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Han Thi Ngoc Le,1,* Kien Xuan Nguyen,2,* Toan Duy Nguyen,1 Ho Quang La,3 Xuan Thanh Nguyen,4 Dung Tien Le,5 Huy Quoc Pham,5 Khai Xuan Nguyen,6 Hiep Hoang Nguyen,7 Viet Van Pham,6 Cong Van Pham,5 Dinh Cong Pho,8 Binh Nhu Do,8 Tien Viet Tran,9 Son Tien Nguyen,10 Tuan Dinh Le,10,* Thuc Cong Luong1 1Cardiovascular Center, Military Hospital 103, Vietnam Military Medical University, Hanoi, 10000, Vietnam; 2Department of Military Medical Command and Organization, Vietnam Medical Military University, Hanoi, 10000, Vietnam; 3Hospital Quality Control Division, Military Hospital 103, Vietnam Military Medical University, Hanoi, 10000, Vietnam; 4Senior Officer Department, Military Hospital 103, Vietnam Military Medical University, Hanoi, 10000, Vietnam; 5Intensive Care, Emergency and Poison Control Center, Military Hospital 103, Vietnam Military Medical University, Hanoi, 10000, Vietnam; 6Interventional Radiology Department, Military Hospital 103, Vietnam Military Medical University, Hanoi, 10000, Vietnam; 7Field Internal Medicine Center, Military Hospital 103, Vietnam Military Medical University, Hanoi, 10000, Vietnam; 8Department of Military Science, Vietnam Military Medical University, Hanoi, 10000, Vietnam; 9Department of Infectious Diseases, Military Hospital 103, Vietnam Medical Military University, Hanoi, 10000, Vietnam; 10Department of Rheumatology and Endocrinology, Vietnam Military Hospital 103, Medical Military University, Hanoi, 10000, Vietnam*These authors contributed equally to this workCorrespondence: Thuc Cong Luong, Cardiovascular Center, Military Hospital 103, Vietnam Military Medical University, 160 Phung Hung Street, Phuc La Ward, Ha Dong District, Hanoi, Vietnam, Email luongcongthuc@vmmu.edu.vnBackground: Personal protective equipment (PPE), an essential shield to protect healthcare workers (HCWs) during the COVID-19 pandemic, has been reported to affect their heart rate variability (HRV).Objective: To investigate the changes of very short-term heart rate variability in HCWs after three hours of wearing PPE to treat COVID-19 patients at different working times and intensities, and related factors.Methods: Sixty-five healthy HCWs were enrolled at the Number 2 Infectious Field Hospital (formed by Military Hospital 103), Vietnam. Two-minute 12-lead electrocardiograms were recorded before wearing and after removing PPE.Results: After three hours of wearing PPE, the mean heart rate of HCWs increased (p = 0.048) meanwhile, the oxygen saturation decreased significantly (p = 0.035). Standard deviation of all normal to normal intervals (SDNN), mean intervals RR (mean NN), and root mean square successive difference (rMSSD) after wearing PPE was also reduced significantly. SDNN, Mean NN, and rMSSD decreased as the working intensity increased (as in mild, moderate, and severe patient departments). In univariate regression analysis, logSDNN, logmean NN and logrMSSD were positively correlated with SpO2 and QT interval (r = 0.14, r = 0.31, r = 0.25; r = 0.39, r = 0.77, r = 0.73, respectively) and were negatively correlated with ambient temperature inside PPE (r = − 0.41, r = − 0.405, r = − 0.25, respectively) while logmean NN and log rMSSD were negatively correlated with diastolic blood pressure (r = − 0.43, r = − 0.39, respectively). In multivariable regression analysis, logSDNN and logmean NN were negatively correlated to ambient temperature inside PPE (r = − 0.34, r = − 0.18, respectively).Conclusion: Time-domain heart rate variability decreased after wearing PPE. Time-domain HRV parameters were related to ambient temperature inside PPE, diastolic blood pressure, QT interval, and SpO2.Keywords: cardiovascular disorders, cardiovascular change, heart rate variability, personal protective equipment, healthcare workers, COVID-19

Heart tumors are sporadic. Secondary heart tumors are 30 times more common than primary ones. Depending on the location and origin of the tumor, clinical pictures vary from asymptomatic to severe manifestations such as arrhythmia, heart failure, pericardial effusion, and cardiogenic shock. We report hereby a rare case who presented with faint clinical symptoms, rapidly progressing to right heart failure within a month. Echocardiography and computed tomography of the chest revealed a tumor in the right heart chamber of 72.0 × 43.0 mm, in addition to large mediastinal lymph and left supraclavicular lymph nodes, cardiogenic shock appeared 4 days after admission. Through examination, it was suspected that this