Multimodal analysis of methylomics and fragmentomics in plasma cell-free DNA for multi-cancer early detection and localization.

Despite their promise, circulating tumor DNA (ctDNA)-based assays for multi-cancer early detection face challenges in test performance, due mostly to the limited abundance of ctDNA and its inherent variability. To address these challenges, published assays to date demanded a very high-depth sequencing, resulting in an elevated price of test. Herein, we developed a multimodal assay called SPOT-MAS (screening for the presence of tumor by methylation and size) to simultaneously profile methylomics, fragmentomics, copy number, and end motifs in a single workflow using targeted and shallow genome-wide sequencing (~0.55×) of cell-free DNA. We applied SPOT-MAS to 738 non-metastatic patients with breast, colorectal, gastric, lung, and liver cancer, and 1550 healthy controls. We then employed machine learning to extract multiple cancer and tissue-specific signatures for detecting and locating cancer. SPOT-MAS successfully detected the five cancer types with a sensitivity of 72.4% at 97.0% specificity. The sensitivities for detecting early-stage cancers were 73.9% and 62.3% for stages I and II, respectively, increasing to 88.3% for non-metastatic stage IIIA. For tumor-of-origin, our assay achieved an accuracy of 0.7. Our study demonstrates comparable performance to other ctDNA-based assays while requiring significantly lower sequencing depth, making it economically feasible for population-wide screening.

Long-term Results of Totally Laparoscopic Near-total Gastrectomy for Middle-third Gastric Cancer.

PURPOSE: In recent years, laparoscopic near-total gastrectomy (LnTG) has emerged as a surgical option for gastric cancer in the middle-third of the stomach. However, its application in locally advanced stages presents technical challenges. This study aims to provide a detailed analysis of the operative outcomes and long-term functional and oncological results of totally LnTG in combination with D2 lymphadenectomy for middle-third gastric cancer. PATIENTS AND METHOD: A prospective study was conducted on 79 patients who underwent totally LnTG and D2 lymphadenectomy for middle-third gastric cancer between January 2017 and December 2021. Short-term outcomes included operative characteristics, and the evaluation of gastroesophageal reflux and gastric remnant condition using endoscopy based on the Los Angeles (LA) and Residue-Gastritis-Bile classifications. Long-term oncological outcomes included overall survival and disease-free survival. RESULTS: Totally LnTG was successfully performed in 98.7% of patients without intraoperative complications or conversions to laparotomy. The mean operation time was 202.2±43.0 min, and the median blood loss was 50 (50;100) mL. The overall incidence of postoperative morbidities was 16.5%, with one patient experiencing a narrowing of the gastrojejunostomy, successfully treated by endoscopic balloon dilation. All patients had tumor-free resection margins, and there were no mortalities. The 5-year overall survival and disease-free survival rates were 80% and 55%, respectively. CONCLUSIONS: Totally LnTG is an effective and feasible approach for gastric cancer in the middle-third of the stomach, yielding favorable short-term outcomes and acceptable long-term results. Routine application of totally LnTG for middle-third gastric cancer is practical and promising.

Regional Lymph Node Metastasis Distribution in Resectable Middle-Third Gastric Cancer: A Cross-Sectional Study.

Introduction Lymph node (LN) metastasis happens even in early gastric cancer (GC) even in LN stations that are not adjacent to the primary tumor. Total or subtotal gastrectomy (TG or sTG) can be performed in the middle third of the GC if the negative proximal margin is maintained. These procedures differed in the extent of LN dissection; therefore, oncology considerations must be taken into consideration when selecting the appropriate procedure. Methods This was a cross-sectional study involving 98 patients suffering from middle-third GC. The metastatic lymph nodes (mLN) ratio was calculated in each case by the ratio between the number of mLN and the number of total LNs retrieved. We compare the difference in the total LN retrieved, number of mLN, and rate of positive LN (N+) between the two groups TG and sTG. Results The majority of patients had advanced GC (82.7% pT2-4). About 65.3% of patients had metastasis LN. The events of LN metastasis and skipped LN metastasis happened even in tumors contained in the submucosal layer. The metastasis rates in each LN station were also increasing in correlation with the depth of tumor invasion. For LN station No. 2, 4sa, 10, 11d (which are not mandatory) in sTG, the rate of mLN was 0% for the pT1-3 tumor, regardless of tumor longitudinal location. The rate of mLN for each station was higher in adjacent stations of the tumor (No. 1-3-5-7 in lesser curvature, No. 4sb-4d-6 in greater curvature, No.1-3-4sb in the anterior wall, No. 3-7-12a in the posterior wall). The total LN retrieved, number of mLN, and rate of positive LN were statistically higher in the TG group compared to the sTG group. However, the mean mLN ratios between the two groups were comparable (p = 0.116). Conclusion In accordance with the macroscopic and microscopic characteristics, we observed a stratified distribution of mLN in the middle third of the GC. With these early results, sTG combined with standard lymphadenectomy was an acceptable treatment for T1-T3 middle-third GC in terms of mLN distribution. Total No. 4sb LN dissection might also be reserved in gastrectomy for T1-T3 GC.

