.5°) in the tibiotalar joint. The flatfoot subjects demonstrated abnormal kinematics and larger joint movements in multiple joints during the mid-stance and terminal stance phases of walking. This demonstrates their high instability levels.

Controlling environmental pollution: dynamic role of fiscal decentralization in CO2 emission in Asian economies.

The "environment" has become one of the important and debatable topics of the world and policymakers identifying the new predictors of CO2 emissions. Therefore, some economies have been promoting fiscal decentralization to encourage environmental quality by granting more financial autonomy to provincial and sub-national governments. Therefore, this study evaluates the dynamic effect of fiscal decentralization on CO2 in selected nine Asian economies using a fresh dynamic panel ARDL model from 1984 to 2017. The empirical findings show that fiscal decentralization has asymmetric effects on CO2 emissions because a positive change in revenue and expenditure decentralization reduced CO2 emissions in Asia. Moreover, a negative change in expenditure decentralization has also enhanced CO2 emissions in the long run. Thus, clean environmental policies and recommendations can be revised and proposed based on nonlinear findings in the modern era.

Differentiation Between Surgical and Nonsurgical Intussusception: A Diagnostic Model Using Multi-Detector Computed Tomography.

BACKGROUND: The differentiation of surgical from nonsurgical adult intussusception may enable the appropriate selection of management strategies. OBJECTIVE: This study aimed to investigate the diagnostic potential of multidetector computed tomography (MCDT) features to differentiate surgical from nonsurgical adult intussusception and develop a diagnostic model. METHODS: A retrospective study was performed on 96 patients with intussusceptions at the University Medical Center Hospital between January 2014 and January 2020. Two radiologists reviewed all images, and intussusception characteristics were documented. The location of intussusception, length, diameter, interposed fat thickness, lead point, and complications were evaluated. Based on the results, a diagnostic tree model was developed to differentiate between surgical and nonsurgical adult intussusception. RESULTS: A total of 99 intussusceptions in 96 patients (mean age: 53.0 ± 16.5 years), including 35 (35.3%) enteroenteric, 27 (27.3%) enterocolic, and 37 (37.4%) colocolic lesions, were evaluated. Of the enteroenteric intussusceptions, 22 (62.9%) were surgical, including 19 (79.2%) with lead points. Among colon intussusceptions, 63 (98.4%) were surgical, and 100% had lead points. The characteristics used to predict surgical intussusceptions included lead point presence, length ≥ 5.0 cm, diameter ≥ 3.2 cm, interposed fat thickness ≥ 0.5 cm, and complications (p < 0.001). Based on these features, we established a diagnostic tree model that correctly classified 96 (97%) of 99 lesions. CONCLUSION: Our study reinforces the importance of MDCT for the diagnosis and guided management of adult intussusceptions. The characteristics that predicted surgical intussusceptions included lead points, length, diameter, interposed fat thickness, and complications. A systematic approach using this diagnostic tree model could be used to distinguish surgical and nonsurgical adult intussusception.

Effects of Feed Mixed with Lactic Acid Bacteria and Carbon, Nitrogen, Phosphorus Supplied to the Water on the Growth and Survival Rate of White Leg Shrimp (Penaeus vannamei) Infected with Acute Hepatopancreatic Necrosis Disease Caused by Vibrio parahaemolyticus.

This study aimed to evaluate the growth, survival rate, and resistance to acute hepatopancreatic necrosis disease (AHPND) of white leg shrimp (Penaeus vannamei) by using Lactobacillus plantarum, Lactobacillus fermentum, and Pediococcus pentosaceus mixed with feed, and at the same time supplying CNP in a ratio of 15:1:0.1 to the water. As a result, the treatments that shrimp were fed with feed containing lactic acid bacteria (LAB), especially L. plantarum, have increased shrimp growth, total hemocyte cells, granulocyte cells, and hyaline cells significantly (p < 0.05) in comparison to the control group. The supply of CNP to the water has promoted the intensity of V. parahaemolyticus effects on shrimp health and significantly decreased total hemocyte cells, granulocyte cells, and hyaline cells by 30-50% in the period after three days of the challenge, except in L. plantarum treatment, which had only a 20% decrease compared to other treatments. In CNP supplying treatments, the AHPND infected rate and mortality of shrimp were higher than those in other treatments. In summary, the supply of CNP had significantly reduced the shrimp's immune response and promoted the susceptibility of shrimp to AHPND in both cases of use with and without LAB-containing diets.

