108 Military Central Hospital

BACKGROUND Kennedy disease, also known as spinal and bulbar muscular atrophy (SBMA), is a rare and incurable X-linked neuromuscular disorder mainly affecting men aged 30 to 60 years. Polymyositis can present similarly, but can be excluded by measuring muscle enzymes, performing muscle imaging, and electromyography. This report describes the case of a 52-year-old man with a 10-year history of progressive limb weakness due to Kennedy disease, established by genetic testing. CASE REPORT A 52-year-old man presented with a 10-year history of gradually progressive proximal limb weakness and persistently elevated creatine kinase levels ranging from 808-2300 U/L (normal 39-308 U/L). One year prior to this admission, the limb weakness had worsened, but initial electromyography, neuroimaging, and muscle biopsy showed no specific abnormalities. Despite a trial of immunosuppressive therapy due to suspected polymyositis, there was no clinical improvement. Neurological examination later revealed gynecomastia, proximal muscle atrophy, and bilateral tongue atrophy with tremor. Electromyography showed chronic neurogenic changes and reduced sensory nerve action potentials. Repeat expansion analysis identified a hemizygous pathogenic CAG repeat expansion in exon 1 of the androgen receptor gene using a short-read next-generation sequencing-based repeat detection algorithm (ExpansionHunter), with an estimated repeat number of 51 (range 50-53). At 6-month follow-up, the patient demonstrated mild progression of motor symptoms but remained functionally stable. CONCLUSIONS This report presents a rare case of Kennedy disease, initially diagnosed as polymyositis, and highlights the importance of follow-up with genetic testing when neurological and electromyography investigations are not typical for polymyositis. Early identification of Kennedy disease helps avoid unnecessary immunosuppressive treatments.

Mục tiêu: Đánh giá tác dụng và tính an toàn của Cao Kim Cương Đông Á-D đối với glucose máu, HbA1c, lipid máu, chức năng gan và thận ở bệnh nhân đái tháo đường typ 2. Phương pháp: Nghiên cứu can thiệp được thực hiện trên 60 bệnh nhân đái tháo đường typ 2 có glucose máu lúc đói từ 7–10 mmol/L và HbA1c < 8%. Các bệnh nhân được chia thành hai nhóm: nhóm bệnh nhân mới được chẩn đoán, đang áp dụng chế độ ăn và luyện tập tối thiểu 1 tháng (30 bệnh nhân) và nhóm bệnh nhân đang sử dụng một thuốc uống hạ đường huyết theo Y học hiện đại trong tối thiểu 1 tháng nhưng chưa kiểm soát glucose máu và HbA1c theo mục tiêu điều trị (30 bệnh nhân). Tất cả đối tượng nghiên cứu được sử dụng Cao Kim Cương Đông Á-D với liều 10 g/ngày trong thời gian 90 ngày. Kết quả: Sau 90 ngày can thiệp, nồng độ glucose máu lúc đói và HbA1c giảm có ý nghĩa thống kê (p < 0,05) ở cả hai nhóm nghiên cứu. Tỷ lệ bệnh nhân đạt mục tiêu điều trị ghi nhận 76,7% ở nhóm bệnh nhân mới chẩn đoán và 30% ở nhóm đang điều trị thuốc uống hạ đường huyết. Không ghi nhận tác dụng không mong muốn trên lâm sàng trong quá trình theo dõi. Kết luận: Cao Kim Cương Đông Á-D có tác dụng hỗ trợ cải thiện glucose máu và HbA1c ở bệnh nhân đái tháo đường typ 2 có glucose máu lúc đói 7–10 mmol/L, HbA1c < 8%, đồng thời an toàn khi sử dụng trong 90 ngày.