Comparison of Perceptions About Patient Safety Culture Between Physicians and Nurses in Public Hospitals in Vietnam.

Introduction: Patient safety culture (PSC) is a vital component in ensuring high-quality and safe patient care. Assessment of physicians' and nurses' perceptions of existing hospital PSC is the first step to promoting PSC. This paper is aimed to assess physicians' and nurses' perceptions of PSC in 5 public general hospitals in Hanoi, Vietnam. Methods: This cross-sectional study surveyed 410 physicians and 824 nurses utilizing the validated Hospital Survey on Patient Safety Culture in an online format. Results: The composite positive physician's perception of PSC varied from 47.8 to 89.6% with the lowest composite score of patient safety for "staffing" (47.8%) and the highest composite score for "teamwork within units" (89.6%). The composite positive responses for perception among nurses varied from 51.3 to 94.2% with the lowest composite score of patient safety for "staffing" (51.3%) and the highest composite score for "teamwork within units" (94.2%). Conclusion: The mean scores for "supervisor/manager expectations"; "staffing", "management support for patient safety", "teamwork across units", "handoffs and transitions" among nurses were significantly higher than that among physicians (p<0.05). About two-thirds of physicians and nurses reported no event in the past 12 months (62.8 and 71.7%, respectively). The nurses reported significantly higher patient grades (every good and excellent) than physicians (75% vs 67.1%, p <0.001). Hospitals could develop and implement intervention programs to improve patient safety, including providing interventions on teamwork and communication, encouraging staff to notify incidents, and avoiding punitive responses.

Massively parallel sequencing of human skeletal remains in Vietnam using the precision ID mtDNA control region panel on the Ion S5™ system.

Mitochondrial DNA (mtDNA) analysis using Sanger sequencing has been a routine practice for the identification of human skeletal remains. However, this process is usually challenging since DNA from the remains is highly degraded and at low concentration. Recently, the advent and implementation of massively parallel sequencing (MPS) have been offered the ability to improve mtDNA sequence data for forensic analysis. To assess the utility of the Ion S5™ system - an MPS platform for mtDNA analysis in challenging samples, we sequenced the mitochondrial control region of 52 age-old skeletal remains. Using the Precision ID mtDNA Control Region Panel, 50 full and two partial control region haplotypes at relatively high mean coverage of 2494 × were achieved for variant calling. Further variant analysis at 10% threshold for point heteroplasmy showed high degradation degree in terms of DNA damage in our bone samples. A higher point heteroplasmy threshold of 20% was required to diminish most of background noise caused by the damage. The results from this study indicated the potential application of the Ion S5™ system in sequencing degraded samples in Vietnam and provided valuable data sources for forensic analyses in the future.

Occupational Stress Among Health Worker in a National Dermatology Hospital in Vietnam, 2018.

A cross-sectional study was conducted among 171 doctors and nurses in a National Dermatology hospital using the Karasek's Job Content Questionnaire which has been validated in Vietnamese (JCQ-V), to assess the prevalence of occupational stress and to explore the association with some associated factors among them. The result showed that doctors and nurses with occupational stress accounted for 6.4%. This proportion was higher among nurse compared to doctor (8.0% vs. 2.2%); among those with diploma literacy compared to bachelor and above (10.6% and 2.3%). This rate was also higher in health workers under 30 years old (12.9%), health workers under 5 years at work (12.1%), working night shift from 3-4 nights (33.3%), temporary employment (12.8%), heavy workload occasionally (12.5%), and working hard occasionally (17.2%) compared to those in the comparison groups with p value <0,05. This prevalence concentrated in some departments such as surgery (11.9%), internal medicine (6.7%), dermatology, and others (1.5%). The study has not found the significant association between the prevalence of occupational stress and heavy workload and skill level. Therefore, it is essential for hospital should conduct screening all doctors, nurses, and medical staffs to identify subjects having occupational stress and give appropriate intervention.

Situation, clinical characteristics and the value of PCR in diagnosis of urogenital chlamydia infection

The study aimed to investigate the situation, clinical characteristics and the value of PCR in diagnosis of urogenital chlamydia infection. During 3 months (6/2003-9/2003) we had studied 416 patients with urogenital discharge attending at laboratory department of the National Institute of Dermatology of Vietnam (NIDV). They had been tested for the C.T by using PCR and /or Hexagon (EIA). Results: 94 patients were detected C.T infection, the rate is 22.6%. In which, number of the women is 3.66 times higher than the men. The highest frequency of C.T infection is group of age from 25 to 34, and patients who live in urban. The most common symptom is cervicitis (in female) and urethritis, pain or burning during urenation (in male). PCR was positive in some cases which were negative with Hexagon test.