Alcohol and gastric motility: pathophysiological and therapeutic implications.

Alcohol has been associated with alterations in gastric motility. The literature identifies that various factors play a role in alcohol's effect on gastric emptying including differences in alcohol concentration, osmolarity, caloric content, amino acids as well as different processing techniques (fermentation vs distillation). Additionally, chronic alcohol consumption has been shown to alter the myenteric nitrergic system resulting in impaired gastrointestinal motor function, and it also has an inhibitory effect on the release of several neurotransmitters that play a key role in gastrointestinal motility, including acetylcholine. Whether social or limited intake of alcohol could have a therapeutic role has not been apparent. Serendipitously, we have identified a therapeutic role for alcohol with a meal in the entity of dumping syndrome (DS) where there is postprandial rapid emptying of voluminous and hyperosmolar gastric contents into the small bowel. In the clinical setting of DS attributed to impaired vagal nerve function, there was normalization of gastric emptying and resolution of accompanying symptoms when drinking a glass of wine before and during meals. We propose that alcohol's anticholinergic effect was augmented in the setting of vagal nerve denervation resulting in slowing of gastric emptying and in alleviation of symptoms of early DS. This review article provides an in-depth analysis of the published literature on alcohol and gastric motility focusing on the accumulated knowledge that may have clinical application and relevance.

Conversions to open surgery greatly increase complications: an analysis of the MBSAQIP database.

BACKGROUND: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database tracks patients, techniques, and outcomes for 30 days. The overwhelming majority of cases reported are performed using a laparoscopic technique. Bariatric surgeons rarely have to convert from laparoscopy to open surgery. OBJECTIVES: We examined the MBSAQIP to determine the characteristics of patients who underwent conversion and evaluated their short-term outcomes. SETTINGS: University program in the United States and nationwide clinical database. METHODS: The MBSAQIP Public Use File for 2017 was examined for primary bariatric operations. We identified patients who underwent a sleeve gastrectomy or gastric bypass using a minimally invasive technique. We identified patients who underwent conversion to another operative technique or were converted to open surgery and analyzed preoperative characteristics and postoperative complication rates. Relative risks (RR) were calculated for complications. P value was significant at < .05. RESULTS: There were 186,962 patients in the entire cohort. Six hundred nine patients underwent conversion from the original surgical approach to either open surgery (n = 457) or to another technique (n = 152). Patients with preoperative oxygen dependency, poor functional status, previous foregut/obesity surgery, preoperative renal insufficiency, and anticoagulation were more likely to undergo conversion. Patients who underwent conversion to the open approach had longer operative times (191 versus 86.6 min [P < .001]) and longer time to discharge (6.2 versus 1.6 d [P < .001]). The RR of death was 18.2 (95% confidence interval 8.7-37.6, P < .001) for procedures converted to open. The RR of sepsis was 10.1 (95% confidence interval 4.2-24.2, P < .001) and the RR for all complications was increased throughout for patients undergoing conversion. CONCLUSIONS: Patients in the MBSAQIP database that undergo conversion to the open surgical approach are at a greatly increased risk for death and complications.

Skeletal kinematics of the midtarsal joint during walking: Midtarsal joint locking revisited.

