Hue Central Hospital (HCH), established in 1894, has been the first Western hospital in Vietnam. The hospitals, providing 3939 beds and occupying 190,000 square meters (included Base 2), is one of three biggest in the country along with Bach Mai Hospital in Hanoi and Chợ Rẫy Hospital in Ho Chi Minh City, and is managed by the Ministry of Health. HCH, positioned as is a top referral hospital, is a central medical institution for the 25 million Central and high land of Vietnam population. It is also the primary training facility for the Hue University of Medical And Pharmacy. .
The standard first-line treatment for patients with hormone receptor-positive (HR +) human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer is cyclin-dependent kinase 4/6 (CDK4/6) inhibitors combined with endocrine therapy (ET). Optimal therapy after CDK4/6 inhibitors remains to be determined. We aimed to define the appropriate second-line treatment after CDK4/6 inhibitors in a real-life population. Patients who had received CDK4/6 inhibitors with aromatase inhibitors (AIs) for HR + /HER2- metastatic breast cancer were included from March 2017 to May 2021 at five French cancer centers.The primary objective was to describe second-line treatment after primary treatment with CDK4/6 inhibitors plus AIs. We included 381 patients who received CDK4/6 inhibitors combined with AIs as first-line therapy. Patients with progressive disease (N = 165) benefited from a second-line of treatment: 69 (41.8
High-energy open tibial fractures with segmental bone loss and extensive soft-tissue necrosis remain limb-threatening, especially when only one recipient artery is patent. We report a 37-year-old man with a Gustilo-Anderson type IIIB open distal tibial fracture, posterior tibial artery injury, a 7-cm tibial defect and a 14 x 25 cm soft-tissue defect after serial debridement. After emergency external fixation and revascularization, the wound was optimized with repeated debridement and circumferential negative-pressure wound therapy. Definitive reconstruction used a vascularized pedicled fibular graft from the injured leg to bridge the tibial defect, combined with a latissimus dorsi free flap for coverage; the thoracodorsal artery was anastomosed end-to-side to the posterior tibial artery under 3D magnification. The flap survived without infection or secondary necrosis, allowing early rehabilitation with stable coverage and maintained alignment.
Effective communication is essential in cancer care, significantly influencing patients’ emotional, psychological, and physical outcomes. As patients’ needs and goals evolve across different stages of the cancer journey, communication barriers also change. This systematic review aimed to identify key communication barriers between healthcare providers and cancer patients across the cancer care continuum. Two reviewers systematically searched four databases (PubMed, Embase, Cochrane Library, and Web of Science) to identify studies examining communication barriers between healthcare providers and cancer patients at specific stages of care. This review is registered with PROSPERO (CRD420251074785). A total of 139 articles were included and categorized into six distinct stages of the cancer journey. (1) During the screening phase, patients were reluctant to discuss or undergo cancer screening due to limited knowledge, the belief that cancer is unlikely in the absence of symptoms, and fear or anxiety about a potential diagnosis. (2) In the diagnosis phase, receiving cancer as ‘bad news’, combined with extensive information about treatment and prognosis, led to shock, emotional distress, and informational overload. (3) During treatment, patients found it difficult to discuss adverse effects, including fatigue, nausea, vomiting, and sexual health concerns. Many perceived these symptoms as normal indicators of treatment effectiveness and hesitated to burden their physicians. Female patients, in particular, reported difficulty discussing sexual health, especially with male physicians. (4) In the follow-up phase, limited consultation time contributed to insufficient discussions about long-term adverse effects, relapse risk, prognosis uncertainty, and individualized survivorship care planning. (5) In the recurrence phase, disclosing cancer recurrence was described by oncologists as particularly challenging, as patients often responded with anger, blame, or emotional withdrawal. (6) In end-of-life care, both patients and healthcare providers frequently delayed or avoided end-of-life conversations for various reasons. Communication barriers between healthcare providers and cancer patients are multifaceted and stage-specific, arising from emotional, cognitive, and relational factors on both sides.
Abstract Background Additive manufacturing technologies have introduced new nanohybrid resin composites for permanent indirect restorations. However, limited evidence exists regarding the mechanical performance of 3D-printed restorations in managing occlusal wear. This study evaluated the effect of preparation design on fracture resistance, preparation time, and failure modes of 3D-printed restorations. Methods Forty maxillary premolars were allocated to four groups (n = 10): sound teeth (ST), overlay (OV), veneerlay (VL), and full crown (FC). Experimental groups received standardized 1.0–1.2 mm occlusal wear simulation. Restorations were designed using CAD software and fabricated with a 3D-printed nanohybrid composite (Rodin Sculpture 2.0). Cementation employed immediate dentin sealing and heated composite resin. Specimens underwent compressive fracture testing in a universal testing machine. Failure modes were categorized as catastrophic and non-catastrophic. One-way ANOVA with Tukey’s post-hoc test and Fisher’s exact test were used (α = 0.05). Results Preparation design significantly influenced fracture resistance (p < 0.05). OV exhibited the highest mean fracture load (1842.82 ± 560.47 N), which was significantly higher than FC (1236.79 ± 497.59 N). Preparation time increased with the invasiveness of the design (OV < VL < FC; p < 0.05). Catastrophic failures occurred most frequently in the FC group (60%) and were not observed in ST or OV. Conclusions 3D-printed occlusal veneers demonstrated fracture resistance values that exceeded physiological loading, with overlays providing superior strength and the lowest risk of catastrophic failure. Conservative adhesive preparation designs should be favored over full crowns in the rehabilitation of worn dentition.