To investigate the association between tumor morphology and muscle-invasive bladder cancer (MIBC) in patients with newly diagnosed bladder cancer (BC). This retrospective study included 416 patients who underwent transurethral resection of a bladder tumor for newly diagnosed BC between January 2018 and December 2023 at a tertiary hospital in Vietnam. Multivariable logistic regression analysis was applied to assess the adjusted association between the sessile morphology of BC on cystoscopy and the risk of muscle invasion. Age, sex, tumor size, number of tumors, and pathological grade were considered confounders. Stratified analysis by tumor size and number of tumors was performed to clarify the effect modification. Patients with MIBC had a significantly higher prevalence of sessile morphology (68.8% vs. 28.4%, p<0.001). After controlling for confounders, patients with sessile tumors were three times more likely to have MIBC than those with papillary tumors (OR = 3.1, 95% CI = [1.8-5.3], p < 0.001). The association of sessile tumor with MIBC was higher in patients with tumor ≤3 cm (about 25%, OR = 3.9, 95% CI = [1.9-7.8]) and having >3 tumors (about 64%, OR = 5.1, 95% CI = [2.1-12.4]). Sessile morphology is associated with the risk of MIBC in patients newly diagnosed with BC. This association was more pronounced in patients with tumor ≤3 cm and >3 tumors.

BACKGROUNDAcute kidney injury (AKI) is a severe complication of acute pancreatitis (AP) associated with increased morbidity and mortality. Early prediction of AKI remains a clinical challenge owing to the limitations of traditional biomarkers, such as serum creatinine.AIMTo evaluate the concentration and predictive value of plasma neutrophil gelatinase-associated lipocalin (NGAL) in patients with AP and AKI.METHODSThis cross-sectional descriptive study was conducted from October 2021 to June 2023 at Bach Mai Hospital. In total, 219 patients were enrolled, including 51 patients with AP and AKI, 168 patients with AP but without AKI, and 35 healthy controls. Plasma NGAL levels were measured and compared between groups. Receiver operating characteristic curve analysis was performed to determine the predictive value of NGAL levels for the severity of AKI and AP.RESULTSAmong AP and AKI cases, 47.1% were classified as Kidney Disease: Improving Global Outcomes stage 1, 33.3% as stage 2, and 19.6% as stage 3. The AP with AKI group (570.9 ng/mL) had significantly higher median plasma NGAL concentrations than the AP without AKI group (400.6 ng/mL) and the healthy control group (234.3 ng/mL) (P < 0.01). The NGAL levels increased proportionally with AKI severity. A plasma NGAL cutoff value of 504.29 ng/mL predicted AKI with 60.8% sensitivity and 68.4% specificity (area under the curve = 0.684; P < 0.001). A cutoff of 486.03 ng/mL predicted AP severity with 66.1% sensitivity and 66.4% specificity (area under the curve = 0.651; P < 0.005). NGAL positively correlated with international normalized ratio, urea, creatinine, lactate dehydrogenase, and lactate levels.CONCLUSIONPlasma NGAL levels predicted both AKI development and disease severity. Therefore, NGAL should be considered a useful biomarker for the early evaluation of patients with AP.

Gastric cancer (GC) is one of the leading causes of cancer-related deaths globally, with a 5-year survival rate of less than 40%. While immune checkpoint inhibitors have provided promising therapeutic options for advanced GC, only a small proportion of patients benefit. In this study, we developed a deep learning model using whole-slide images to predict prognoses and sensitivity to immune checkpoint inhibitors in GC patients by predicting a novel marker. Formalin-fixed, paraffin-embedded whole-slide images from 292 patients in the Cancer Genome Atlas-Stomach Adenocarcinoma cohort were analyzed. Tumor regions were identified using a ResNet50-based tumor detection model and validated in HiESD dataset. Tiles classified as malignant were extracted for subsequent analysis. Risk score prediction models were developed using convolutional neural networks, clustering-constrained attention multiple-instance learning (CLAM), and dual-stream multiple-instance learning (DSMIL). Attention heatmap visualization was used to interpret tumor microenvironment (TME) features and a multi-model classification framework utilizing a support vector machine (SVM) was developed to assess the impact of clinical variables in model performances. The results were evaluated using the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, specificity, and F1 score. The tumor detection model achieved an AUROC of 0.99 on the training set, 0.92 on the test set, and 0.87 on external test set. Among risk score prediction models, DSMIL demonstrated the highest performance, with an AUROC of 0.73 and accuracy of 0.73 on the training set and AUROC of 0.70 and accuracy of 0.68 on the internal test set. High-risk patients exhibited worse survival outcomes and lower immunotherapy response rates compared with low-risk patients. Feature attribution analysis using attention heatmaps confirmed that the model prioritized TME components, specifically regions with dense lymphocytic infiltration. The muti-modal analysis showed that the image features alone were superior to the model combining image features with clinicopathological data. Deep learning models leveraging whole-slide images show potential in predicting prognoses and immunotherapy responses in GC. By integrating tumor-specific and tumor microenvironmental features, this approach offers a scalable, objective tool for personalized treatment planning, improving precision oncology strategies.