The kinematics of the human foot complex have been investigated to understand the weight bearing mechanism of the foot. This study aims to investigate midtarsal joint locking during walking by noninvasively measuring the movements of foot bones using a high-speed bi-planar fluoroscopic system. Eighteen healthy subjects volunteered for the study; the subjects underwent computed tomography imaging and bi-planar radiographs of the foot in order to measure the three-dimensional (3D) midtarsal joint kinematics using a 2D-to-3D registration method and anatomical coordinate system in each bone. The relative movements on bone surfaces were also calculated in the talonavicular and calcaneocuboid joints and quantified as surface relative velocity vectors on articular surfaces to understand the kinematic interactions in the midtarsal joint. The midtarsal joint performed a coupled motion in the early stance to pronate the foot to extreme pose in the range of motion during walking and maintained this pose during the mid-stance. In the terminal stance, the talonavicular joint performed plantar-flexion, inversion, and internal rotation while the calcaneocuboid joint performed mainly inversion. The midtarsal joint moved towards an extreme supinated pose, rather than a minimum motion in the terminal stance. The study provides a new perspective to understand the kinematics and kinetics of the movement of foot bones and so-called midtarsal joint locking, during walking. The midtarsal joint continuously moved towards extreme poses together with the activation of muscle forces, which would support the foot for more effective force transfer during push-off in the terminal stance.

Safety of a quadrivalent meningococcal conjugate vaccine in healthy subjects aged 9 months to 55 years in Vietnam.

PURPOSE: Meningococcal disease is a major global health concern due to its severe and sudden clinical manifestations, devastating long-term sequelae, and predominance in younger age groups. This study evaluated the safety of a quadrivalent meningococcal polysaccharide diphtheria toxoid conjugate vaccine (MenACWY-D; Menactra) in participants aged 9 months to 55 years in Vietnam. METHODS: This was an open-label, single-arm study conducted between June and December 2016. Participants received one 0.5-mL dose of the vaccine, and those aged 9 to 23 months received a second 0.5-mL dose 3 months later. Participants (or their parents or legal guardians) reported adverse events during the 28 days after each dose. RESULTS: The study included 112 participants aged 9 to 23 months and 112 participants aged 2 to 55 years. Of these 224 participants, 100 (44.6%) had one or more solicited reactions within 7 days following any MenACWY-D dose, mostly injection site pain, lost appetite (in 9 to 23-month-olds), and malaise (in 2 to 55-year-olds). Most solicited reactions were of mild or moderate intensity and resolved within 3 days. Five participants had unsolicited adverse reactions (ARs), two of which (tonsillitis and febrile convulsion), in 9 to 23-month-olds, were considered by the investigator as serious adverse events related to the vaccine. No immediate unsolicited ARs, severe unsolicited nonserious ARs, or unsolicited injection site reactions were reported, and both participants who experienced vaccine-related serious adverse events recovered. CONCLUSION: Consistent with studies in other countries, MenACWY-D had an acceptable safety profile in individuals from Vietnam aged 9 months to 55 years (WHO Universal Trial Number: U1111-1143-9207).

Predicting body movements for person identification under different walking conditions.

Human motion during walking provides biometric information which can be utilized to quantify the similarity between two persons or identify a person. The purpose of this study was to develop a method for identifying a person using their walking motion when another walking motion under different conditions is given. This type of situation occurs frequently in forensic gait science. Twenty-eight subjects were asked to walk in a gait laboratory, and the positions of their joints were tracked using a three-dimensional motion capture system. The subjects repeated their walking motion both without a weight and with a tote bag weighing a total of 5% of their body weight in their right hand. The positions of 17 anatomical landmarks during two cycles of a gait trial were generated to form a gait vector. We developed two different linear transformation methods to determine the functional relationship between the normal gait vectors and the tote-bag gait vectors from the collected gait data, one using linear transformations and the other using partial least squares regression. These methods were validated by predicting the tote-bag gait vector given a normal gait vector of a person, accomplished by calculating the Euclidean distance between the predicted vector to the measured tote-bag gait vector of the same person. The mean values of the prediction scores for the two methods were 96.4 and 95.0, respectively. This study demonstrated the potential for identifying a person based on their walking motion, even under different walking conditions.

Fetal Zika Virus Infection in Vietnam.

As of 13 July 2016, 13 countries have reported fetal Zika virus (ZIKV) infection. Here we report a case of fetal ZIKV infection that resulted from an infection originating in Vietnam.