was a cardiac lymphoma. The patient was treated with 2 mg methylprednisolone per kg body weight. Symptoms of cardiogenic shock improved significantly and disappeared after 6 hours of treatment. After supraclavicular lymph node biopsy and immunohistochemistry, the final result was diagnosed as diffuse large B-cell non-Hodgkin lymphoma with large lymphoma in the right heart. The patient received chemotherapy with the R-CHOP regimen (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone). Re-examination before the 5th chemotherapy cycle showed no signs of right heart failure, normal self-activity, and no dyspnea on exertion, and the tumor size in the heart on the echocardiogram was 23.8 × 19.1 mm. The report shows that a large right heart tumor with a clinical picture of cardiogenic shock in a patient with diffuse large B-cell non-Hodgkin's lymphoma was well-responded to initial treatment with methylprednisolone at a dose of 2 mg/kg body weight and R-CHOP chemotherapy., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Objective: To examine the incidence of atrial fibrillation (AF) newly developed after cardiovascular surgery in Vietnam, its associated risk factors, and postoperative complications. We also sought to evaluate the feasibility of a novel screening strategy for post-operative AF (POAF) using the combination of two portable devices., Methods: Single-centre, prospective cohort study at the Cardiovascular Centre, E Hospital, Hanoi, Vietnam. All patients aged≥18 years, undergoing cardiovascular surgery and in sinus rhythm preoperatively were eligible. The primary outcome was occurrence of new-onset POAF detected by hand-held single-lead electrocardiography (ECG) or a sphygmomanometer with AF-detection algorithm. Multivariate logistic regression was used to identify risk factors of developing post-operative AF. Feasibility was evaluated by compliance to the protocol and semi-structured interviews., Results: 112 patients were enrolled between 2018-2019: mean age 52.9±12.2 years; 50.9% female;92.0% (n=103) valve surgery; 9.8% (n=11)coronary surgery. New-onset POAF developed in 49patients (43.8%) with median time to onset 1.27days (IQR 0.96 -2.00 days). Age≥65 years was the only significant risk factor for the development of POAF(OR 3.78, 95% CI 1.16-12.34).The median thromboembolism risk scores (CHA2DS2-VASc score) were comparable among patients with and without POAF (1.0 vs. 1.0, p=0.104). The occurrence of POAF was associated with higher rates of postoperative complications (24.5% vs. 3.2%, p<0.001). Both doctors and nurses found this screening strategy feasible to be implemented long-term with the main difficulties being the instructions on both devices were in English, and an increase in workload., Conclusions: In this single-centre study, new-onset POAF occurred in 43.8% of patients who underwent cardiovascular surgery. This novel POAF screening strategy was feasible in a low resource setting, and its implementation could be improved by providing continuous training and translation to local language.

Acetolactate synthase (ALS) catalyzes the first common step in the biosynthesis of valine, leucine, and isoleucine. ALS is the target of several classes of herbicides, including the sulfonylureas, the imidazolinones, and the triazolopyrimidines. The conserved methionine residues of ALS from plants were identified by multiple sequence alignment using ClustalW. The alignment of 17 ALS sequences from plants revealed 149 identical residues, seven of which were methionine residues. The roles of three well-conserved methionine residues (M350, M512, and M569) in tobacco ALS were determined using site-directed mutagenesis. The mutation of M350V, M512V, and M569V inactivated the enzyme and abolished the binding affinity for cofactor FAD. Nevertheless, the secondary structure of each of the mutants determined by CD spectrum was not affected significantly by the mutation. Both M350C and M569C mutants were strongly resistant to three classes of herbicides, Londax (a sulfonylurea), Cadre (an imidazolinone), and TP (a triazolopyrimidine), while M512C mutant did not show a significant resistance to the herbicides. The mutant M350C was more sensitive to pH change, while the mutant M569C showed a profile for pH dependence activity similar to that of wild type. These results suggest that M512 residue is likely located at or near the active site, and that M350 and M569 residues are probably located at the overlapping region between the active site and a common herbicide binding site.