Off-pump coronary artery bypass surgery causes hemodynamic changes due to position and surgical manipulation, which directly affect cardiovascular function and increase the rate of postoperative complications. The study's goal was to evaluate the efficacy of early goal-directed therapy for hemodynamic stability in off-pump coronary artery bypass surgery. A case-control study was conducted between May 2022 and December 2024 in the Department of Anesthesiology and Critical Care at Military Hospital 175. Patients were monitored intraoperatively with ten time points using either the FloTrac/EV1000 system or conventional methods. Hemodynamic stability was measured by hemodynamic parameters (directly) and post-operative lactate levels (indirectly). The study included 70 patients (EGDT group: 36, Control group: 34). Baseline characteristics were similar between groups. Open surgery was performed in 90% of cases. Patients undergoing analysis recorded intraoperative hemodynamics with insignificant fluctuations of less than 5% in both groups. Both groups experienced a MAP nadir at T4 - post-anchoring suture (Control: 59.56 vs. EGDT: 62.42 mmHg). The EGDT group maintained significantly higher MAP After these points, the EGDT group showed faster MAP recovery. The EGDT implementation was associated with a 70% reduction in postoperative hyperlactatemia risk (OR 0.29; 95% CI 0.08-0.97; p = 0.023). Application of early goal-directed therapy in off-pump coronary artery bypass surgery showed hemodynamic stability, better control, and a statistical significance reduction in the risk of postoperative hyperlactatemia by 70%.

Diabetes treatment requires reliable blood glucose monitoring to allow for appropriate adjustments and interventions. The conventional finger-prick test is associated with significant discomfort and poor compliance, highlighting the critical need for non-invasive, user-friendly solutions. This study proposes and validates an open-source, multi-wavelength spectroscopy system that combines visible (660nm) and near-infrared (940nm) wavelengths through six distinct transmission and reflection strategies. The system was validated through a rigorous three-phase process. Phase I established a preliminary regression model against a commercial meter using 500 controlled samples ([Formula: see text] up to 0.8832). Phase II expanded this validation in 96 healthy volunteers, confirming high clinical acceptability (over 95% in Zone A, Clarke Error Grid) and a mean absolute error of 8.438mg/dL relative to the commercial device. Critically, Phase III performed a definitive clinical validation, comparing our system and the commercial meter against the venous plasma glucose (VPG) gold standard. This analysis definitively established the clinical failure of all reflection-based strategies (resulting in Zone D errors), while confirming 100% clinical safety (Zones A/B) for all transmission modes. Notably, our multi-wavelength transmission (MT) strategy achieved 100% Zone A accuracy and demonstrated superior analytical precision (tighter ISO15197:2015 compliance) than the ISO-compliant commercial benchmark when both were compared to the VPG. This work validates a transparent, open-source platform as a clinically reliable and accurate non-invasive alternative for intermittent glucose monitoring.

[This corrects the article DOI: 10.3389/bjbs.2025.15455.].